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.

Bronchiolar adenoma (BA) is a rare type of lung tumor characterized by bilayered epithelial cells having a continuous basal layer and a luminal layer. It resembles mucinous adenocarcinoma (MA) on frozen section, with difficulty in distinguishing the basal layer. Immunohistochemistry is the best choice for verifying the diagnosis. This study aimed to comprehensively characterize three cases of BA-combined carcinoma using clinical, histopathological, and genetic features. BA and carcinoma sections were subjected to next-generation sequencing, respectively. It was hypothesized that while different mutation forms matched different regions, BA and lung adenocarcinoma shared the same gene mutation when they co-occurred in the same location. BA with extensive carcinoma is extremely rare and presents diagnostic challenges due to its overlap with conditions such as MA. Because of its distinctive morphological characteristics, BA may be regarded as a low-grade malignancy, particularly during a confusing evaluation. A multifaceted examination of clinical, radiological, immunohistochemical, and genetic data is necessary for an accurate diagnosis.

Objectives:To evaluate the efficacies of laminoplasty(LP)and laminectomy and fusion(LF)in the treatment of multi-level ossification of the posterior longitudinal ligament(OPLL)in the cervical spine through meta-analysis.Methods:The databases of CNKI,Wanfang,Pubmed,Cochrane Library,EMBASE were searched by computer from their inceptions to June 2023 and the published clinical studies comparing LP and LF in the treatment of multi-level OPLL in the cervical spine were included.Cochrane risk bias assess-ment tool and Newcastle-Ottawa scale(NOS)were used to evaluate the quality of the included studies.Rele-vant data including operation time,intraoperative blood loss,the improvement rate of Japanese Orthopaedic Association(JOA)score,the change value of visual analogue scale(VAS)score,neck disability index(NDI),cer-vical curvature index(CCI),sagittal vertical axis(SVA)and cervical range of motion(CROM)at the final fol-low-up,the postoperative complication rate and OPLL progression rate were extracted and sorted.Then the meta-analysis was conducted by RevMan 5.4 and StataSE 16.0 softwares.Results:12 literatures(3 randomized controlled studies and 9 cohort studies)were ultimately included,involving a total sample size of 1496 cases,containing 839 cases in the LP group and 657 cases in the LF group.The results of meta-analysis were as follows:the LP group was better than LF group with significant differences in operation time[WMD=-28.01,95％CI(-36.25,-19.77),P＜0.00001],intraoperative blood loss[WMD=-115.09,95％CI(-197.91,-32.27),P=0.006],the change value of CROM[WMD=-7.83,95％CI(-8.10,-7.55),P＜0.00001]compared with those before surgery at final follow-up,the incidence of postoperative C5 nerve root paralysis[OR=0.32,95％CI(0.21,0.50),P＜0.00001]and axial symptoms[OR=0.44,95％CI(0.28,0.71),P=0.0006].The LF group was better than the LP group with significant differences in the change value of the CCI[WMD=-0.75,95％CI(-0.92,-0.58),P＜0.00001]and SVA[WMD=5.49,95％CI(5.30,5.68),P＜0.00001]compared with those before surgery at final follow-up,and the postoperative OPLL progression rate[OR=1.76,95％CI(1.26,2.46),P=0.0009].There were no significant differences between the two groups in the improvement rate of JOA score[WMD=-1.24,95％CI(-4.02,1.54),P=0.38],the change value of VAS[WMD=0.03,95％CI(-0.43,0.49),P=0.89]and NDI[WMD=0.54,95％CI(-0.07,1.14),P=0.08]compared with those before surgery at final follow-up,the incidence of postoperative cerebrospinal fluid leakage[OR=0.58,95％CI(0.24,1.39),P=0.22],incision infection[OR=0.71,95％CI(0.32,1.57),P=0.39]and epidural hematoma[OR=0.37,95％CI(0.06,2.16),P=0.27].Conclusions:Both LF and LP can effectively treat multi-level OPLL in the cervical spine and improve the neurological function of patients.Compared to LF,LP causes less surgical damage,preserves more cervical mobility and additionally,has a lower incidence of the postoperative C5 nerve root paralysis and axial symptoms.In comparison,LF can better maintain the curvature and stability of the cervical spine and delay the progression of ossification.

Objective:To evaluate the value of ultrasound radiomics combined with machine learning for early diagnosis of seronegative Hashimoto’s thyroiditis (SN-HT) .Methods:This retrospective study included 164 patients from Liaoning Provincial People’s Hospital , Lixin County People’s Hospital, Linghai Dalinghe Hospital, Fengcheng Phoenix Hospital, who underwent thyroidectomy for solitary nodules with normal thyroid function between Nov. 2016 and Jan. 2024. Postoperative pathology confirmed Hashimoto’s thyroiditis (HT) in some cases, who were further categorized into antibody-positive and antibody-negative groups based on serum antibody status. Patients without Hashimoto’s thyroiditis served as the control group. A total of 298 ultrasound images were analyzed. Radiomics features were extracted from hypoechoic non-nodular areas within 0.5 cm surrounding the tumor. Two senior pathologists and two senior ultrasound physicians independently assessed lymphocytic infiltration, eosinophilic changes of follicular epithelium, and the proportion of hypoechoic areas in pathology and ultrasound images, respectively. A machine learning model, CCH-NET, was developed using linear regression and t-distributed stochastic neighbor embedding (t-SNE) techniques. The dataset was divided into a training set (80%) and a validation set (20%) to compare the diagnostic accuracy of CCH-NET with that of senior ultrasound physicians. Results:In internal validation, CCH-NET achieved a diagnostic accuracy of 88.89% for both antibody-positive and antibody-negative groups, significantly higher than the 66.67% accuracy of senior ultrasound physicians ( P<0.01). In external validation, CCH-NET achieved 75.00% and 66.67% accuracy for the two groups, compared to 50.00% by senior ultrasound physicians. For the control group, both methods achieved 93.33% accuracy. The AUC of CCH-NET was 0.848, outperforming senior ultrasound physicians (0.681) ,demonstrating superior diagnostic performance. Conclusion:The radiomics-based CCH-NET model, using non-nodular hypoechoic areas as a specific indicator, can accurately identify early SN-HT in euthyroid patients. It significantly outperforms senior ultrasound physicians, improving diagnostic accuracy and reducing missed diagnoses.

Objective This study examines the factors influencing oral frailty in the elderly community,develops a risk prediction model,and validates its efficacy,so as to provide references for identifying and preventing oral weakness in the elderly.Methods 556 elderly individuals from 4 communities were selected by convenience sampling from June to August 2024 in Zigong City Sichuan Province.They were randomly divided into a training group(383 cases)and a validation group(165 cases).Data were collected by a general information questionnaire,Social Frailty Scale,Geriatric Depression Scale,and the Oral Frailty Index-8 screening tool.Logistic regression was used to determine the influencing factors,and R software was used to establish a nomogram model for predicting the risk of oral frailty.Bootstrap method and the validation group were used for internally validation of the model.Calibration curve was used to evaluate the prediction performance of the model.Results 548 valid questionnaires were collected.The final model variables included whether the age ≥80 years,wearing removable dentures,reduced frequency of going out,brushing teeth less than twice a day,frequent dry mouth,increased difficulty in eating hard foods,and choking.The area under the receiver operating characteristic curve of the training group was 0.95(95％CI:0.93～0.97),and the best cutoff value was 0.687.The model achieved an accuracy of 87％,sensitivity of 91％,specificity of 85％,positive predictive value of 0.75,and negative predictive value of 0.95.The Hosmer-Lemeshow fitting test show that x2=3.036,P=0.932,indicating a good model fit.Conclusion The oral frailty prediction model demonstrated a good discrimination,calibration,and clinical utility,which can provide a scientific basis for the prevention and early screening of oral frailty in the elderly.

Sepsis is a life-threatening organ dysfunction disease caused by a dysregulated host response to infection.It has com-plex pathophysiological changes,and in severe cases,it can rap-idly develop into septic shock and multiple organ dysfunction or multiple organ failure.At present,the pathological mechanism of sepsis and its induced organ dysfunction is complex and the in-fluencing factors are numerous.So far,there is still a lack of specific and effective treatment strategies.RNA modify-N6-methyladenosine(m6 A)is one of the most common post-tran-scriptional modifications on eukaryotic RNAs.It is involved in the regulation of the occurrence and development of a variety of inflammatory diseases,including sepsis,and even multiple organ dysfunction induced by sepsis by affecting the metabolism of RNAs.It includes cardiac dysfunction,acute lung injury(ALI)and acute kidney injury(AKI).Therefore,this article will dis-cuss the effect of m6A modification on the function of immune cells,and its important role in sepsis and its induced multiple or-gan dysfunction diseases by regulating inflammatory signals,py-roptosis,mitochondrial damage and ferroptosis.This will provide new therapeutic targets and strategies for the clinical prevention and treatment of sepsis and its induced multiple organ dysfunc-tion diseases.

Adenoid cystic carcinoma(ACC)of the cervix is a rare and highly aggressive subtype of cervical cancer,accounting for less than 1%of all cervical cancer cases.ACC predominantly affects postmenopausal women over the age of 60,with postmenopausal vaginal bleeding being the most common symptom.Diagnosis of ACC primarily relies on histopathological examination and immunohistochemical analysis.Although there is currently no standard treatment protocol,surgical resection combined with radiotherapy or concurrent chemoradiotherapy is considered to be an effective approach.However,the effectiveness is limited,particularly in advanced cases,which generally have a poor prognosis.The treatment and prognosis of ACC are closely related to tumor staging,perineural invasion,and margin status.This paper discusses the clinical data and follow-up of six ACC patients treated at our institution,and goes through a literature review,examines its clinical features and treatment outcomes,underscores the critical importance of early diagnosis and individualized treatment.

Objectives:To evaluate the efficacies of laminoplasty(LP)and laminectomy and fusion(LF)in the treatment of multi-level ossification of the posterior longitudinal ligament(OPLL)in the cervical spine through meta-analysis.Methods:The databases of CNKI,Wanfang,Pubmed,Cochrane Library,EMBASE were searched by computer from their inceptions to June 2023 and the published clinical studies comparing LP and LF in the treatment of multi-level OPLL in the cervical spine were included.Cochrane risk bias assess-ment tool and Newcastle-Ottawa scale(NOS)were used to evaluate the quality of the included studies.Rele-vant data including operation time,intraoperative blood loss,the improvement rate of Japanese Orthopaedic Association(JOA)score,the change value of visual analogue scale(VAS)score,neck disability index(NDI),cer-vical curvature index(CCI),sagittal vertical axis(SVA)and cervical range of motion(CROM)at the final fol-low-up,the postoperative complication rate and OPLL progression rate were extracted and sorted.Then the meta-analysis was conducted by RevMan 5.4 and StataSE 16.0 softwares.Results:12 literatures(3 randomized controlled studies and 9 cohort studies)were ultimately included,involving a total sample size of 1496 cases,containing 839 cases in the LP group and 657 cases in the LF group.The results of meta-analysis were as follows:the LP group was better than LF group with significant differences in operation time[WMD=-28.01,95％CI(-36.25,-19.77),P＜0.00001],intraoperative blood loss[WMD=-115.09,95％CI(-197.91,-32.27),P=0.006],the change value of CROM[WMD=-7.83,95％CI(-8.10,-7.55),P＜0.00001]compared with those before surgery at final follow-up,the incidence of postoperative C5 nerve root paralysis[OR=0.32,95％CI(0.21,0.50),P＜0.00001]and axial symptoms[OR=0.44,95％CI(0.28,0.71),P=0.0006].The LF group was better than the LP group with significant differences in the change value of the CCI[WMD=-0.75,95％CI(-0.92,-0.58),P＜0.00001]and SVA[WMD=5.49,95％CI(5.30,5.68),P＜0.00001]compared with those before surgery at final follow-up,and the postoperative OPLL progression rate[OR=1.76,95％CI(1.26,2.46),P=0.0009].There were no significant differences between the two groups in the improvement rate of JOA score[WMD=-1.24,95％CI(-4.02,1.54),P=0.38],the change value of VAS[WMD=0.03,95％CI(-0.43,0.49),P=0.89]and NDI[WMD=0.54,95％CI(-0.07,1.14),P=0.08]compared with those before surgery at final follow-up,the incidence of postoperative cerebrospinal fluid leakage[OR=0.58,95％CI(0.24,1.39),P=0.22],incision infection[OR=0.71,95％CI(0.32,1.57),P=0.39]and epidural hematoma[OR=0.37,95％CI(0.06,2.16),P=0.27].Conclusions:Both LF and LP can effectively treat multi-level OPLL in the cervical spine and improve the neurological function of patients.Compared to LF,LP causes less surgical damage,preserves more cervical mobility and additionally,has a lower incidence of the postoperative C5 nerve root paralysis and axial symptoms.In comparison,LF can better maintain the curvature and stability of the cervical spine and delay the progression of ossification.

Purpose To investigate the predictive value of nomogram based on preoperative CT imaging for predicting programmed cell death receptor ligand 1(PD-L1)expression in patient with lung adenocarcinoma.Materials and Methods A total of 158 patients with lung adenocarcinoma were enrolled in Shenzhen people's Hospital from January 2021 to July 2022,of which 82 were negative for PD-L1 and 76 were positive for PD-L1.They were randomly divided into training set(n=119)and verification set(n=39)according to the proportion of 7:3.The significant characteristics between PD-L1 negative and PD-L1 positive were screened by univariate and multivariate Logistic regression to construct a clinical model.Radiomics features were extracted from preoperative CT images,and then features were screened and modeled.Finally,the combined model was established by clinical factors and radiomics features,which was visualized by nomogram.The diagnostic performance of the model was evaluated using receiver operating characteristic curves and area under the curve(AUC).Results The area under the curve(AUC)of the clinical model composed of carcinoembryonic antigen and vascular convergence sign was 0.774(95%CI 0.687-0.860)and 0.808(95%CI 0.670-0.947)in the training set and validation set,respectively.Through feature screening,the radiomics model was composed of 17 radiomics features,and the AUC of the training and validation sets was 0.837(95%CI 0.764-0.910)and 0.778(95%CI 0.633-0.923).The training set and validation set of the combined model composed of carcinoembryonic antigen,vascular convergence sign and radiomics score were AUC 0.892(95%CI 0.832-0.952)and 0.853(95%CI 0.737-0.968).In the training set,the AUC of the combined model was higher than that of the other two models(Z=-2.640,-2.855,P＜0.05).Conclusion Based on preoperative CT radiomics nomogram,it had high predictive efficacy on the expression of PD-L1 in lung adenocarcinoma and could provide decision-making support for the selection of clinical treatment regimens for lung adenocarcinoma patients.

Objective:To evaluate the value of ultrasound radiomics combined with machine learning for early diagnosis of seronegative Hashimoto’s thyroiditis (SN-HT) .Methods:This retrospective study included 164 patients from Liaoning Provincial People’s Hospital , Lixin County People’s Hospital, Linghai Dalinghe Hospital, Fengcheng Phoenix Hospital, who underwent thyroidectomy for solitary nodules with normal thyroid function between Nov. 2016 and Jan. 2024. Postoperative pathology confirmed Hashimoto’s thyroiditis (HT) in some cases, who were further categorized into antibody-positive and antibody-negative groups based on serum antibody status. Patients without Hashimoto’s thyroiditis served as the control group. A total of 298 ultrasound images were analyzed. Radiomics features were extracted from hypoechoic non-nodular areas within 0.5 cm surrounding the tumor. Two senior pathologists and two senior ultrasound physicians independently assessed lymphocytic infiltration, eosinophilic changes of follicular epithelium, and the proportion of hypoechoic areas in pathology and ultrasound images, respectively. A machine learning model, CCH-NET, was developed using linear regression and t-distributed stochastic neighbor embedding (t-SNE) techniques. The dataset was divided into a training set (80%) and a validation set (20%) to compare the diagnostic accuracy of CCH-NET with that of senior ultrasound physicians. Results:In internal validation, CCH-NET achieved a diagnostic accuracy of 88.89% for both antibody-positive and antibody-negative groups, significantly higher than the 66.67% accuracy of senior ultrasound physicians ( P<0.01). In external validation, CCH-NET achieved 75.00% and 66.67% accuracy for the two groups, compared to 50.00% by senior ultrasound physicians. For the control group, both methods achieved 93.33% accuracy. The AUC of CCH-NET was 0.848, outperforming senior ultrasound physicians (0.681) ,demonstrating superior diagnostic performance. Conclusion:The radiomics-based CCH-NET model, using non-nodular hypoechoic areas as a specific indicator, can accurately identify early SN-HT in euthyroid patients. It significantly outperforms senior ultrasound physicians, improving diagnostic accuracy and reducing missed diagnoses.