Objective: To investigate the spatio-temporal clustering characteristics of influenza in Shaoxing City, Zhejiang Province from 2015 to 2024, so as to provide the basis for formulating influenza prevention and control strategies. Methods: Influenza case data in Shaoxing City from 2015 to 2024 were collected through the Infectious Disease Surveillance Reporting System of the Chinese Disease Prevention and Control Information System. Descriptive epidemiological methods analyses were used to analyze the epidemiological characteristics of influenza. Spatial autocorrelation and spatio-temporal scanning were used to analyze the spatio-temporal clustering characteristics of influenza. Results: A total of 328 759 influenza cases were reported in Shaoxing City from 2015 to 2024, with an average annual reported incidence of 639.90/100 000, which showed an upward trend (AAPC=68.95%, P<0.05). The peak incidence period was from December to February of the following year, with 193 051 cases reported, accounting for 58.72%. There were 165 408 male cases and 163 351 female cases, with a male-to-female ratio of 1.01∶1. Children and adolescents aged 0-<15 years constituted the high-incidence population, while students represented the predominant occupational category, comprising 113 589 cases (34.55%). Keqiao District, Shengzhou City, and Yuecheng District had the top three average annual reported incidence of influenza, at 995.64/100 000, 734.66/100 000, and 687.44/100 000, respectively. Spatial autocorrelation analysis showed that, there were 155 high-high aggregation areas in Shaoxing City from 2015 to 2024, which gradually expanded from the local aggregation in the central part of Shengzhou City to Keqiao District and then spread to Yuecheng District. Spatio-temporal scanning analysis showed that, from November 2023 to February 2024, the strongest spatio-temporal clustering of influenza centered on Keqiao Street in Keqiao District, covering 11 towns (streets) in Yuecheng District and Keqiao District. From 2015 to 2018, the primary-type clustering of influenza was mainly concentrated in Xinchang County and Shengzhou City. After 2019, they gradually shifted to Yuecheng District and Keqiao District, with the main clustering period being from November to February of the following year. Conclusions The incidence of influenza in Shaoxing City from 2015 to 2024 showed an upward trend, with obvious spatio-temporal clustering. The clustering area expanded from Shengzhou City in the central region to Keqiao District and Yuecheng District in the northern region, mainly clustering from November to February of the following year.

Objective:This multicenter retrospective study aimed to analyze the clinicopathological features of duodenal adenocarcinoma (DA) and identify prognostic factors for postoperative survival.Methods:Demographic characteristics, clinicopathological features, treatment outcomes and survival of DA patients undergoing surgical treatment at 18 Chinese medical centers from January 2012 to December 2023 were retrospectively analyzed.Results:Among the 2 056 DA patients included, 46.8% (963) had extra-ampullary DA (EA-DA), and 53.2% (1 093) had peri-ampullary DA (PA-DA). The 1-, 3-, and 5-year overall survival (OS) rates for patients who underwent radical surgery were 93.2%, 71.0%, and 57.2%, respectively. The median overall survival was 76 months, and the median progression-free survival (PFS) was 65 months. No differences in survival were observed between the laparotomy group and minimally invasive surgery (MIS) group either before or after propensity score matching (OS: 76 vs. 75 months before PSM, P=0.986; OS: 75 vs. 75 months after PSM, P=0.602). Furthermore, there were no significant differences between-group in operation time and postoperative complications ( P＞0.05). The MIS group experienced less intraoperative blood loss and shorter hospital stays. The multivariate Cox regression analysis revealed that advanced age ( HR=1.43,95% CI:1.18-1.73), elevated carbohydrate antigen 19-9 levels ( HR=1.24,95% CI:1.02-1.51), perineural invasion ( HR=1.44,95% CI:1.14-1.81), vascular invasion ( HR=1.35,95% CI:1.07-1.71), advanced T stage (T3-4 vs. T1-2: HR=1.86,95% CI:1.49-2.31), regional lymph node metastasis ( HR=1.93,95% CI:1.58-2.36), preoperative biliary drainage ( HR=1.26,95% CI:1.04-1.53), intraoperative blood loss ( HR=1.34,95% CI:1.11-1.62), clinically significant postoperative pancreatic fistulas ( HR=1.53,95% CI:1.12-2.09), and postoperative hemorrhage ( HR=1.62,95% CI:1.14-2.29) were independent risk factors for poor prognosis after surgery (all P＜0.05). Conclusions:Radical surgery is associated with favorable overall survival among DA patients, and no difference in survival is observed between EA-DA and PA-DA patients. MIS is a reliable alternative for DA treatment.

Objective:To analyze the feasibility and safety of laparoscopic transhepatic section biliary exploration without T-tube drainage in the treatment of intrahepatic and extrahepatic bile duct stones.Methods:A retrospective analysis was conducted on the clinical data of 200 patients with intrahepatic and extrahepatic bile duct stones who underwent surgical treatment in Ankang Central Hospital from January 2020 to December 2024, including 79 males and 121 females, with the average age of (64.1±6.1) years. Among the 200 patients, 100 underwent laparoscopic hepatectomy and stone removal through transhepatic section cholangiography and choledochoscopy and were included in the observation group. Another 100 patients underwent laparoscopic hepatectomy, common bile duct incision, choledochoscopic exploration and stone removal, and T-tube drainage and were included in the control group. The intraoperative blood loss, operation time, postoperative hospital stay, hospitalization cost, postoperative pain score, time to get out of bed and move around, recovery time of intestinal function, abdominal drainage time, total complication rate, recurrence of stones, biliary tract infection, etc. were compared between the two groups.Results:The operation time, intraoperative blood loss, postoperative hospital stay and hospitalization cost of the observation group (165.8±29.9 min, 158.9±23.7 ml, 8.8±1.8 d and 46, 037.8±312.6 yuan, respectively) were all lower than those of the control group (220.3±37.5 min, 232.5±36.7 ml, 12.5±2.5 d, and 57 006.2±528.5 yuan) and the differences were statistically significant (all P<0.05). The postoperative pain score of the control group was (4.8±1.3) points, the postoperative time to get out of bed for activities was (1.6±0.5) d, the postoperative recovery time of intestinal function was (3.2±0.7) d, and the abdominal drainage time was (5.0±0.8) d. All were higher than those of the observation group (3.2±0.8) points, (0.8±0.2) d, (1.8±0.5) d, and (2.5±0.6) d, and the differences were statistically significant (all P<0.05). The total incidence of complications, recurrence of stones and infection rate of biliary tract in the observation group were 6.0%(6/100), 3.0%(3/100) and 2.0%(2/100) respectively, which were lower than those in the control group at 36.0%(36/100), 11.0%(11/100) and 9.0%(9/100). The differences were all statistically significant (all P<0.05). Conclusion:Laparoscopic transhepatic section biliary exploration without T-tube drainage for the treatment of intrahepatic and extrahepatic bile duct stones is feasible and safe.

Objective:This multicenter retrospective study aimed to analyze the clinicopathological features of duodenal adenocarcinoma (DA) and identify prognostic factors for postoperative survival.Methods:Demographic characteristics, clinicopathological features, treatment outcomes and survival of DA patients undergoing surgical treatment at 18 Chinese medical centers from January 2012 to December 2023 were retrospectively analyzed.Results:Among the 2 056 DA patients included, 46.8% (963) had extra-ampullary DA (EA-DA), and 53.2% (1 093) had peri-ampullary DA (PA-DA). The 1-, 3-, and 5-year overall survival (OS) rates for patients who underwent radical surgery were 93.2%, 71.0%, and 57.2%, respectively. The median overall survival was 76 months, and the median progression-free survival (PFS) was 65 months. No differences in survival were observed between the laparotomy group and minimally invasive surgery (MIS) group either before or after propensity score matching (OS: 76 vs. 75 months before PSM, P=0.986; OS: 75 vs. 75 months after PSM, P=0.602). Furthermore, there were no significant differences between-group in operation time and postoperative complications ( P＞0.05). The MIS group experienced less intraoperative blood loss and shorter hospital stays. The multivariate Cox regression analysis revealed that advanced age ( HR=1.43,95% CI:1.18-1.73), elevated carbohydrate antigen 19-9 levels ( HR=1.24,95% CI:1.02-1.51), perineural invasion ( HR=1.44,95% CI:1.14-1.81), vascular invasion ( HR=1.35,95% CI:1.07-1.71), advanced T stage (T3-4 vs. T1-2: HR=1.86,95% CI:1.49-2.31), regional lymph node metastasis ( HR=1.93,95% CI:1.58-2.36), preoperative biliary drainage ( HR=1.26,95% CI:1.04-1.53), intraoperative blood loss ( HR=1.34,95% CI:1.11-1.62), clinically significant postoperative pancreatic fistulas ( HR=1.53,95% CI:1.12-2.09), and postoperative hemorrhage ( HR=1.62,95% CI:1.14-2.29) were independent risk factors for poor prognosis after surgery (all P＜0.05). Conclusions:Radical surgery is associated with favorable overall survival among DA patients, and no difference in survival is observed between EA-DA and PA-DA patients. MIS is a reliable alternative for DA treatment.

Objective:To analyze the feasibility and safety of laparoscopic transhepatic section biliary exploration without T-tube drainage in the treatment of intrahepatic and extrahepatic bile duct stones.Methods:A retrospective analysis was conducted on the clinical data of 200 patients with intrahepatic and extrahepatic bile duct stones who underwent surgical treatment in Ankang Central Hospital from January 2020 to December 2024, including 79 males and 121 females, with the average age of (64.1±6.1) years. Among the 200 patients, 100 underwent laparoscopic hepatectomy and stone removal through transhepatic section cholangiography and choledochoscopy and were included in the observation group. Another 100 patients underwent laparoscopic hepatectomy, common bile duct incision, choledochoscopic exploration and stone removal, and T-tube drainage and were included in the control group. The intraoperative blood loss, operation time, postoperative hospital stay, hospitalization cost, postoperative pain score, time to get out of bed and move around, recovery time of intestinal function, abdominal drainage time, total complication rate, recurrence of stones, biliary tract infection, etc. were compared between the two groups.Results:The operation time, intraoperative blood loss, postoperative hospital stay and hospitalization cost of the observation group (165.8±29.9 min, 158.9±23.7 ml, 8.8±1.8 d and 46, 037.8±312.6 yuan, respectively) were all lower than those of the control group (220.3±37.5 min, 232.5±36.7 ml, 12.5±2.5 d, and 57 006.2±528.5 yuan) and the differences were statistically significant (all P<0.05). The postoperative pain score of the control group was (4.8±1.3) points, the postoperative time to get out of bed for activities was (1.6±0.5) d, the postoperative recovery time of intestinal function was (3.2±0.7) d, and the abdominal drainage time was (5.0±0.8) d. All were higher than those of the observation group (3.2±0.8) points, (0.8±0.2) d, (1.8±0.5) d, and (2.5±0.6) d, and the differences were statistically significant (all P<0.05). The total incidence of complications, recurrence of stones and infection rate of biliary tract in the observation group were 6.0%(6/100), 3.0%(3/100) and 2.0%(2/100) respectively, which were lower than those in the control group at 36.0%(36/100), 11.0%(11/100) and 9.0%(9/100). The differences were all statistically significant (all P<0.05). Conclusion:Laparoscopic transhepatic section biliary exploration without T-tube drainage for the treatment of intrahepatic and extrahepatic bile duct stones is feasible and safe.

Radiotherapy is one of the main treatment methods for malignant tumors, which can cause the radiation damage to normal tissues. Radiation-induced skin injury (RISI) is one of the main adverse reactions caused by radiotherapy. The main clinical manifestations of RISI are dermatitis, ulcer, erosion and necrosis, which seriously affect the quality of life and treatment effect of tumor radiotherapy patients, and even affect the overall survival of patients. The pathological mechanism of RISI is still unclear. Some studies have shown that inflammation and oxidative stress are the main causes of RISI. RISI can be divided into acute and chronic RISI according to the different onset time, and different treatment strategies can be formulated according to the severity of the injury. In this article, clinical manifestations, classification, pathogenesis, prevention and treatment of RISI are comprehensively summarized.

Objective To investigate changes in coagulation function and inflammation levels during sepsis.Methods A rat model of sepsis was established using the multiple infection sepsis model(MIM)based on cecal ligation and puncture.Forty-eight male Sprague-Dawley rats were assigned randomly to the following groups:control group,sham group,4 h sepsis group,8 h sepsis group,12 h sepsis group,and 16 h sepsis group(n=8 per group).Inflammatory markers and coagulation-related indicators were measured by enzyme-linked immunosorbent assay and coagulation analysis.Results(1)Lipopolysaccharide(LPS)and interleukin-6(IL-6)levels were significantly higher in the model rats at all time points compared with the sham group(P＜0.001).LPS and IL-6 levels increased gradually with disease progression,with no further changes in LPS after 12 hours.(2)Prothrombin time(PT)was significantly prolonged in the middle and late stages of the sepsis model,starting from 8,compared with the sham group(P＜0.01).(3)Partially activated prothrombin time(APTT)time was significantly prolonged in the 8,12,and 16 h groups compared with the sham group(P＜0.05,P＜0.01).APTT gradually lengthened from 8 h,but approached control levels thereafter.(4)Fibrinogen(Fbg)content was significantly higher in all sepsis groups,except for the 8 h group,compared with the sham group(P＜0.01).(5)Fibrin degradation products(FDP)differed significantly between the control and sham groups(P＜0.01),but not between the sham and sepsis groups.(6)Antithrombin-Ⅲ(AT-Ⅲ)levels decreased significantly throughout each stage of sepsis progression compared with the sham group(P＜0.01),and AT-Ⅲ showed a downward trend with the course of disease,with significant differences among the 4,8,and 16 h groups.Conclusions The MIM rat model can reflect the development of inflammatory and blood coagulation disorders and their relationship during the course of sepsis,and may thus provide a good foundation for further research into the disease course of sepsis.

With the development of clinical related disciplines, the update and establishment of relevant standards/guidelines at home and abroad, GBZ 185-2006 Diagnostic Criteria for Occupational Medicamentose-like Dermatitis due to Trichloroethylene (hereinafter referred to as “GBZ 185-2006”) was unable to meet clinical needs. Therefore, the GBZ 185-2006 was revised based on the principles of evidence-based medicine, in accordance with relevant laws/regulations and relevant standards/guidelines in combination with review of research data on occupational medicamentose-like dermatitis due to trichloroethylene (OMDT) home and abroad, and the development of clinical practice and clinical related disciplines. The main modifications include: adding terms and definitions of OMDT, modifying the description of clinical manifestations of the diagnostic principles, adjusting the description of latency, deleting the diagnostic requirement of the incidence probability, adding the specific allergen patch test as the etiological diagnostic index, standardizing the application scope, operating procedure and precautions of the specific allergen patch test. In addition, the relevant content of “Basic Characteristics and Clinical Types of Skin Damage of Medicamentose-like Dermatitis due to Trichloroethylene” in Appendix A is improved, the treatment principles are revised, and the content of new progress in treatment, artificial liver application, are added. The revised GBZ 185-2024 Diagnostic Standard for Occupational Medicamentose-like Dermatitis due to Trichloroethylene is more scientific and practical, and can provide technical basis for the standardized diagnosis and treatment of OMDT in medical and health institutions.

Objective: To analyze epidemiological characteristics of brucellosis in Shaoxing City, Zhejiang Province from 2005 to 2023, so as to provide the basis for developing targeted control measures. Methods: Data of brucellosis cases and epidemiological investigation in Shaoxing City from 2005 to 2023 were collected from the Monitoring and Reporting Management System of the Chinese Disease Prevention and Control Information System. The epidemiological characteristics of brucellosis were descriptively analyzed, the trend in incidence of brucellosis was analyzed using average annual percent change (AAPC). Results: A total of 270 cases of brucellosis were reported in Shaoxing City from 2005 to 2023, with an average annual incidence of 0.29/105. The AAPC was 0.812%, with no significant changing trend (P>0.05). The incidence of brucellosis peaked from February to March, with 80 cases (29.63%). The reported cases were mainly distributed in Shangyu District (139 cases, 51.48%) and Shengzhou City (74 cases, 27.41%). There were 188 male cases and 82 female cases, with a male-to-female ratio of 2.29∶1. The cases were primarily concentrated in the age group of 40 to <70 years, with 205 cases accounting for 75.93%. Among these, 86 cases were reported in the 50 to <60 years of age group, accounting for 41.95%. The majority of the cases were farmers, with 187 cases accounting for 69.26%. The median interval from onset to diagnosis was 22.73 (interquartile range, 39.97) days, with a delayed diagnosis rate of 62.96%. Infections through breeding, selling and transporting cattle and sheep resulted in 164 cases (60.74%), and through buying and slaughtering resulted in 36 cases (13.33%). An outbreak of brucellosis was reported in Xinchang County in 2018, with three confirmed cases. Conclusions The incidence of brucellosis in Shaoxing City had no significant change from 2005 to 2023. The peak period was from February to March. The cases were mainly distributed in Shangyu District and Shengzhou City. People aged 50 to <60 years, males, and farmers were the key groups for prevention and control.

Cancer of unknown primary(CUP)refers to a group of histopathologically confirmed malignancies that cannot be identified in terms of their primary origin despite thorough investigations.CUP accounts for approximately 3%-5%of all newly diagnosed cancers worldwide,with an overall survival(OS)ranging from 2.7 to 16.0 months.CUP has long been a significant scientific challenge due to the elusive nature and heterogeneity of the primary sites.In the era of immunohistochemistry(IHC),IHC has been applied to identify the primary site in approximately 70%of CUP cases.However,IHC also has limitations for undifferentiated cancers of unknown primary,and results can be influenced by experimental and human factors.In recent years,with the development of molecular tumor profiling(MTP),techniques such as cytology,histology,gene expression profiling(GEP),genomics and epigenomics have been able to accurately detect the primary site in 90%of cases.Currently,the 90-gene tumor tissue origin test has been proven to have an accuracy rate of 94.4%in diagnosing the primary site of CUP,laying the foundation for precision treatment.In the past,platinum and taxane-based empirical chemotherapy was commonly used for treating CUP.However,these treatments did not yield significant improvements in patient survival and prognosis.Since 2008,there has been a global emergence of clinical studies on MTP-guided first-line therapy for CUP.However,due to study design flaws and result controversies,there is no international consensus on the superiority of organ-specific treatment over empirical chemotherapy in terms of improving progression-free survival(PFS)and OS for CUP.Based on this,our center conducted the world's first phase Ⅲ clinical trial in 2017,and demonstrated improved PFS and favorable OS by GEP-guided site-specific therapy of CUP,which established the primacy of site-specific first-line therapy for CUP.In this review,we detailed the epidemiology,pathogenesis,clinical characteristics and the progression of CUP diagnosis from the era of IHC to MTP.Furthermore,we reviewed the advancements in CUP treatment from empirical chemotherapy to MTP-guided organ-specific treatment.Additionally,this review delved into the exploration of second-line treatment options and the establishment of a clinical stratified management model,which are two topics in future research of CUP.This review aimed to summarize the progress in the diagnosis and treatment of CUP,further explore future research directions for CUP,and improve the survival and prognosis of patients with CUP.