Objective To examine the impact of extreme temperature and drought stress on the survival of Bulinus globosus, so as to provide the theoretical evidence for the genomic research of Bulinus in absence of reference genes. Methods B. globosus snail samples were collected from Kiwani Shehia in Pemba Island, Zanzibar, Tanzania, and offspring snails were obtained through laboratory breeding and reproduction. A total of 120 10-week-old B. globosus snails from the same generation were selected and randomly assigned into four groups, including the high-temperature drought (HD) group, normal temperature drought (D) group, low-temperature drought (LD) group, and the control (C) group, of 30 snails in each group. Snails in HD, D, and LD groups were placed in beakers containing dry soil at the bottom and subsequently housed in climate chambers at 35, 26 ℃, and 10 ℃, respectively, while snails in Group C were maintained in 500 mL petri dishes containing dechlorinated tap water at 26 ℃. Following 3 days of breeding, living snails in each group were collected, and soft tissues were dissected and isolated. Total RNA was extracted from snail soft tissues for library construction, followed by high-throughput sequencing on the Illumina HiSeq 4000 sequencing system. De novo transcriptome assembly was performed using the Trinity software, and the longest transcripts were selected as unigenes. Gene functional annotations of unigenes were conducted using the Diamond software against Gene Ontology (GO) knowledgebase, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway database, NCBI non-redundant (NR) protein sequences database, Protein Family (Pfam) database, and UniProtKB/Swiss-Prot (Swiss-Prot) knowledgebase. GO and KEGG enrichment analyses of differentially expressed genes (DEGs) were performed using the topGO and clusterProfiler software, respectively. In addition, four relevant genes were selected for validation using a real-time quantitative PCR (qRT-PCR) assay to verify the reliability of transcriptome sequencing results. Results Following 3 days of breeding, there were 7, 20, 28, and 30 survival B. globosus snails in HD, LD, D, and C groups, with corresponding survival rates of 23.33% (7/30), 66.67% (20/30), 93.33% (28/30), and 100.00% (30/30), respectively (χ² = 52.72, P < 0.001). De novo transcriptome assembly generated 176 942 unigenes, with annotation rates of 0.98%, 13.49%, 26.46%, 12.48%, and 14.39% against GO knowledgebase, KEGG pathway database, NR protein sequences database, Pfam database, and Swiss-Prot knowledgebase, respectively. There were 33 up-regulated and 72 down-regulated genes in Group D, 483 up-regulated and 815 down-regulated genes in Group HD, and 245 up-regulated and 172 down-regulated genes in Group LD relative to in Group C. Following removal of overlapping genes across groups and unmatched genes, 11 candidate genes were identified. GO and KEGG analyses revealed 3 heat shock protein (HSP)-related DEGs in these 11 candidate genes, which were annotated as HSP12.2, HSP70, and HSP20 genes and were all significantly up-regulated in each treatment group. Three immune and nervous system-related DEGs were identified, and were all significantly down-regulated in each treatment group, which were involved in the neural cell adhesion molecule L1-like protein pathway, fibrinogen binding protein pathway, and leukocyte elastase inhibitor-like protein pathway. qRT-PCR assay quantified that the expression trends of four genes related to temperature and drought stress across different treatment groups were highly consistent with transcriptome sequencing data. Conclusion The survival rate of B. globosus significantly reduces under combined stresses of extreme temperature and drought, possibly due to an imbalance in its cellular homeostasis regulatory system.

Objective:To analyze the overall level,structure,and regional differences of central government's health and wellness transfer payments to local governments in China,providing a basis for improving the fiscal transfer payment system.Methods:The regional differences and their changes in central government's health and wellness transfer payments to local governments were analyzed using range,standard deviation,coefficient of variation,and Kendall's coefficient of concordance.Results:From the perspective of the per capita level of central government's health and wellness transfer payments to local governments,the relative differences among provinces have shown a downward trend,but the absolute differences have expanded.Meanwhile,the absolute and relative differences in the proportion of central government's health and wellness transfer payments to local governments in total government health expenditures have remained relatively stable.The Kendall's coefficient of concordance between per capita central government's health and wellness transfer payments to local governments and per capita general public budget revenue has shown a downward trend.Conclusion:Due to the different standards for sharing the expenditure responsibilities of common fiscal matters between the central and local governments,the existence of regional differences in central government's health and wellness transfer payments to local governments is inevitable.However,within regions with similar levels of economic development,there should not be significant differences in the standards and degrees of central government's health and wellness transfer payments to local governments.Therefore,it is necessary to evaluate the current standards for the division of fiscal powers,responsibilities,and expenditure responsibilities between the central and local governments,optimize the allocation mechanism of fiscal transfer payments,control the expansion of regional differences,and improve the regular assessment mechanism for fiscal transfer payments.

Objective:To analyze the overall level,structure,and regional differences of central government's health and wellness transfer payments to local governments in China,providing a basis for improving the fiscal transfer payment system.Methods:The regional differences and their changes in central government's health and wellness transfer payments to local governments were analyzed using range,standard deviation,coefficient of variation,and Kendall's coefficient of concordance.Results:From the perspective of the per capita level of central government's health and wellness transfer payments to local governments,the relative differences among provinces have shown a downward trend,but the absolute differences have expanded.Meanwhile,the absolute and relative differences in the proportion of central government's health and wellness transfer payments to local governments in total government health expenditures have remained relatively stable.The Kendall's coefficient of concordance between per capita central government's health and wellness transfer payments to local governments and per capita general public budget revenue has shown a downward trend.Conclusion:Due to the different standards for sharing the expenditure responsibilities of common fiscal matters between the central and local governments,the existence of regional differences in central government's health and wellness transfer payments to local governments is inevitable.However,within regions with similar levels of economic development,there should not be significant differences in the standards and degrees of central government's health and wellness transfer payments to local governments.Therefore,it is necessary to evaluate the current standards for the division of fiscal powers,responsibilities,and expenditure responsibilities between the central and local governments,optimize the allocation mechanism of fiscal transfer payments,control the expansion of regional differences,and improve the regular assessment mechanism for fiscal transfer payments.

To effectively play the guiding role of pathogenic diagnosis in the rational use of antibiotics, hospitals at all levels urgently need to establish an effective control system for clinical microbial specimen submission. In response to the common problems in medical institutions in China, such as the low rate of microbiological specimen submission before antibiotic treatment, unreasonable structure of microbiological specimens, and the majority of morning sputum and urine specimens collected for pathogen testing, the Second Affiliated Hospital of Zhejiang University School of Medicine has constructed a management system for clinical microbiological specimen submission using artificial intelligence technology. It used a built-in intelligent rule engine to implement full process control over the sampling and submission of microbiological specimens by doctors when prescribing antibiotics, urge doctors to implement the requirement of collecting samples before using antibiotics for treatment, and recommend priority the collection of sterile specimens. In addition, the hospital transformed the laboratory and testing process with the goal of receiving microbial samples 24 hours without interruption and inoculating in real-time. The informatization management system began to be applied throughout the hospital in December 2015. The average rate of microbial sample submission before the first therapeutic use of antibiotics from June 2016 to 2023 was 79.2%, an increase of 90.2 percentage points from 41.7% in June 2014 ( χ2=467.781, P<0.01). The structure of microbial specimens continued to be optimized, and the proportion of sterile specimens in all submitted specimens increased from 47.2% in 2014 to 49.9% in 2023 ( χ2=139.119, P<0.01). The proportion of morning sputum and morning urine specimens decreased from 65.2% and 60.6% in 2014 to 11.1% and 16.9% in 2023, respectively ( χ2 values were 19 787.434 and 4 346.664, respectively, P<0.01), providing a more reliable basis for pathogenic diagnosis in clinical practice and providing reference for improving the management of pathogenic specimen submission in medical institutions.

Objective To investigate the clinical application of 3D printed bolus with specific density in breast cancer radiotherapy,and to evaluate its effects on dose distribution and positioning.Methods Forty post-mastectomy patients undergoing intensity-modulated radiotherapy were randomly enrolled for 3D printed bolus(n=20)and conventional bolus(n=20),and all patients were fixed in the supine position using styrofoam.Conventional positioning was performed based on in-room lasers and body markers,with daily Catalyst HD optical surface monitoring combined with weekly CBCT verification.The absolute dose,patients'skin surface dose,surgical incision,planned field,target area doses(VCTV50Gy,VPTV50Gy)and organs-at-risk doses in patients with different boluses were recorded,and the conformity index and homogeneity index were calculated,and the setup errors using CBCT and Catalyst HD were also analyzed.Results The difference in absolute dose between different boluses was trivial,but the skin surface dose with 3D printed bolus was significantly higher than with conventional bolus[(54.83±0.44)Gyvs(54.43±0.51)Gy,P<0.05].Patients with 3D printed boluses had a higher conformity index than with conventional boluses(0.69±0.04 vs 0.65±0.02).For different boluses,there was no significant difference in VCTV50 Gy,while the VPTV50 Gy and organs-at-risk doses were lower in those with 3D printed bolus than conventional boluses(P<0.05),with heart Vmean of 9.68%±3.24%vs11.43%±3.60%.In patients with 3D printed boluses,both planned field arrangement and surgical incision affected the target doses,and the doses of the target area without an internal breast wrap was greater than those with internal breast wrap(P<0.05).When the field was not wrapped around the internal breast,the surgical incisions only affected VPTV50 Gy,and the VPTV50 Gy was greater with the transverse fusiform incision than with the oblique vertical incision(P<0.05),which were 95.58%±0.51%vs95.44%±0.71%.The optical monitoring accuracies with different boluses differed only in the left-right direction(P<0.05),with(0.08±0.57)cm and(-0.15±0.46)cm for 3D printed and conventional boluses.Conclusion Compared with conventional bolus,3D printed bolus can improve dose distribution and optical monitoring accuracy.The surgical incision and planned field arrangement under 3D-printed bolus would exert effects on target doses.

Objective:To explore the influence of the contours of different parts of the human body on the setup errors of Catalyst HD optical surface imaging (OSI) system-guided radiotherapy.Methods:Using the 3D printing technology, arc- and oval arc-shaped phantoms with base angles of 5°-45° (step length: 5°) were designed to simulate the contours of different body parts of patients. A Catalyst HD system was employed for monitoring, during which the gains and integration time of the system were adjusted. The treatment couches were manually moved (range: -5 mm to 5 mm, with a step length of 2 mm). The ratios of transverse to longitudinal dimensions of all phantoms were recorded. The recorded items also included couch value errors in the anterior-posterior (AP), inferior-superior (SI), and left-right (LR) directions for transversely and longitudinally placed phantoms, as well as the setup errors monitored using the Catalyst HD system. Then, this study presented an analysis of the correlation between phantoms for different body contours and the gains and integration time of the Catalyst HD system. The purpose was to compare the setup errors under the two different placement conditions of phantoms and to analyze the correlation between the monitored values of the Catalyst HD system and couch values.Results:There was a significant linear negative correlation between the gain and the logarithm of integration time required for monitoring using the Catalyst HD system, with a slope of -0.001. There was a certain functional relationship between the intercept and the ratio of the transverse to longitudinal dimensions of the phantoms. Under the same gain, the integration time decreased with an increase in the base angles of phantoms. The Catalyst HD system showed different monitoring accuracy under different placement conditions of the phantoms ( Z = -8.59 to -0.02, P < 0.05), with the monitoring accuracy in the LR and AP directions higher in the transverse position. The correlation between the monitored values of the Catalyst HD system and the actual couch values increased in the LR and SI directions with an increase in the base angle of the phantoms, showing a strong correlation in the case of base angles of ≥ 25°. Furthermore, the correlation was always significant in the AP direction ( R > 0.9). Conclusions:When the best surface images are obtained using the Catalyst HD system, the gains and integration time of the system are correlated with body surface contours. The Catalyst HD system shows high monitoring accuracy in the AP direction. This system shows high accuracy in all directions when the ratios of transverse to longitudinal dimensions are ≤ 2 or the base angles ≥ 25°.

Objective:To evaluate the effectiveness of the information management system on the clinical application of special-grade antimicrobial.Methods:Using the established knowledge database, a computer program was designed and developed, which was embedded in the electronic medical record to intervene the clinical use of the special-grade antimicrobial since 2015. The basic information of all discharged patients from the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2013 to December 2020 were extracted from the HIS system, including the medical orders for antibiotics and the drug storehouse dispensing data.The trend analysis was carried out on the changes of the use rates and antibiotic use density (AUD) of the special-grade antimicrobials in the whole hospital and intensive care units (ICU). The data were processed and analyzed using SPSS 24.0.Results:From 2013 to 2015, except for meropenem and amphotericin B, the usage rate of all special-grade antimicrobials in the whole hospital showed an upward trend ( P<0.05). The proportion of special-grade antimicrobials used in the hospital increased year by year ( χ2=7 804.081, P<0.01). The total usage rate of special-grade antimicrobials in ICU showed an upward trend year by year ( χ2=67.028, P<0.01). Since the implementation of the special-grade antimicrobial information management system in 2015, the total use rate of special-grade antimicrobials in the hospital, the use rate of various antibiotics except linezolid, amphotericin B and posaconazole, and the proportion of special-grade antimicrobials used in the hospital have all shown a downward trend year by year ( P<0.01). The total usage rate and total AUD of special-grade antimicrobials in ICU showed a decreasing trend year by year ( χ2=343.514, P<0.01, β=-0.963, P=0.002). Conclusion:The information management system for special-grade antimicrobial can effectively reduce the utilization rate and AUD of most special-grade antibiotics in hospitalized patients including ICU, and has a good clinical application value in antimicrobial stewardship.

Objective:To explore the risk factors of thyroid nodules in diabetic patients and its correlation with Traditional Chinese Medicine (TCM) constitution.Methods:A Total of 213 cases of diabetic patients in Guang’anmen Hospital and Tangshan Hospital from January 2019 to August 2020 were choosen to do the questionnaire, with containly symptom and constitution. The patients were divided into diabetes with thyroid nodules group and diabetes without thyroid nodules group according to whether thyroid nodules were combined. We compared the clinical data characteristics of 2 groups, and used multi-factor logistic regression model to analyze the risk factors of diabetic patients with thyroid nodules and their correlation with TCM constitutions. Results:Diabetes patients aged from 50-80 years old [ OR=2.949, 95% CI (1.266-6.714)], females [ OR=3.736, 95% CI (1.823-1.541)], diabetes duration≥15 years [ OR=1.558, 95% CI (1.623-1.585)], elevated HbA1c [ OR=5.862, 95% CI (1.418-23.629)], elevated VLDL [ OR=2.851, 95% CI (1.597-6.824)], frequent insomnia [ OR=1.970, 95% CI (1.315-3.395)], Qi stagnation [ OR=4.357, 95% CI (2.634-8.377)], blood stasis [ OR=4.420, 95% CI (1.874-15.258)] are more likely to suffer from thyroid nodules ( P<0.05). Conclusion:Diabetic patients aged from 50-80 years old, females, diabetes duration≥15 years, elevated HbA1c, family history of thyroid nodules, frequent insomnia, and mood swings are more likely to develop thyroid nodules; qi stagnation and blood stasis are dangerous constitutions for diabetic patients with thyroid nodules.

Robot-assisted laparoscopy hepatectomy (RALH) is a new technique for surgical operation. Compared with conventional laparoscopic hepatectomy, RALH is more frequently used in complex liver tumor and liver tumor with special locations, but this technique is still under development and is limited by the burden of high costs and surgical devices. Meanwhile, there is a lack of generally accepted and confirmed clinical data, and therefore, the role of RALH is still under debate. This article reviews the surgical indication, learning curve, advantages, and limitations of RALH.