ObjectiveTo conduct an epidemiological investigation, isolate and identify the pathogenic bacteria, and perform whole-genome sequencing (WGS) analysis of a food poisoning outbreak in Suzhou High-tech Zone, so as to provide references for the prevention and management of similar incidents. MethodsAn epidemiological investigation was carried out on affected individuals and restaurant staff. Multi-pathogen screening was performed on rectal swab samples from affected cases and restaurant staff, as well as on environmental swab samples from food preparation areas and retained food samples. WGS was performed on the pathogens isolated from the samples. ResultsA total of 15 cases were identified through hospital visit record reviews and on-site inquiries. Of the 15 case samples, 14 tested positive for Staphylococcus aureus (SA). In addition, 3 out of 15 staff samples and 6 out of 34 retained food samples tested positive for SA. WGS results revealed that the 6 food-derived isolates and 13 case-derived isolates shared the same sequence type (ST), Staphylococcal Protein A (SPA) type, and enterotoxin gene profile, with whole-genome single nucleotide polymorphism (wgSNP) differences of ≤5. Two novel SA sequence types: ST9159 and ST9161, were also identified in this study. ConclusionThis food poisoning outbreak is caused by contamination food with SA harbouring the seb and sec enterotoxin genes. The primary causes of contamination and cross-contamination included improper food handling practices, the use of the same utensils for raw and cooked foods, and extended storage of certain dishes at room temperature. Strengthening sanitary supervision in food handling facilities is crucial for reducing the occurrence of similar incidents.

【Objective】 To establish an information management platform for provincial rare blood group bank to achieve the interconnection and sharing of data such as rare blood group types, donor information and blood inventory, so as to enhance the supply security of rare blood group blood. 【Methods】 The information barriers of rare blood group management in each business link and among blood stations in Zhejiang province were analyzed using fishbone diagram. Data modeling technology was introduced based on the unified blood collection and supply business system and blood cloud platform of Zhejiang, the database view of rare blood group donors and rare blood group was constructed through demand analysis and model design, and a unified query platform was developed to achieve the sharing of rare blood group information. 【Results】 The system integrated, retrievaled and displayed rare blood type information, achieving the interconnection of information among various business links and blood stations within blood banks. Up to now, in addition to RhD negative blood group, there were 8 types of rare red blood cells in the bank, covering 7 blood group systems, 289 rare blood group donors and 216 units of frozen red blood cells of rare blood group. 【Conclusion】 The information system based on data modeling can improve the overall efficiency and collaboration of the system, and reduce the workload of system development and operation. It can provide reference for standardized data management and application, and also provide a model for establishing and improving of a national rare blood group information network.

Objective To establish a three-dimensional visualization model of complex anal fistula based on high-resolution mag-netic resonance imaging(HR-MRI),and to explore its feasibility and clinical application value.Methods The clinical and imaging data of 26 patients with complex anal fistula were analyzed retrospectively,and a three-dimensional visualization model based on HR-MRI images was established.The Parks typing,internal orifice,external orifice,branch fistula and abscess were evaluated by radiolo-gists and anorectal surgeons in HR-MRI images and the three-dimensional visualization model,and the SPSS 22.0 software was used to analyze the assessment results against the clinical surgery one by one.Results A total of 26 patients had 17 trans sphincteric fis-tulas,7 inter sphincteric fistulas,and 2 suprasphincteric fistulas,and the accuracy of Parks typing based on HR-MRI images and three-dimensional visualization model was 100％;26 patients had a total of 33 internal orifices,and the evaluation of internal orifices based on HR-MRI images was better than that of three-dimensional visualization model(P=0.180 vs P=0.022);15 patients had a total of 32 external orifices,and the evaluation of external orifices based on three-dimensional visualization model was better than that of HR-MRI images(P=0.791 vs P=0.049);20 patients had perianal abscesses,and the evaluations based on HR-MRI images and three-dimensional visualization model were both highly accurate(P=0.549 vs P=0.625);18 patients with branch fistula,the evaluation of branch fistula based on three-dimensional visualization model was significantly better than that of HR-MRI images(P=1.000 vs P＜0.001).Conclusion Based on three-dimensional visualization model of HR-MRI,the evaluation of complex anal fistula Parks typing,external orifice,branch fistula and abscess is more accurate,which is worthy of further research and promotion.

Objective:To evaluate the efficacy of compound chamomile and lidocaine hydrochloride gel in prevention of complications related to laryngeal mask airway (LMA) insertion.Methods:Ninety American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients, aged 18-60 yr, undergoing elective surgery with ventilation using LMA under general anesthesia, were divided into 3 groups ( n=30 each) using a random number table method: paraffin oil group (group A), compound lidocaine cream group (group B), and compound chamomile and lidocaine hydrochloride gel group (group C). The paraffin oil, compound lidocaine cream, and compound chamomile and lidocaine hydrochloride gel were evenly applied on the front, shoulder and back of the LMA before inserting the LMA in A, B and C groups, respectively.The severity of sore throat, oropharyngeal mucositis score, hoarseness score and occurrence in each time period (0-1 h, >1-6 h, >6-24 h, > 24-48 h) were recorded at 1, 6, 24 and 48 h after removal of the laryngeal mask.The stress responses during removal of the LMA and occurrence of drug-related adverse reactions within 48 h after removal of LMA were recorded. Results:Twenty-nine cases in group A, 28 cases in group B and 27 cases in group C completed the trial.Compared with group A, the severity of sore throat at each time point after removal of the LMA and incidence of sore throat in each time period were significantly decreased, the oropharyngeal mucositis score at 6, 24 and 48 h after removal of the LMA and the incidence of oropharyngeal mucositis in the time period >1-48 h were decreased, and the incidence of drug-related adverse reactions was increased in group C ( P<0.05). Compared with group B, the severity of sore throat at 6 h after removal of the LMA and incidence of sore throat > 1-48 h after removal of the LMA were significantly decreased, the oropharyngeal mucositis score at 6, 24 and 48 h after removal of the LMA and incidence of oropharyngeal mucositis in the time period >1-48 h after LMA removal were reduced, and the incidence of drug-related adverse reactions was decreased in group C ( P<0.05). There was no significant difference in the hoarseness score and incidence of hoarseness after removal of the LMA and incidence of stress responses during removal of the LMA among the three groups ( P>0.05). Conclusions:Compound chamomile and lidocaine hydrochloride gel has a certain efficacy in preventing complications related to LMA placement.

Objective:To construct enhanced computed tomography (CT)-based nomograph model, to assist physicians in differentiating gastric schwannoma from gastric stromal tumor.Methods:From January 1, 2012 to January 1, 2022, at the Second Affiliated Hospital of Zhejiang University School of Medicine and Ningbo Hwamei Hospital, University of Chinese Academy of Sciences, 57 patients with gastric schwannoma and 275 patients with gastric stromal tumor confirmed by surgical pathology were retrospectively collected, among whom 39 patients with gastric schwannoma and 201 patients with gastric stromal tumor were enrolled in the training set, and the other 18 patients with gastric schwannoma and 74 patients with gastric stromal tumor were enrolled in the validation set. The contrast-enhanced CT imaging features (tumor size index, arterial phase CT value, venous phase CT value, necrosis, calcification, integrity of mucosal surface, and uniform enhancement, etc.) and clinical data (history of gastritis, carbohydrate antigen 19-9 (CA19-9), carcinoembryonic antigen, and monocyte to lymphocyte ratio (MLR), etc.) were collected. The least absolute shrinkage and selection operator (LASSO) regression analysis was used to screen the independent predictive factors of imaging features in the differential diagnosis of gastric schwannoma and gastric stromal tumor, and a nomograph model was constracted. Logistic regression analysis was used to analyze and screen the independent predictive factors of clinical indicators to distinguish gastric schwannoma from gastric stromal tumor, and a clinical control model was established. The receiver operating characteristic curve(ROC) was used to analyze the area under the curve (AUC) of the nomograph model in the training set and the verification set, and concordance index (CI) and decision curve analysis (DCA) were used to evaluate the predictive efficiency and clinical application value of the nomograph model. DeLong test was used for statistical analysis.Results:The results of LASSO regression analysis showed that tumor size index, arterial phase CT value, venous phase CT value, necrosis, calcification, integrity of mucosal surface, and uniform enhancement were independent predictive factors of imaging features in the differential diagnosis of gastric schwannoma and gastric stromal tumor(all P<0.05). The results of logistic regression analysis indicated that the history of gastritis ( OR=0.280, 95% confidence interval 0.138 to 0.566), CA19-9 ( OR=0.940, 95% confidence interval 0.890 to 0.993), carcinoembryonic antigen ( OR=0.794, 95% confidence interval 0.661 to 0.952), and MLR ( OR=0.087, 95% confidence interval 0.009 to 0.860) were independent predictive factors of clinical indicators in the differential diagnosis of gastric schwannoma and gastric stromal tumor ( P<0.001, =0.028, 0.013 and 0.037). The AUCs of the nomograph model in the training and validation set were 0.881 and 0.850, respectively, and the AUCs of the clinical control model in the training and validation set were 0.814 and 0.772, respectively, and the differences were statistically significant ( Z=2.57 and 1.96, P=0.005 and 0.030). The average CI of the nomograph model was 0.885. The results of DCA analysis showed that the overall benefit of the nomograph model was higher than that of the clinical control model. Conclusion:The enhanced CT-based nomograph model can effectively distinguish gastric schwannoma from gastric stromal tumor, and can help physicians to make precise clinical decisions.

Objective:To provide references for encouraging translation of medical and pharmaceutical research outcomes from a policy perspective.Methods:In view of characteristics of such translation and using policy tools, the authors introduced the innovation value chain and innovation entity chain to create a three-dimensional analysis framework. The three dimensions refer to policy tools(supply side, environment side and demand side), innovation value chain(research and development, clinical research and pilot application, and commercial industrialization), and innovation entity chain(colleges, medial institutions, enterprises, government, and third parties). A three-dimensional framework was introduced for textual quantitative analysis, centering on 70 policy documents on such translation released from 2015 to 2019.Results:Excessiveness was found in the environment side and supply side policy tools usage, while the demand side was deficient relatively; clinical research and pilot applications constitute the policy support weakness in innovation value chain; policy frequency on medical institutions and third parties was weak in the innovation entity chain dimension.Conclusions:Based on the three-dimensional framework analysis results and sector specifics, the paper proposed such policy recommendations as highlighting features of medical and pharmaceutical sector, activating incentives of hospitals and colleges, and expanding resources for clinical research.

Objective:To explore the differences in clinical and imaging features between pancreatic adenosquamous carcinoma (PASC) and pancreatic ductal adenocarcinoma (PDAC).Methods:The clinical data, imaging and pathological data of 171 patients pathologically diagnosed with PASC after surgical resection (PASC group) (from February 2011 to October 2020, 148 patients from the First Affiliated Hospital of Naval Medical University and 23 patients from the Second Affiliated Hospital of Zhejiang University School of Medicine) and 100 patients pathologically diagnosed with PDAC after surgical resection (PDAC group) (from January to June, 2018, at the First Affiliated Hospital of Naval Medical University) were retrospectively analyzed. Computed tomography and magnetic resonance imaging features were analyzed by two associate chief physician of department of radiology. Independent sample t test, rank sum test, chi-square test or Fisher exact probability test were used for statistical analysis. Multivariate logistic regression analysis was used to analyze independent predictors of PASC. Results:The longest diameter of tumor of PASC group was larger than that of PDAC group (35.0 mm (28.0 mm to 45.0 mm) vs. 29.5 mm (23.0 mm to 36.0 mm)), and the rates of cystic necrosis, ring-enhancement, normal distal main pancreatic duct and normal pancreatic parenchyma of PASC group were higher than those of PDAC group (62.0%, 106/171 vs. 12.0%, 12/100; 66.1%, 113/171 vs. 25.0%, 25/100; 52.0%, 89/171 vs. 12.0%, 12/100; 70.2%, 120/171 vs. 29.0%, 29/100, respectively); and the differences were statistically significant ( Z=-4.001, χ2=72.183, 42.612, 43.284 and 43.221, all P<0.01). The results of multivariate logistic regression analysis showed that the cystic necrosis, ring-enhancement, normal distal main pancreatic duct and normal pancreatic parenchyma were indenpendent predictors of PASC (odds ratio=10.083, 2.361, 3.086 and 2.632, 95% confidence interval 8.736 to 11.639, 2.096 to 2.660, 2.605 to 3.656 and 2.267 to 3.057, all P<0.01); and the sensitivity for PASC diagnosis was 62.0%, 66.1%, 51.7% and 70.3%, respectively; the specificity was 88.0%, 75.0%, 88.0% and 71.0%, respectively; the positive predictive value was 89.3%, 81.9%, 88.1% and 80.5%, respectively. Conclusions:PASC and PDAC have similar clinical features. The imaging features of cystic necrosis, ring-enhancement, normal distal main pancreatic duct and normal pancreatic parenchyma are independent predictive factors of PASC.

Objective To observe the efficacy of Ramulus Cinnamomi , Poria capsules combined with mifepristone in the treatment of hysteromyoma .Methods 60 patients with hysteromyoma were treated with drugs ,and according to the outpatient number they were randomly divided into three groups .Ⅰgroup ( n=20) were orally given mifepristone in a dosage of 12.5mg once daily for three months.Ⅱgroup (n=20) were orally given Cassia Tuckahoe Capsule for three months ,and Ⅲ group ( n=20 ) were orally given Cassia Tuckahoe Capsule for three months after given mifepristone in a dosage of 2.5mg once daily for one month.The size of hysteromyoma,FSH,LH,E2 and P were detected before and after treatment .The changes of clinical symptoms and adverse drug reactions were observed . Results The size of hysteromyoma of Ⅰ group and Ⅲ group [(2.41 ±1.03)cm3,(2.69 ±0.97)cm3]reduced significantly(P<0.05).FSH,LH,E2 and P in blood of Ⅰgroup reduced significantly(P<0.05),which inⅡgroup and Ⅲ group had no statistically significant differences between before and after treatment ( all P >0.05 ) . Conclusion Mifepristone combined with cassia tuckahoe capsule in treatment of patients with hysteromyoma is better than those only using mifepristone or cassia tuckahoe capsule .This combination therapy is indicated for preoperative medication or perimenopausal patients for conservative treatment of hysteromyoma .

Objective To study the impacts of different tube voltage and different noise index(NI) guided automatic tube current modulation on the image quality and radiation dose in cerebrovascular imaging and determine the optimal scanning condition. Methods PH3 angiographic CT head phantom was used for head CTA examination. Scanning protocols: all the scanning objectives were divided into three groups according to the different tube voltages of 80, 100 and 120 kV. Each group applied certain tube current(300,400 mA)and automatic tube current modulation technique with NI from 3 to 10 to perform head CTA. There were 30 scanning proposals with different parameter combinations of tube voltage and tube current. The radiation dose [ CT dose index volume (CTDIvol), dose length product (DLP) and effective dose (ED)], objective indicators of images(CT value of the blood vessels and its noise, CT value of brain tissue and its noise, signal-to-noise ratio , contrast-to-noise ratio) and the subjective scores of the five cerebrovascular segments were recorded. Differences of CT value of the blood vessels and its noise, CT value of brain tissue and its noise, signal-to-noise ratio and contrast-to-noise ratio between different tube voltages and tube currents were analyzed by One-Way ANOVA. Results When the tube voltage was certain, the CTDIvol, DLP and ED were all dropped while NI was increased from 3 to 10. Compared with group(120 kV, 300 mA), CTDIvol of group with 100 kV, 300 mA decreased 35.32%(12.22/34.59), CTDIvol of group(100 kV, NI=6) decreased 46.72%(16.16/34.59). Compared with group(100 kV, 300 mA), CTDIvol of group (100 kV, NI=6) decreased 17.61%(3.94/22.37). When the tube voltage was certain and the tube current and NI were not certain, there is no statistical difference (P>0.05) between CT values of blood vessel and brain, while blood vessel noise, noise of brain, SNR and CNR showed statistical difference (P<0.05). When tube current and NI were certain while tube voltage was varied, all objective indicators discussed above all exhibited statistical difference (P<0.05). SNR and CNR of group(100 kV, NI=6) were higher than group(120 kV, 300 mA) with 6.31%(2.69/42.66)and 7.18%(2.64/36.78), respectively. The tube voltage, NI and tube current had no effect on the subjective scores of first and second grade vessel but greater impact on the fourth and fifth grade vessel. Conclusion In the head CTA scanning, combined the use of NI 6 guided automatic adjustment tube current and low tube voltage(100 kV)technique not only can get better image quality but also significantly decreased the radiation dose.

Objective To study the impacts of different tube voltage and different noise index(NI) guided automatic tube current modulation on the image quality and radiation dose in cerebrovascular imaging and determine the optimal scanning condition. Methods PH3 angiographic CT head phantom was used for head CTA examination. Scanning protocols: all the scanning objectives were divided into three groups according to the different tube voltages of 80, 100 and 120 kV. Each group applied certain tube current(300,400 mA)and automatic tube current modulation technique with NI from 3 to 10 to perform head CTA. There were 30 scanning proposals with different parameter combinations of tube voltage and tube current. The radiation dose [ CT dose index volume (CTDIvol), dose length product (DLP) and effective dose (ED)], objective indicators of images(CT value of the blood vessels and its noise, CT value of brain tissue and its noise, signal-to-noise ratio , contrast-to-noise ratio) and the subjective scores of the five cerebrovascular segments were recorded. Differences of CT value of the blood vessels and its noise, CT value of brain tissue and its noise, signal-to-noise ratio and contrast-to-noise ratio between different tube voltages and tube currents were analyzed by One-Way ANOVA. Results When the tube voltage was certain, the CTDIvol, DLP and ED were all dropped while NI was increased from 3 to 10. Compared with group(120 kV, 300 mA), CTDIvol of group with 100 kV, 300 mA decreased 35.32%(12.22/34.59), CTDIvol of group(100 kV, NI=6) decreased 46.72%(16.16/34.59). Compared with group(100 kV, 300 mA), CTDIvol of group (100 kV, NI=6) decreased 17.61%(3.94/22.37). When the tube voltage was certain and the tube current and NI were not certain, there is no statistical difference (P>0.05) between CT values of blood vessel and brain, while blood vessel noise, noise of brain, SNR and CNR showed statistical difference (P<0.05). When tube current and NI were certain while tube voltage was varied, all objective indicators discussed above all exhibited statistical difference (P<0.05). SNR and CNR of group(100 kV, NI=6) were higher than group(120 kV, 300 mA) with 6.31%(2.69/42.66)and 7.18%(2.64/36.78), respectively. The tube voltage, NI and tube current had no effect on the subjective scores of first and second grade vessel but greater impact on the fourth and fifth grade vessel. Conclusion In the head CTA scanning, combined the use of NI 6 guided automatic adjustment tube current and low tube voltage(100 kV)technique not only can get better image quality but also significantly decreased the radiation dose.