ObjectiveTo evaluate the public health governance capacity in Jiangsu Province and provide an optimized pathway for the construction of a “strong, rich, beautiful, and high-quality” new Jiangsu. MethodsA total of 806 policy documents, 658 public information reports, and 148 research literatures related to public health governance capacity in Jiangsu Province from January 1995 to December 2023 were collected. The status of current public health goverance was assessed based on the evaluation criteria suitable for public health systems, and the strengths and the weaknesses of the system were identified. ResultsThe public health governance capability of Jiangsu Province was scored at 738.3 points, ranking 3rd nationally. Maternal health care and emergency response capacities achieved leading positions nationwide, both ranking 2nd. Jiangsu had exhibited a standardized guidance in the strategic level, a well-established management mechanism, an extensive coverage in information collection, and a scientifically established health targets setting. However, bottlenecks remained, including an unclear division of responsibilities across organizational departments, an insufficient public-health workforce, the absence of a stable growth mechanism for government funding investment, and difficulties in promptly identifying public needs. ConclusionJiangsu’s public-health system demonstrates leading nationally, yet several components remain underdeveloped. Future efforts should consolidate advantages while addressing weaknesses, further diversify content and forms, establish a stable funding increase mechanism, and clarify departmental functions, thereby providing solid health support for realizing the developmental goals of a “strong, rich, beautiful and high-quality” new Jiangsu.

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.

NAFLD is the most prevalent chronic liver disease,which has become a world public health issue and the incidence rate is also showing an increasing trend.A series of liver disea-ses,such as simple fatty liver disease,NASH,liver cirrhosis,liv-er failure and liver cancer,can be collectively referred to as NAFLD.Through the study of numerous factors that influence the production of NAFLD,it has been found that the main patho-logical mechanism is excessive synthesis of fat,which is difficult to be transported into the blood,causing massive lipid accumula-tion.Alcohol has a direct damaging effect on liver and will in-hibit the breakdown of liver fat,eventually forming AFLD.How-ever,it is still controversial whether alcohol has a synergistic effect on NAFLD onset.This article provides a review on the effect of alcohol intake on NAFLD and its potential mechanisms of action.

As the globalization process accelerates and international medical exchanges become increasingly frequent, the status of foreign trainees in Chinese medical education system has become increasingly important. This paper explores the application of artificial intelligence technology in teaching vascular surgery for foreign trainees, including its specific application forms in theoretical teaching, surgical skill training, case analysis, and clinical decision-making. This article analyzes the advantages of integrating artificial intelligence into teaching foreign trainees, such as improving teaching efficiency, enhancing individualized teaching, and promoting cultural integration. Moreover, this paper discusses the challenges such as data security and privacy protection, technical reliability and adaptability, the transformation of educational concepts, and cross-cultural education, and proposes corresponding strategies to address these issues. The rational use of artificial intelligence technology is expected to improve the teaching quality of vascular surgery for foreign trainees and make a positive contribution to the cultivation of international medical talents.

Objective:To analyze the association between the number and type of comorbidities—specifically high-risk(HR)and at-risk(AR)—and the risk of in-hospital mortality among elderly patients aged 65 years and older with community-acquired pneumonia(CAP).Methods:A retrospective study was conducted to gather basic information, along with diagnostic and treatment data, for elderly CAP patients hospitalized at the Third Hospital of Peking University from January 1, 2010, to December 31, 2019.Binary logistic regression was employed to examine the relationships between both the number and type of coexisting chronic diseases and in-hospital mortality in this patient population.Results:This study included a total of 2 466 elderly patients aged ≥65 years with CAP, of whom 428(17.36%)died during hospitalization.The presence of HR comorbidities was associated with an increased likelihood of in-hospital mortality ( OR=1.81, 95% CI: 1.44-2.28, P<0.001).Similarly, the presence of AR comorbidities was significantly linked to higher in-hospital mortality ( OR=15.72, 95% CI: 7.39-33.42, P<0.001).The risk of mortality escalated with the accumulation of AR comorbidities, with risk ratios ranging from 5.46 to 44.72.Notably, elderly CAP patients with 4 to 5 AR comorbidities in conjunction with HR comorbidities exhibited the highest mortality risk ( OR=85.56, 95% CI: 19.86-368.67, P<0.001).Among the comorbidities assessed, chronic liver disease emerged as the most significant factor associated with mortality in elderly CAP patients, with an importance coefficient of 0.258. Conclusions:In addition to specific comorbidities, the total number of combined comorbidities and the interplay between AR and HR comorbidities may significantly influence the outcomes of hospitalized CAP patients aged 65 years and older.Therefore, it is essential to carefully consider the diagnosis and management of comorbidities in elderly CAP patients to mitigate their risk of mortality.

AIM To optimize the extraction process for Jiangzhi Ligan Decoction,and to investigate its effects on improving lipid deposition in HepG2 cells.METHODS With extraction time,extraction frequency and solvent consumption as influencing factors,comprehensive score for tanshensu,lotine,catechin contents and extract yield as an evaluation index,the extraction process was optimized by Box-Behnken response surface method on the basis of single factor test.Palmitic acid-induced HepG2 cells were adopted in the establishment of non-alcoholic fatty liver disease model,after which the effect of drug-containing serum on TC and TG levels was investigated.RESULTS The optimal conditions were determined to be 90 min for extraction time,three times for extraction frequency,and 11 times for solvent consumption.Compared with the control group,the model group demonstrated increased TG,TC levels(P＜0.01);compared with the model group,the Jiangzhi Ligan Decoction high-dose group displayed decreased TG,TC levels(P＜0.05,P＜0.01),especially for those after optimization(P＜0.05,P＜0.01).CONCLUSION Jiangzhi Ligan Decoction can alleviate lipid deposition in HepG2 cells induced by palmitic acid,whose efficacy after extraction process optimization is better than that reported in literature.

Objectives:Comparative analysis of the beagles acute-phase electrocardiographic,hemodynamic,left ventricular flow field status,and energy consumption characteristics of pacing at different sites of conduction system may help to elucidate the scientific mechanism of left bundle branch pacing(LBBP)as a option of physiological pacing therapy.Methods:Eight healthy adult beagles were used in this study.Initially,an active fixation lead was implanted in the right atrial appendage,followed by implantation of another active fixation lead at the right ventricular apex,distal His bundle,and left bundle septal branch,respectively.After connecting a dual-chamber pacemaker,electrocardiographic and acute phase hemodynamic parameters under sinus rhythm,right ventricular apex pacing(RVAP),distal His bundle pacing(DHBP),and LBBP states were collected and analyzed.Three complete cardiac cycles of standard apical three-chamber color Doppler dynamic images were acquired under vector flow mapping(VFM)mode.Offline analysis was performed on obtained parameters including isovolumic contraction period,rapid ejection period,isovolumic relaxation period,rapid filling period,atrial contraction period,and left ventricular intracavitary energy consumption.These parameters were compared under pacing at different sites and the linear correlations of major parameters were analyzed.Results:The QRS duration of baseline intrinsic sinus rhythm,RVAP,DHBP and LBBP were(45.0±4.0)ms,(98.4±6.2)ms,(50.0±4.5)ms and(62.0±4.7)ms,respectively.The LBBP-QRS duration was significantly wider than intrinsic sinus rhythm and DHBP,but significantly narrower than RVAP(all P<0.01).Compared with baseline AOO mode(the pacing rate was performed at 10 beats/min above the intrinsic heart rate),the change of acute phase maximum left ventricular pressure rise rate(LVdP/dtmax)in RVAP,DHBP and LBBP was([-7.89±5.67]% ),([0.74±2.05]% )and([-0.14±3.59]% ),respectively.There was no significant difference in LVdP/dtmax changes between DHBP and LBBP(P=0.667),but both pacing modalities were significantly better than RVAP(all P<0.01).The average energy consumption of the left ventricle under RVAP was significantly higher than that of intrinsic sinus rhythm,DHBP,and LBBP in isovolumic contraction period,rapid ejection period,isovolumic relaxation period,rapid filling period,and atrial contraction period(all P<0.01).However,there was no statistically significant difference in energy consumption among intrinsic sinus rhythm,DHBP,and LBBP during the above five phases(all P>0.05).DHBP and LBBP did not show a significant increase in the number of left ventricular vortices,vortex area,and circulation intensity compared to intrinsic sinus rhythm,and LBBP did not show a significant increase in vortex area and circulation intensity compared to DHBP.Conclusions:Although LBBP canines significantly prolonged the paced QRS duration,it showed no significant differences in acute phase left ventricular hemodynamics,left ventricular flow field status,and energy consumption compared to intrinsic sinus rhythm and DHBP.Performance of LBBP was superior to RVAP.This study may contribute to revealing the theoretical basis of LBBP as a feasible physiological pacing therapy.

Objective:To investigate the effect of sevoflurane combined with propofol general anesthesia on immune function and cognitive function in patients undergoing laparoscopic inguinal hernia repair.Methods:A total of 120 patients with laparoscopic inguinal hernia repair treated in Wuxi Ninth People's Hospital Affiliated to Soochow University from January 2021 to March 2022 were randomly divided into control group and observation group.They were operated under general anesthesia.Control group were given pro-pofol intravenous pump,and observation group were given sevoflurane combined inhalation+propofol intravenous pump.The vital signs(mean arterial pressure,heart rate),postoperative pain(VAS score),immune function[T cell subsets(CD3+T,CD4+T,CD8+T,CD4+T/CD8+T),IgG,IgA,IgM],cognitive function(MMSE score,incidence of cognitive impairment)and adverse reac-tions(nausea and vomiting,dizziness,drowsiness,respiratory depression and body movement)were observed.Results:The mean ar-terial pressure at 10 min after laryngeal mask implantation,at the beginning of operation and 10 min after laryngeal mask removal in the two groups were lower than that before anesthesia induction(P<0.05),the heart rate at the beginning of operation in the control group was lower than that before anesthesia induction(P<0.05),and the mean arterial pressure and heart rate in each time period in the two groups were similar(P>0.05);the VAS scores of the observation group were lower than those of the control group(P<0.05);The levels of CD3+T,CD4+T,CD4+T/CD8+T,IgG,IgA,IgM in the observation group were higher than those in the control group(P<0.05),and CD8+T was lower than those in the control group 1 day after operation(P<0.05);the MMSE score and the incidence of cog-nitive impairment were similar in the two groups 1 day after operation(P>0.05);the incidence of adverse reactions in the two groups were similar(P>0.05).Conclusion:Sevoflurane combined with propofol general anesthesia has a good effect in laparoscopic inguinal hernia repair.It can stabilize patients'intraoperative vital signs,reduce postoperative pain,improve immune function indexes,and does not increase the incidence of postoperative cognitive impairment and adverse reactions.

[Purpose]To analyze the trends in pancreatic cancer mortality and disease burden among residents in Shanghai Pudong New Area from 2002 to 2022,and to investigate the effects of age,period,and birth cohort on mortality risk.[Methods]Data on pancreatic cancer deaths among residents of Pudong New Area from 2002 to 2022 were collected through the Shanghai Population Cause of Death Registration System.The crude mortality rate,age-standardized mortality rate by Chinese standard population(ASMRC),potential years of life lost(PYLL),potential years of life lost rate(PYLLR),and average years of life lost(AYLL)were calculated.Joinpoint regression was applied to calculate the average annual percentage change(AAPC)for analyzing the changing trend of the mortality rate of pancreatic cancer.The age-period-cohort model was applied with R 4.4.1 to analyze the age,period,and cohort effects on the mortality risk of pancreatic cancer.[Results]The crude mortality rate of pancreatic cancer among residents in Pudong New Area increased from 10.42/105 in 2002 to 18.73/105 in 2022,showing a significant upward trend(AAPC=2.90％,P＜0.001);the ASMRC was generally stable(AAPC=-0.05％,P=0.775).The crude mortality rate of males(17.09/105)was higher than that of females(13.75/105),and both showed an upward trend(AAPC=3.05％and 2.75％respectively,both P＜0.001).After the age of 40,the mortality rate of pancreatic cancer increased significantly with the growth of age in both sexes.The PYLL was 31 347 person-years,showing an upward trend(AAPC=1.83％,P＜0.001),and the AYLL was 3.59 years,showing a downward trend(AAPC=-2.45％,P＜0.001).The age effect showed that the mortality risk of pan-creatic cancer was increased with age;the period effect showed that the mortality risk decreased from 2002 to 2016 and then increased;the cohort effect showed that the mortality risk increased with the advancement of the birth cohort.[Conclusion]From 2002 to 2022,the crude mortality rate of pancreatic cancer in Pudong New Area showed an upward trend,and the mortality rate of males was higher than that of females.The mortality risk of pancreatic cancer increases with age,and the later the birth year of the residents,the higher the mortality risk.Early screening should be strengthened for men and the elderly,environmental and lifestyle risk factors should be paid attention to in combination with the characteristics of cohort effect,and the prevention and control strategy for the whole population should be optimized.

Aim To explore the mechanism of the syn-ergistic effect of the ferroptosis inducer erastin com-bined with shikonin in promoting ferroptosis in human hypertrophic scar fibroblasts(HSFBs).Methods Hypertrophic scar tissues provided by the General Hos-pital of Ningxia Medical University were collected,and HSFBs were extracted.HSFBs were identified by HE staining and immunofluorescence.The inhibitory rates of Era and SHK on HSFBs at different concentrations were detected by CCK-8 assay,and the IC50 value was calculated.CompuSyn software was used to calculate the co-use index(CI).Control group,Erastin(Era)group,shikonin(SHK)group and Era+SHK group were set up,and the number and morphological chan-ges of cells were observed after 24 hours of interven-tion.The ability of cell migration and invasion was de-tected by scratch test and Transwell test.The changes of malondialdehyde(MDA),total iron ion and reactive oxygen species(ROS)were detected by corresponding biochemical kits.The expressions of collagen I,α-SMA and GOT1,SLC7A11,GPX4 and FTH1 were detected by Western blot.Results The IC50 value of Era and SHK of primary HSFBs was 2.22 μmol·L-1 and 3.94μmol·L-1 respectively,which was used as the single drug concentration for subsequent experiments.The CompuSyn software was employed to calculate the CI value when the two drugs were used in combination,and the concentrations corresponding to CI=0.39597(Era:1.2 μmol·L-1+SHK:1.5 μmol·L-1)were selected as subsequent combination concentrations(Because when CI was equal to 0.395 97,the concen-tration of each drug was lower than the concentration of single drug,and the inhibition rate of combined drug was greater than 50％).Compared with the monother-apy group,the number of HSFBs in the SHK+Era group was significantly reduced,cell membrane showed breakage and vesiculation,cell wrinkling became smal-ler,and cytoplasm was concentrated.The migration and invasion ability of HSFBs in the SHK+Era group were obviously weakened(P＜0.05),and the expres-sion of fibrosis-related proteins collagen Ⅰ and α-SMA was reduced(P＜0.05);the contents of MDA,total i-ron ions,and ROS in HSFBs of the SHK+Era group increased(P＜0.05),and the protein expression lev-els of SLC7A11,GOT1,GPX4,and FTH1 further de-creased(P＜0.05).Conclusions Erastin in combi-nation with shikonin can synergistically inhibit the pro-liferation,migration and fibrosis levels of HSFBs.The mechanism may be that erastin enhances the inhibition of shikotin on GOT1,increases the levels of cellular i-ron ions,ROS,and lipid peroxides,thereby promoting ferroptosis in HSFBs.