OBJECTIVE To investigate the incidence of hospital-associated infections among the neurosurgery de-partment patients undergoing brain tumor resection and analyze the economic cost so as to provide scientific bases for formulating prevention strategies.METHODS Totally 1027 patients who underwent brain tumor resection in neurosurgery department of the First Affiliated Hospital of Shandong First Medical University from Jan.1,2020 to Dec.31,2024 were recruited as the research subjects.The 36 patients who had postoperative hos-pital-associated infections were assigned as the infection group,and 991 patients who did not have hospital-associ-ated infection were assigned as the no infection group.The patients of the infection group and the non-infection group were matched in a 1∶1 ratio by using propensity score matching method(caliper value 0.005).The length of hospital stay and costs of medical items were compared between the infection group and the non-infection group,and the economic burden due to the hospital-associated infections was estimated.RESULTS The incidence of hospital-associated infections was 3.51％among the patients undergoing brain tumor resection,and totally 36 pairs were matched successfully with the propensity score.The hospitalization cost of the infection group was 109,103.81(73,370.21,163,628.37)yuan after the matching,which was increased by 50,087.69 yuan as com-pared with the non-infection group(Z=-5.237,P＜0.001);the length of hospital stay was 23.00(17.25,36.00)days,which was prolonged by 8.50 days(Z=-3.764,P＜0.001).Among the costs of medical items,the medial costs of western medicine,treatment materials and clinical laboratory tests increased most.CONCLUSIONS The control of the costs of western medicine,treatment materials and clinical laboratory tests is the key to reduce the costs of brain tumor resection patients with hospital-associated infections.It is necessary to carry out the real-time monitoring of the hospital-associated infections and early warning of suspected cases and reduce the incidence of hospital-associated infections so as to reduce the economic costs.

OBJECTIVE To analyze the clinical data of the immunocompromised patients complicated with Pneumo-cystis jirovecii pneumonia(PJP)and explore the values of G test and lymphocyte subsets in diagnosis of the PJP in the immunocompromised patients.METHODS A total of 78 immunocompromised patients who were treated in respiratory intensive care unit of the First Affiliated Hospital of Shandong First Medical University from Jan.2019 to Dec.2021 wee recruited as the research subjects,39 of whom had PJP and were assigned as the PJP group,39 did not have PJP and were assigned as the non-PJP group.The clinical data were compared between the two groups.The values of the clinical laboratory test indexes in diagnosis of PJP in the immunocompromised patients were analyzed by means of receiver operating characteristic(ROC)curves.RESULTS The mortality rate of the PJP group was higher than that of the non-PJP group(P＜0.05).There were significant differences in the white blood cell(WBC)counts,neutrophils(Neu)counts,platelet distribution width(PDW),procalcitonin(PCT),C-reac-tive protein(CRP)and GM test between the PJP group and the non-PJP group;the G test was(1843.59±1621.41)pg/ml in the PJP group,(87.15±111.01)pg/ml in the non-PJP group;the percentage of CD8 lympho-cyte was(36.22±19.34)％in the PJP group,(25.99±13.10)％in the non-PJP group,and there were significant differences(P＜0.05).The areas under the curves(AUCs)of the G test and the percentage of CD8 lymphocyte were respectively 0.981 and 0.714 in diagnosis of PJP in the immunocompromised patients,and the cutoff values were 368.40 pg/ml and 31.30％,respectively.CONCLUSIONS It is necessary for the clinicians to pay great attention to the high mortality rate of the immunocompromised patients complicated with severe pneumonia.The G test and the percentage of CD8 lymphocyte have certain values in diagnosis of PJP in the immunocompromised patients.

Objective:To investigate the efficacy of anatomical resection (AR) in the early stages of treating solitary hepatocellular carcinoma (HCC) combined with liver cirrhosis with a diameter of ≤5 cm in comparison to different surgical methods of preferential hepatic parenchymal preservation (non-anatomical liver resection, NAR).Methods:The clinical data of 1 390 cases with solitary HCC combined with liver cirrhosis at an early stage who underwent liver resection at Mengchao Hepatobiliary Hospital of Fujian Medical University and six other medical centers from September 2013 to May 2019 were retrospectively analyzed. Patients were divided into the AR group (486 cases) and the NAR group (904 cases) and the wide surgical margin (WSM) group (745 cases) and the narrow surgical margin (NSM) group (645 cases) according to whether they received AR and the width of the surgical margin (1 cm). The basic information of the patients, preoperative evaluation index data, and postoperative follow-up (follow-up every 3 months) were collected. The Kaplan-Meier method was used to plot the survival curve.The log-rank test was used to compare the difference in survival between the two groups. The Cox proportional hazards regression model was used to analyze the factors affecting the prognosis. Propensity score matching (PSM) was applied to reduce intergroup bias.Results:The overall survival (OS) rates for all patients at 1, 3, and 5 years were 95.5%, 79.9%, and 63.5%, respectively. The recurrence-free survival (RFS) rates were 81.5%, 59.0%, and 43.7%, respectively. There was a statistically significant difference in RFS rate between the AR group and the NAR group prior to PSM, but no statistically significant difference in OS rate (RFS rate: 47.0% vs. 41.9%, P<0.05; OS rate: 64.4% vs. 62.9%, P>0.05). The postoperative RFS rate and OS rate were significantly superior in the WSM group than those of the NSM group (RFS rate: 47.8% vs. 37.2%, P<0.001; OS rate: 69.0% vs. 57.3%, P<0.001). There was no statistically significant difference in OS rate and RFS rate between the AR group and the NAR group following PSM (RFS: 46.3% vs. 45.1%, P>0.05; OS rate: 64.0% vs. 64.3%, P>0.05).The 5-year OS and RFS rates in the WSM group were 66.8% and 60.2%, respectively. The 5-year OS and RFS rates for the NSM group were 48.7% and 41.4%, respectively, with a statistically significant difference ( P<0.05). Cox multivariate analysis indicated that serum albumin, tumor diameter, microvascular invasion, and surgical margin were independent prognostic factors affecting OS and RFS. The Child-Pugh grade and satellite lesions were independent prognostic factors affecting OS. Conclusion:Anatomical liver resection is not an independent risk factor for prognosis, but the state of the resection margin determines the prognosis of patients with solitary HCC combined with cirrhosis. Therefore, hepatic resection margins should be prioritized in such patients.

Objective:To investigate the efficacy of anatomical resection (AR) in the early stages of treating solitary hepatocellular carcinoma (HCC) combined with liver cirrhosis with a diameter of ≤5 cm in comparison to different surgical methods of preferential hepatic parenchymal preservation (non-anatomical liver resection, NAR).Methods:The clinical data of 1 390 cases with solitary HCC combined with liver cirrhosis at an early stage who underwent liver resection at Mengchao Hepatobiliary Hospital of Fujian Medical University and six other medical centers from September 2013 to May 2019 were retrospectively analyzed. Patients were divided into the AR group (486 cases) and the NAR group (904 cases) and the wide surgical margin (WSM) group (745 cases) and the narrow surgical margin (NSM) group (645 cases) according to whether they received AR and the width of the surgical margin (1 cm). The basic information of the patients, preoperative evaluation index data, and postoperative follow-up (follow-up every 3 months) were collected. The Kaplan-Meier method was used to plot the survival curve.The log-rank test was used to compare the difference in survival between the two groups. The Cox proportional hazards regression model was used to analyze the factors affecting the prognosis. Propensity score matching (PSM) was applied to reduce intergroup bias.Results:The overall survival (OS) rates for all patients at 1, 3, and 5 years were 95.5%, 79.9%, and 63.5%, respectively. The recurrence-free survival (RFS) rates were 81.5%, 59.0%, and 43.7%, respectively. There was a statistically significant difference in RFS rate between the AR group and the NAR group prior to PSM, but no statistically significant difference in OS rate (RFS rate: 47.0% vs. 41.9%, P<0.05; OS rate: 64.4% vs. 62.9%, P>0.05). The postoperative RFS rate and OS rate were significantly superior in the WSM group than those of the NSM group (RFS rate: 47.8% vs. 37.2%, P<0.001; OS rate: 69.0% vs. 57.3%, P<0.001). There was no statistically significant difference in OS rate and RFS rate between the AR group and the NAR group following PSM (RFS: 46.3% vs. 45.1%, P>0.05; OS rate: 64.0% vs. 64.3%, P>0.05).The 5-year OS and RFS rates in the WSM group were 66.8% and 60.2%, respectively. The 5-year OS and RFS rates for the NSM group were 48.7% and 41.4%, respectively, with a statistically significant difference ( P<0.05). Cox multivariate analysis indicated that serum albumin, tumor diameter, microvascular invasion, and surgical margin were independent prognostic factors affecting OS and RFS. The Child-Pugh grade and satellite lesions were independent prognostic factors affecting OS. Conclusion:Anatomical liver resection is not an independent risk factor for prognosis, but the state of the resection margin determines the prognosis of patients with solitary HCC combined with cirrhosis. Therefore, hepatic resection margins should be prioritized in such patients.

OBJECTIVE To investigate the incidence of hospital-associated infections among the neurosurgery de-partment patients undergoing brain tumor resection and analyze the economic cost so as to provide scientific bases for formulating prevention strategies.METHODS Totally 1027 patients who underwent brain tumor resection in neurosurgery department of the First Affiliated Hospital of Shandong First Medical University from Jan.1,2020 to Dec.31,2024 were recruited as the research subjects.The 36 patients who had postoperative hos-pital-associated infections were assigned as the infection group,and 991 patients who did not have hospital-associ-ated infection were assigned as the no infection group.The patients of the infection group and the non-infection group were matched in a 1∶1 ratio by using propensity score matching method(caliper value 0.005).The length of hospital stay and costs of medical items were compared between the infection group and the non-infection group,and the economic burden due to the hospital-associated infections was estimated.RESULTS The incidence of hospital-associated infections was 3.51％among the patients undergoing brain tumor resection,and totally 36 pairs were matched successfully with the propensity score.The hospitalization cost of the infection group was 109,103.81(73,370.21,163,628.37)yuan after the matching,which was increased by 50,087.69 yuan as com-pared with the non-infection group(Z=-5.237,P＜0.001);the length of hospital stay was 23.00(17.25,36.00)days,which was prolonged by 8.50 days(Z=-3.764,P＜0.001).Among the costs of medical items,the medial costs of western medicine,treatment materials and clinical laboratory tests increased most.CONCLUSIONS The control of the costs of western medicine,treatment materials and clinical laboratory tests is the key to reduce the costs of brain tumor resection patients with hospital-associated infections.It is necessary to carry out the real-time monitoring of the hospital-associated infections and early warning of suspected cases and reduce the incidence of hospital-associated infections so as to reduce the economic costs.

Objective To investigate and analyze the epidemiological characteristics and the causes of a suspected outbreak of carbapenem-resistant Acinetobacter baumannii(CRAB)infection,and provide basis for healthcare-asso-ciated infection(HAI)prevention and control.Methods Information of 3 patients with CRAB positive culture from the respiratory intensive care unit(RICU)of a hospital in May 2024 was collected.Microbiological sampling was performed in patients' ward environment,and the specimens were cultured and strains were identified.CRAB strains detected from the environment and patients were performed whole genome sequencing(WGS).Multiple de-partments jointly formulated and implemented comprehensive infection control measures,and the effectiveness were evaluated.Results CRAB was cultured from specimens of sputum and bedside office mice of 3 patients.WGS de-tection showed that ST2158 and ST1791 resistance genes were detected from both sputum and bedside office mice of 2 patients.After comprehensive assessment,2 patients were confirmed with HAI and 1 patient was confirmed with colonization,ruling out an outbreak of HAI.A total of 24 environmental specimens were taken for environmental hygiene monitoring,with a CRAB detection rate of 58.33％.CRAB detected from bedside mice and patients' spu-tum specimen had consistent CRAB drug susceptibility testing results.After implementing measures such as in-creasing the frequency of cleaning and disinfection of ward environment,strengthening the implementation of hand hygiene,and enhancing the supervision of department personnel as well as HAI prevention and control training,HAI was effectively controlled.Conclusion The possible transmission route of this suspected CRAB outbreak in RICU is the contamination of office mice,which caused healthcare workers carrying CRAB in their hands,leading to cross infection due to poor hand hygiene implementation of healthcare workers.Strengthening the cleaning and dis-infection of environmental surface and the management of hand hygiene of healthcare workers are key measures to prevent CRAB HAI.

OBJECTIVE To analyze the clinical data of the immunocompromised patients complicated with Pneumo-cystis jirovecii pneumonia(PJP)and explore the values of G test and lymphocyte subsets in diagnosis of the PJP in the immunocompromised patients.METHODS A total of 78 immunocompromised patients who were treated in respiratory intensive care unit of the First Affiliated Hospital of Shandong First Medical University from Jan.2019 to Dec.2021 wee recruited as the research subjects,39 of whom had PJP and were assigned as the PJP group,39 did not have PJP and were assigned as the non-PJP group.The clinical data were compared between the two groups.The values of the clinical laboratory test indexes in diagnosis of PJP in the immunocompromised patients were analyzed by means of receiver operating characteristic(ROC)curves.RESULTS The mortality rate of the PJP group was higher than that of the non-PJP group(P＜0.05).There were significant differences in the white blood cell(WBC)counts,neutrophils(Neu)counts,platelet distribution width(PDW),procalcitonin(PCT),C-reac-tive protein(CRP)and GM test between the PJP group and the non-PJP group;the G test was(1843.59±1621.41)pg/ml in the PJP group,(87.15±111.01)pg/ml in the non-PJP group;the percentage of CD8 lympho-cyte was(36.22±19.34)％in the PJP group,(25.99±13.10)％in the non-PJP group,and there were significant differences(P＜0.05).The areas under the curves(AUCs)of the G test and the percentage of CD8 lymphocyte were respectively 0.981 and 0.714 in diagnosis of PJP in the immunocompromised patients,and the cutoff values were 368.40 pg/ml and 31.30％,respectively.CONCLUSIONS It is necessary for the clinicians to pay great attention to the high mortality rate of the immunocompromised patients complicated with severe pneumonia.The G test and the percentage of CD8 lymphocyte have certain values in diagnosis of PJP in the immunocompromised patients.

Objective To investigate and analyze the epidemiological characteristics and the causes of a suspected outbreak of carbapenem-resistant Acinetobacter baumannii(CRAB)infection,and provide basis for healthcare-asso-ciated infection(HAI)prevention and control.Methods Information of 3 patients with CRAB positive culture from the respiratory intensive care unit(RICU)of a hospital in May 2024 was collected.Microbiological sampling was performed in patients' ward environment,and the specimens were cultured and strains were identified.CRAB strains detected from the environment and patients were performed whole genome sequencing(WGS).Multiple de-partments jointly formulated and implemented comprehensive infection control measures,and the effectiveness were evaluated.Results CRAB was cultured from specimens of sputum and bedside office mice of 3 patients.WGS de-tection showed that ST2158 and ST1791 resistance genes were detected from both sputum and bedside office mice of 2 patients.After comprehensive assessment,2 patients were confirmed with HAI and 1 patient was confirmed with colonization,ruling out an outbreak of HAI.A total of 24 environmental specimens were taken for environmental hygiene monitoring,with a CRAB detection rate of 58.33％.CRAB detected from bedside mice and patients' spu-tum specimen had consistent CRAB drug susceptibility testing results.After implementing measures such as in-creasing the frequency of cleaning and disinfection of ward environment,strengthening the implementation of hand hygiene,and enhancing the supervision of department personnel as well as HAI prevention and control training,HAI was effectively controlled.Conclusion The possible transmission route of this suspected CRAB outbreak in RICU is the contamination of office mice,which caused healthcare workers carrying CRAB in their hands,leading to cross infection due to poor hand hygiene implementation of healthcare workers.Strengthening the cleaning and dis-infection of environmental surface and the management of hand hygiene of healthcare workers are key measures to prevent CRAB HAI.

Objective:Immune checkpoint inhibitors have a high remission rate in the preoperative application of resectable and potentially resectable non-small cell lung cancer when combined with chemotherapy. For the unresectable stage Ⅲ non-small cell lung cancer, whether the transformation can be achieved through this regimen to provide opportunities for surgical resection is controversial. In this study, we evaluated the pattern of transformation therapy by reviewing the efficacy and safety of preoperative therapy and surgery of this group.Methods:A review of 23 patients undergoing surgical resection after transformation therapy by preoperative immunotherapy combined chemotherapy between November 2019 and November 2021 was performed. All patients must clarify the pathological diagnosis of non-small cell lung cancer by biopsy. After the multi-disciplinary treatment team and preoperative imaging assessment, the diagnosis should be consistent with unresectable stage III as described in the Expert Consensus on Multidisciplinary Management of Stage Ⅲ Non-Small Cell Lung Cancer, 2019 Edition. After 2 to 4 cycles of preoperative anti-PD-1 monoclonal antibody combined with chemotherapy, the surgical team assessed the chance of resection and performed surgery. Important indicators such as surgical resection rate, R0 resection rate, MPR, pCR, incidence of grade 3-5 adverse reactions and various other perioperative data were counted.Results:In the whole group, initial imaging evaluation was 10 of stage cⅢA and 13 of stage cⅢB.15 cases had multiple stations N2 lymph nodes metastasis, 9 had enlarged fused N2 lymph nodes metastasis, 6 had large vessel invasion(T4), and 1 had contralateral mediastinal lymph node metastasis(N3). After preoperative neoadjuvant therapy, 17 cases achieved PR, 3 achieved SD and 3 achieved PD. The surgical resection rate of the whole group was 91.3%(21/23, 1 lobectomy combined with superior vena cava reconstruction, 2 sleeve lobectomy, 5 pneumonectomy, 12 lobectomy/combined lobectomy, 1 wedge resection and 2 unresectable cases), R0 resection rate was 95.2%(20/21). MPR was achieved in 13 cases, 8 of them reached pCR. There were no perioperative deaths, median surgical time was 260(190-460) min, median bleeding volume was 100(50-750) ml, median drainage time was 5(3-9) days, and median hospitalization was 7(5-11) days. Two cases got immunotherapy-related grade 3 adverse reactions, one was interstitial pneumonia and the other was immune-related injury involving the eye, oral and genital mucosa. Two cases got surgical complications and one was persistent lung leakage, which stopped after 46 days of conservative treatment; The other was pleural effusion, which was relieved after drainage.Conclusion:For the unresectable stage Ⅲ NSCLC, immunotherapy combined chemotherapy is an effective preoperative downstage method. It can convert 91.3% cases to resectable ones while achieving a good degree of pathological remission. Its side reactions are generally controllable and safety.

Objective To establish and assess the new method of APTT assay based on the combinations of Mg2+and Ca2+for lupus anticoagulants(LA)measurements.Methods This prospective study included 309 trisodium citrate anticoagulated plasma samples from 244 random patients and 65 patients with different autoimmune diseases(AID)to establish and assess the method of LA measurement, respectively.Final concentrations of 0,2.0, 4.0, 8.0,16.0 mmol/L Mg2+were added into 25 mmol/L Ca2+solution, and Actin reagent was used to measured plasma APTT of 94 patients.The applied concentration of Mg2+-Ca2+solution was confirmed through the special and significant alteration of APTT from LA-positive and -negative plasma observed in the presence of Mg 2+(test solution).Based on Actin reagent use,the test solution and 25 mmol/L Ca2+solution were applied to measure APTT of patients and normal individuals, respectively, and the ratio of Mg2+-Ca2+-APTT to Ca2+-APTT(Mg2+-Ca2+-APTT indices)and normalized Mg2+-Ca2+-APTT indices(NAR)were calculated, respectively.Mixed plasma NAR was measured,and CV%was calculated to evaluate the repeatability and stability of Mg 2+-Ca2+-APTT method.APTT of 150 patients was measured with the test solution and Actin reagent to calculate Mg 2+-Ca2+-APTT indices, and normalized LA ratio was determined with dRVVT method.The applicability of Mg2+-Ca2+-APTT assay was assessed through comparisons of the results from the two methods.Finally, NAR and NLR of 65 patients with AID(including 26 SLE patients)were measured with Mg2+-Ca2+-APTT assay and dRVVT method, respectively, and ROC curve was also used to assess the efficacy of the two methods for LA measurements.Results In all LA-negative plasma,APTT increased from 28.1 ±4.5 s to 61.2 ±7.9 s in normal APTT group,47.2 ±8.9 s to 97.5 ±10.3 s in increased APTT group,and 27.6 ± 5.1 s to 61.2 ±7.9 s in ACA-positive group when Mg2+increased from 0 to 8 mmol/L in Mg2+-Ca2+solution(F=34.12, 38.9 and 28.35,P<0.01).Following increased Mg2+concentration, APTT shortened from 0 to 4.0 mmol/L, but simultaneously prolonged from 4.0 to 16.0 mmol/L in LA-positive plasma with prolonged or normal APTT(F=31.55 and 39.51, P<0.01), and APTT was significantly higher in 8.0 mmol/L than that in 4.0 mmol/L(P<0.001).The test concentration of Mg 2+/Ca2+solution was 4.0 mmol/L.The within, inter-day CV% of NAR was 1.39%,2.30%, and 3.44%, respectively. According to the judging criteria of <0.966 and >1.034 of Mg2+/Ca2+indices, there was 141 patients with increased indices and NLR <1.20, and 9 patients with decreased ones and NLR≥1.20 in all 150 patients.The area under ROC curve of NAR and NLR for LA detection was 0.913(95%CI:0.848-0.978) and 0.892(95%CI:0.817-0.966), respectively, and the cut-off value was 0.87 and 1.13, respectively. The sensitivity and specificity of NAR(85% and 77%)was higher than that of NLR(81% and 74%), respectively.The accordant rate of positive,negative,and total results between NAR and NLR was 94.4%, 98.5%,and 98%,respectively.Conclusion The method of APTT assay based on Mg2+combining Ca2+for LA measurements is feasible,and can be used to detect plasma LA of patients.