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:This study aims to explore whether there are specific behavioral deficits of response inhibition and emotional processing in patients with checking obsessive-compulsive disorder (OCD) and those with washing OCD.Methods:A cross-sectional study was conducted from January 2020 to December 2022, collecting clinical data from 75 OCD patients at the outpatient psychological consultation clinic of Xiangya Second Hospital and the clinical psychology department of Hunan Brain Hospital. The sample included 40 OCD patients with checking type (checking group, 24 males, 16 females, aged 14-34 years, mean age 22.1±5.0 years) and 35 OCD patients with washing type (washing group, 12 males, 23 females, aged 14-41 years, mean age 22.6±6.7 years). An age-matched healthy control group (control group) of 80 individuals (HCs, 37 males and 43 females, aged 14-25 years, mean age 20.8±1.9 years) was also recruited. All participants completed the Go/No-go task and Hariri task with behavioral data recorded. The Dimensional Yale-Brown Obsessive-Compulsive Scale was used to assess the severity of OCD symptoms. The Center for Epidemiologic Studies Depression Scale (CES-D) and State Anxiety Inventory (STAI) were used to assess the severity of depression and anxiety. A 3 (group: checking OCD, washing OCD and HC)×2 (task type: Go vs. No-go/Shape vs. Face) repeated-measures ANOVA was conducted to compare the behavioral performance across tasks.Results:Compared with HC group, both checking OCD group and washing OCD group had significantly higher scores in depression and anxiety ( F=85.43, 32.33,both P<0.05). When performing Go/No-go task, a significant group×task interaction effect was observed ( F3(2, 152)=3.23, P3=0.042, partialη32=0.04). In the checking OCD group, No-go accuracy was significantly lower than Go accuracy (accuracy=0.821 vs. 0.893, P<0.001); the checking OCD had significantly lower accuracy than HC in the No-go task (accuracy=0.821 vs. 0.876, P=0.005); there were no significant group differences between the washing OCD and HC in the No-go task ( P>0.05). When performing Hariri task, a significant group×task interaction effect was found ( F3(2, 152)=4.91, P3=0.009, partial η32=0.06). The washing OCD group showed significantly lower accuracy in matching emotional faces than the control group (0.879 vs. 0.936, P=0.001), whereas the checking OCD group showed no significant difference from the HC ( P>0.05); there were no significant group differences in shape matching task ( P>0.05). The accuracy of shape matching task was significantly higher than face matching task in the three groups (shape: checking OCD=0.936,washing OCD=0.929,HC=0.943; face:checking OCD=0.877,washing OCD=0.844,HC=0.917;all P>0.05). Conclusions:Checking OCD and washing OCD exhibit distinct behavioral impairment patterns in response inhibition and emotional processing. Checking-type OCD is primarily characterized by impaired response inhibition, whereas washing-type OCD is mainly associated with deficits in emotion processing.

Objective:To explore the clinical characteristics and healthcare burden in patients with McCune-Albright syndrome (MAS).Methods:A cross-sectional study was conducted at the Children′s Hospital, Zhejiang University School of Medicine. Clinical and healthcare burden data were systematically collected through structured questionnaires in 164 children with MAS from February 2022 to May 2023. According to the clinical characteristics, patients were categorized into 3 groups: monosymptomatic, bisymptomatic and trisymptomatic groups. Patients were also divided into 3 groups according to the age of <7, 7-<10 and 10-18 years. Comparative analyses of clinical characteristics and healthcare burden were conducted across age, sex, and symptom categories.Results:The cohort comprised 59 males (36.0%) and 105 females (64.0%) with an age of 4.6 (2.0, 7.4) years. Age stratification revealed 117 cases (71.3%) aged 0-<7 years, 29 cases (17.7%) aged 7-<10 years, and 18 cases (11.0%) aged 10-<18 years. Among monosymptomatic (67 cases, 40.9%), the cohort comprised 32 females (47.8%) and 35 males (52.2%), predominantly presenting with fibrous dysplasia (57 cases, 85.1%). This subgroup showed peak prevalence in the 0-<7 years age range (29 cases (50.9%)). The bisymptomatic cohort (56 cases, 34.1%) consisted of 39 females (69.6%) and 17 males (30.4%), predominantly manifesting fibrous dysplasia with skin hyperpigmentation (25 cases, 44.6%). Peak prevalence occurred in the 0-<7 years subgroup(16 cases (64.0%)). The trisymptomatic cohort (41 cases, 25.0%) consisted of 34 females (82.9%) and 7 males (17.1%), with peak prevalence occurring in the 0-<7 years subgroup (36 cases (87.8%)). The diagnostic journey analysis revealed 94 cases (57.3%) required 1-3 referrals, and 34 cases (20.7%) necessitated >3 referrals from symptom onset to definitive diagnosis. Healthcare expenditure analysis revealed 69 families (42.1%) incurred direct medical costs of 10 000-100 000 CNY, with 11 families (6.7%) exceeding >100 000 CNY. Direct non-medical costs reached of 10 000-100 000 CNY for 62 families (37.8%) and >100 000 CNY for 4 families (2.4%). Productivity loss affected 58 families (35.4%) at 10 000-100 000 CNY and 8 families (4.9%) above 100 000 CNY during the study period.Conclusion:MAS requires increased attention to skeletal manifestations, especially in children aged 0-<7 years. Moreover, the significant financial burden on families necessitates a society-wide support system.

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 construct a shoulder and neck functional exercise program for patients undergoing endoscopic thyroidectomy by a gasless unilateral axillary approach and to explore its effectiveness.Methods:The first draft of the shoulder and neck functional exercise program for patients undergoing endoscopic thyroidectomy by a gasless unilateral axillary approach was constructed through literature review, and two rounds of expert consultation were conducted with 20 experts to determine the final draft of the program with the results of the pretest. A total of 98 patients who underwent endoscopic thyroidectomy by a gasless unilateral axillary approach in the Department of Thyroid Surgery of the First Affiliated Hospital of Zhengzhou University from September 2023 to January 2024 were selected for the study using the convenience sampling method. Patients from September to December 2023 were set up as control group and patients from October 2023 to January 2024 were set up as experimental group, with 49 patients in each group. Control group implemented routine nursing, and experimental group received the shoulder and neck functional exercise program developed in this study on the basis of control group. Constant-Murley Score score, occurrence of numbness in the chest wall access area, and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire scores in cancer patients were compared between the two groups at one week, one month, and three months post-intervention.Results:In the two rounds of expert consultation, the effective questionnaire recovery rates were 85.00% (17/20) and 94.12% (16/17), and the coefficient of the expert familiarity was 0.938, the coefficient of basis of judgment was 0.891, and the coefficient of authority was 0.915. The coefficients of variation for the importance ratings of the entries in the second round of consultation were 0.096 to 0.190 and Kendall's harmony coefficient was 0.155 ( P<0.01). The shoulder and neck function exercise program for patients undergoing endoscopic thyroidectomy by a gasless unilateral axillary approach included three first-level items, five second-level items, and 13 third-level items. At one week post-intervention, the difference in occurrence of numbness in the chest wall access area was statistically significant in both groups ( P<0.05). At one month post-intervention, the differences in shoulder function scores, occurrence of numbness in the chest wall access area, and quality of life scores between the two groups were statistically significant (all P<0.05). At three months post-intervention, the differences in shoulder function scores and quality of life scores between the two groups were statistically significant (all P<0.05) . Conclusions:The shoulder and neck function exercise program for patients undergoing endoscopic thyroidectomy by a gasless unilateral axillary approach has certain scientific validity and feasibility, which can improve the shoulder and neck function of patients undergoing endoscopic thyroidectomy by axillary approach, reduce the numbness in the chest wall access area, and improve the quality of life of the patients in the postoperative period.

Objective:To construct a shoulder and neck functional exercise program for patients undergoing endoscopic thyroidectomy by a gasless unilateral axillary approach and to explore its effectiveness.Methods:The first draft of the shoulder and neck functional exercise program for patients undergoing endoscopic thyroidectomy by a gasless unilateral axillary approach was constructed through literature review, and two rounds of expert consultation were conducted with 20 experts to determine the final draft of the program with the results of the pretest. A total of 98 patients who underwent endoscopic thyroidectomy by a gasless unilateral axillary approach in the Department of Thyroid Surgery of the First Affiliated Hospital of Zhengzhou University from September 2023 to January 2024 were selected for the study using the convenience sampling method. Patients from September to December 2023 were set up as control group and patients from October 2023 to January 2024 were set up as experimental group, with 49 patients in each group. Control group implemented routine nursing, and experimental group received the shoulder and neck functional exercise program developed in this study on the basis of control group. Constant-Murley Score score, occurrence of numbness in the chest wall access area, and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire scores in cancer patients were compared between the two groups at one week, one month, and three months post-intervention.Results:In the two rounds of expert consultation, the effective questionnaire recovery rates were 85.00% (17/20) and 94.12% (16/17), and the coefficient of the expert familiarity was 0.938, the coefficient of basis of judgment was 0.891, and the coefficient of authority was 0.915. The coefficients of variation for the importance ratings of the entries in the second round of consultation were 0.096 to 0.190 and Kendall's harmony coefficient was 0.155 ( P<0.01). The shoulder and neck function exercise program for patients undergoing endoscopic thyroidectomy by a gasless unilateral axillary approach included three first-level items, five second-level items, and 13 third-level items. At one week post-intervention, the difference in occurrence of numbness in the chest wall access area was statistically significant in both groups ( P<0.05). At one month post-intervention, the differences in shoulder function scores, occurrence of numbness in the chest wall access area, and quality of life scores between the two groups were statistically significant (all P<0.05). At three months post-intervention, the differences in shoulder function scores and quality of life scores between the two groups were statistically significant (all P<0.05) . Conclusions:The shoulder and neck function exercise program for patients undergoing endoscopic thyroidectomy by a gasless unilateral axillary approach has certain scientific validity and feasibility, which can improve the shoulder and neck function of patients undergoing endoscopic thyroidectomy by axillary approach, reduce the numbness in the chest wall access area, and improve the quality of life of the patients in the postoperative period.

Objective:To explore the clinical characteristics and healthcare burden in patients with McCune-Albright syndrome (MAS).Methods:A cross-sectional study was conducted at the Children′s Hospital, Zhejiang University School of Medicine. Clinical and healthcare burden data were systematically collected through structured questionnaires in 164 children with MAS from February 2022 to May 2023. According to the clinical characteristics, patients were categorized into 3 groups: monosymptomatic, bisymptomatic and trisymptomatic groups. Patients were also divided into 3 groups according to the age of <7, 7-<10 and 10-18 years. Comparative analyses of clinical characteristics and healthcare burden were conducted across age, sex, and symptom categories.Results:The cohort comprised 59 males (36.0%) and 105 females (64.0%) with an age of 4.6 (2.0, 7.4) years. Age stratification revealed 117 cases (71.3%) aged 0-<7 years, 29 cases (17.7%) aged 7-<10 years, and 18 cases (11.0%) aged 10-<18 years. Among monosymptomatic (67 cases, 40.9%), the cohort comprised 32 females (47.8%) and 35 males (52.2%), predominantly presenting with fibrous dysplasia (57 cases, 85.1%). This subgroup showed peak prevalence in the 0-<7 years age range (29 cases (50.9%)). The bisymptomatic cohort (56 cases, 34.1%) consisted of 39 females (69.6%) and 17 males (30.4%), predominantly manifesting fibrous dysplasia with skin hyperpigmentation (25 cases, 44.6%). Peak prevalence occurred in the 0-<7 years subgroup(16 cases (64.0%)). The trisymptomatic cohort (41 cases, 25.0%) consisted of 34 females (82.9%) and 7 males (17.1%), with peak prevalence occurring in the 0-<7 years subgroup (36 cases (87.8%)). The diagnostic journey analysis revealed 94 cases (57.3%) required 1-3 referrals, and 34 cases (20.7%) necessitated >3 referrals from symptom onset to definitive diagnosis. Healthcare expenditure analysis revealed 69 families (42.1%) incurred direct medical costs of 10 000-100 000 CNY, with 11 families (6.7%) exceeding >100 000 CNY. Direct non-medical costs reached of 10 000-100 000 CNY for 62 families (37.8%) and >100 000 CNY for 4 families (2.4%). Productivity loss affected 58 families (35.4%) at 10 000-100 000 CNY and 8 families (4.9%) above 100 000 CNY during the study period.Conclusion:MAS requires increased attention to skeletal manifestations, especially in children aged 0-<7 years. Moreover, the significant financial burden on families necessitates a society-wide support system.

Objective:This study aims to explore whether there are specific behavioral deficits of response inhibition and emotional processing in patients with checking obsessive-compulsive disorder (OCD) and those with washing OCD.Methods:A cross-sectional study was conducted from January 2020 to December 2022, collecting clinical data from 75 OCD patients at the outpatient psychological consultation clinic of Xiangya Second Hospital and the clinical psychology department of Hunan Brain Hospital. The sample included 40 OCD patients with checking type (checking group, 24 males, 16 females, aged 14-34 years, mean age 22.1±5.0 years) and 35 OCD patients with washing type (washing group, 12 males, 23 females, aged 14-41 years, mean age 22.6±6.7 years). An age-matched healthy control group (control group) of 80 individuals (HCs, 37 males and 43 females, aged 14-25 years, mean age 20.8±1.9 years) was also recruited. All participants completed the Go/No-go task and Hariri task with behavioral data recorded. The Dimensional Yale-Brown Obsessive-Compulsive Scale was used to assess the severity of OCD symptoms. The Center for Epidemiologic Studies Depression Scale (CES-D) and State Anxiety Inventory (STAI) were used to assess the severity of depression and anxiety. A 3 (group: checking OCD, washing OCD and HC)×2 (task type: Go vs. No-go/Shape vs. Face) repeated-measures ANOVA was conducted to compare the behavioral performance across tasks.Results:Compared with HC group, both checking OCD group and washing OCD group had significantly higher scores in depression and anxiety ( F=85.43, 32.33,both P<0.05). When performing Go/No-go task, a significant group×task interaction effect was observed ( F3(2, 152)=3.23, P3=0.042, partialη32=0.04). In the checking OCD group, No-go accuracy was significantly lower than Go accuracy (accuracy=0.821 vs. 0.893, P<0.001); the checking OCD had significantly lower accuracy than HC in the No-go task (accuracy=0.821 vs. 0.876, P=0.005); there were no significant group differences between the washing OCD and HC in the No-go task ( P>0.05). When performing Hariri task, a significant group×task interaction effect was found ( F3(2, 152)=4.91, P3=0.009, partial η32=0.06). The washing OCD group showed significantly lower accuracy in matching emotional faces than the control group (0.879 vs. 0.936, P=0.001), whereas the checking OCD group showed no significant difference from the HC ( P>0.05); there were no significant group differences in shape matching task ( P>0.05). The accuracy of shape matching task was significantly higher than face matching task in the three groups (shape: checking OCD=0.936,washing OCD=0.929,HC=0.943; face:checking OCD=0.877,washing OCD=0.844,HC=0.917;all P>0.05). Conclusions:Checking OCD and washing OCD exhibit distinct behavioral impairment patterns in response inhibition and emotional processing. Checking-type OCD is primarily characterized by impaired response inhibition, whereas washing-type OCD is mainly associated with deficits in emotion processing.

Objective:To evaluate the efficacy and safety of Qingxuan Zhike granules in improving cough symptoms and shortening the course of influenza (wind-heat invading lung) in children.Methods:In this multicenter, randomized, controlled clinical trial, a total of 240 outpatient influenza patients from 7 hospitals, including the First Affiliated Hospital of Yunnan University of Traditional Chinese Medicine, from April 2023 to December 2023 were collected.The subjects were randomly divided into the control group and the experimental group via SAS software using the block randomization method.The differences between two groups were compared with t test, corrected t test and χ2 test.Subjects in the control group were given Oseltamivir phosphate granules, orally, twice a day (weight ≤15 kg, 30 mg/time; weight >15-23 kg, 45 mg/time; weight >23-40 kg, 60 mg/time; weight >40 kg, 75 mg/time; age≥13 years, 75 mg/time).In addition to Oseltamivir phosphate granules, subjects in the experimental group were also given Qingxuan Zhike granules, orally, 3 times a day (1-3 years old, 1/2 bag each time; >3-6 years old, 3/4 bag each time; >6-14 years old, 1 bag each time).After 5 days of treatment, the medication was suspended for 2 days.The effect of cough, antipyretic effect, clinical recovery rate, clinical recovery time, Canadian Acute Respiratory Illness and Flu Scale (CARIFS) score, traditional Chinese medicine (TCM) syndrome effect, complication rate, and adverse reactions were evaluated between the two groups. Results:Finally, 232 cases were included in the study, including 115 cases in the experimental group and 117 cases in the control group.Before and after treatment, there were no significant difference in CARIFS cough score between the experimental group and the control group (all P>0.05).After treatment, the change in CARIFS cough score in the experimental group [(-1.00±0.91) scores]was significantly higher than that in the control group [(-0.75±0.98) scores] ( t=-1.995, P=0.047).After treatment, the change in TCM syndrome cough score in the experimental group [(-1.69±1.51) scores] was significantly higher than that in the control group [(-0.97±1.63) scores] ( t′=-0.035, P=0.001).The time of complete regression of fever in the experimental group [(44.82±22.72) h] was shorter than that in the control group [(51.35±27.07) h], and the difference between the two groups was statistically significant ( t=-1.966, P=0.050).The fever score showed that the area under the curve between the CARIFS symptom fever score and time in the experimental group was 4.40±2.42, while that in the control group was 5.12±2.44, and the difference between the two groups was statistically significant ( t=-2.252, P=0.025).The clinical recovery rate was 93.91%(108/115) in the experimental group and 92.31%(108/117) in the control group, and there was no significant difference between the two groups ( χ2=0.233, P>0.05).The clinical recovery time in the experimental group [(2.93±1.21) d] was shorter than that in the control group [(3.29±1.15) d], and the difference between the two groups was statistically significant ( t=-2.279, P=0.024).After treatment, there was a significant difference in TCM syndrome score variation between the experimental group [(-12.00±4.13) scores] and the control group [(-10.85±4.31) scores] ( t′=-2.067, P=0.040).No complication occurred in both groups, and there was no significant difference in the incidence of adverse events between the two groups ( χ2=1.299, P>0.05). Conclusions:Qingxuan Zhike granules combined with Oseltamivir phosphate can effectively improve the cough symptoms associated with influenza in children, shorten the time and course of fever, and improve the TCM syndrome score; thus, they are safe in clinical application.

Abstract: Objective　To explore the clinical features and survival prognosis of stage Ⅳ non-small cell lung cancer (NSCLC) and provide a reference for prognosis evaluation and prevention and treatment of the disease. Methods A retrospective analysis was performed on 195 patients with stage Ⅳ NSCLC admitted to the Department of Medical Oncology and the Department of Respiratory Medicine of the First Affiliated Hospital of Hainan Medical University from 2016 to 2020, who were diagnosed pathologically and available for the analysis and study. Patients' hospitalization records and follow-up information were collected to analyze the survival of the patients at the cut-off of follow-up. The Kaplan-Meier method was used to calculate survival rates, and the Log-rank method was employed for univariate analysis of factors affecting survival. The risk factors for patients' survival prognosis were analyzed by multivariate Cox regression model. Results The median survival time for patients with stage Ⅳ NSCLC was 17.05 months (95% CI: 12.64-21.45), with cumulative survival rates of 70.7%, 41.5%, and 22.0% at 1, 2, and 3 years, respectively. The results of multivariate analysis suggested that gender (HR=0.697, 95% CI: 0.486-0.999, P=0.049), functional status scale (Karnofsky, KPS) (HR=1.535, 95% CI: 1.038-2.270, P=0.032), computed tomography (CT) tumor location (HR=1.481, 95%CI:1.003-2.186, P=0.036), pathology type (HR=1.181, 95%CI:0.715-1.950, P=0.019), metastatic site (HR=1.710, 95%CI:1.214-2.409, P=0.002), N stage (HR=2.094, 95%CI:0.973-4.509, P=0.006), gene mutation (HR=2.387, 95%CI:1.590-3.584, P<0.001), treatment with chemotherapy-containing regimen (HR=1.713, 95%CI:1.094-2.683, P= 0.019), and combination therapy (HR=1.874, 95%CI:1.253-2.802, P=0.002) were independent prognostic factors affecting the survival of patients with stage Ⅳ NSCLC (all P<0.05). In the subgroup analysis, metastatic site and chemotherapy-containing treatment regimen were independent prognostic factors affecting the survival of mutation-positive patients with stage Ⅳ NSCLC, and patients who received targeted therapy had longer survival time. The metastatic site, chemotherapy-containing treatment regimen, and combination therapy were prognostic factors affecting the survival prognosis of patients with gene mutation-negative stage Ⅳ NSCLC or unknown status. Conclusions In this study, gender, KPS score, CT tumor location, pathologic type, metastatic site, N stage, gene mutation, treatment with chemotherapy-containing regimen, and combination therapy were the important factors affecting the survival prognosis of patients with stage Ⅳ NSCLC. In terms of treatment options, chemotherapy remains an indispensable basic treatment option. Moreover, comprehensive treatment can prolong survival compared to a single treatment option. Patients with positive gene mutations who received targeted drugs had longer survival times; therefore, detecting gene mutation status and selecting corresponding targeted drugs in the treatment of stage Ⅳ NSCLC could extend survival periods.