Objective Objective To analyze the potential spatial factors affecting the genetic differentiation of Oncomelania hupensis robertsoni in Yunnan Province. Methods A total of 13 administrative villages were selected from schistosomiasis-endemic areas of Yunnan Province as O. hupensis snail sampling sites. At least 200 snails were collected in each site, and the spatial variable data of each site were recorded, including longitude, latitude and altitude. Thirty active and Schistosoma japonicum uninfected O. hupensis snails were selected from each sampling site by means of the crawling method and the cercarial shedding method. Genomic DNA was extracted from O. hupensis snails. Following PCR amplification, purification of PCR amplification products and sequencing, the gene sequences of O. hupensis snail samples were spliced and edited using the DNAstar software and the NCBI database to yield the complete mitochondrial sequences of O. hupensis snails at each sampling site, and the mitochondrial genetic distance matrix of O. hupensis robertsoni was calculated at each sampling site. The geographical coordinates of each sampling site were marked using the software ArcGIS 10.2, and the straight-line geographical distance between each sampling site was calculated. The altitude difference, longitude difference and latitude difference between each sampling site were calculated using the Excel software, and the correlation between the mitochondrial genetic distance matrix of O. hupensis robertsoni and each spatial variable matrix was examined by using the Mantel test at 13 sampling sites in Yunnan Province. Results Among the 13 O. hupensis snail sampling sites in Yunnan Province, the largest mitochondrial genetic distance of O. hupensis robertsoni snail populations was seen between Anding Village, Nanjian Yi Autonomous County and Caizhuang Village, Midu County (26.244 2), and the largest geographical distance was seen between Dongyuan Village, Gucheng District and Cangling Village, Chuxiong County (272.64 km). The highest altitude difference was seen between Anding Village, Nanjian Yi Autonomous County and Dongyuan Village, Gucheng District (1 086.10 m), and the largest longitude difference was found between Qiandian Village, Eryuan County and Cangling Village, Chuxiong County (1.86°), while the largest latitude difference was measured between Leqiu Village, Nanjian Yi Autonomous County and Dongyuan Village, Gucheng District (1.81°). In addition, the mitochondrial genetic distance of O. hupensis robertsoni snail populations was positively correlated with altitude at 13 snail sampling sites in Yunnan Province (r = 0.542 8, P < 0.001), and showed no significant correlations with geographical distance (r = 0.093 4, P > 0.05), longitude (r = −0.199 5, P > 0.05) or latitude (r = 0.205 7, P > 0.05). Conclusion Altitude may be a potential spatial factor affecting the genetic differentiation of O. hupensis robertsoni in Yunnan Province.

Objective: To investigate the correlation between peripheral blood CD4 T lymphocyte subsets and delayed graft function (DGF) and short-term prognosis in kidney transplant recipients, so as to help optimize preoperative assessment for kidney transplantation and provide insights into the immune mechanisms of DGF. Methods: A retrospective analysis was conducted on the clinical data of 103 kidney transplant recipients at the First Affiliated Hospital of Soochow University during Jun.2022 and Oct.2023. A total of 61 recipients were finally included in this study, and were categorized into two groups based on postoperative renal function recovery：the DGF group (n=20) and the immediate graft function (IGF) group (n=41).Flow cytometry was used to detect the proportions and absolute counts of various CD4 T lymphocyte subsets in the peripheral blood on postoperative day 7.The clinical data and peripheral blood lymphocyte subsets between the two groups were compared.For the subsets that exhibited significant differences, the correlation between their proportions and absolute counts and serum creatinine (Scr) levels on postoperative day 7 was further analyzed in the DGF group.Receiver operating characteristic (ROC) curves were plotted, and the area under the curve (AUC) was calculated to evaluate the predictive performance of the most strongly correlated CD4 T lymphocyte subset in terms of proportion and absolute count for short-term renal function. Results: There were no statistically significant differences in the proportions and absolute counts of Th1, Th2, Th17, and regulatory T cells (Treg) between the DGF and IGF groups (P>0.05).The proportions and absolute counts of follicular helper T cells (Tfh) and PD-1 Tfh cells were significantly higher in the DGF group than in the IGF group (P＜0.000 1). The Scr levels at 1 month and 1 year postoperatively were significantly higher in the DGF group than in the IGF group (P＜0.01), while the estimated glomerular filtration rate (eGFR) was significantly lower in the DGF group compared with the IGF group (P＜0.01, P=0.02).Spearman correlation analysis showed that the proportions and absolute counts of Tfh and PD-1 Tfh cell subsets were positively correlated with the Scr level on post-operative day 7 in the DGF group (P＜0.05).The ROC curve demonstrated that the AUC for the proportion of PD-1 Tfh cells in predicting Scr and eGFR at 1 month after surgery was 0.73(95%CI:0.61-0.86) and 0.75 (95%CI:0.62-0.88), respectively.Additionally, the AUC for predicting Scr and eGFR at 1 year was 0.72(95%CI:0.59-0.86) and 0.70(95%CI:0.58-0.83), respectively. Conclusion: The increase in the proportions and absolute counts of Tfh and PD-1 Tfh cells is associated with postoperative DGF of renal transplant recipients, and the proportion of PD-1 Tfh cells may help predict the short-term renal function of recipients.

Objective:To determine the correlation between serum soluble CD146 (sCD146) levels and disease activity in patients with systemic vasculitis and the potential of sCD146 as a novel biomarker.Methods:We recruited 304 patients from the systemic vasculitis cohort at Peking Union Medical College Hospital from July 2013 to December 2022. The cohort comprised 200 patients with Takayasu arteritis (TAK) and 104 with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). The patient′s demographic and clinical data, including age, sex, disease duration, disease type, laboratory results, and disease status, were extracted from the database. The serum sCD146 concentration was measured using a sandwich enzyme-linked immunosorbent assay (ELISA). Continuous variables were presented as mean±standard deviation if normally distributed, with between-group comparisons conducted using the t-test. For non-normally distributed data, median ( Q1, Q3) was used, and comparisons between groups were performed using the Mann-Whitney U test. Categorical data were expressed as percentages, and comparisons between groups were conducted using the Chi-square test or Fisher′s exact test,as appropriate. Kendall′s tau-b′s rank correlation coefficient was calculated to evaluate the correlation between sCD146 and variables associated with systemic vasculitis. A two-sided P value <0.05 was considered statistically significant. Results:Serum sCD146 levels were significantly lower in patients with active disease compared to those in remission in both cohorts [TAK: 246 (218, 287) vs. 277 (230, 322) μg/L, Z=-2.58, P=0.010; AAV: (301±90) vs. (344±81) μg/L, t=-2.56, P=0.007]. Serum sCD146 levels were positively correlated with age and disease duration (TAK: τ=0.09, 0.12, P=0.040, P=0.009; AAV: τ=0.28, 0.15, P<0.001, P=0.020). In patients with TAK, sCD146 levels were negatively correlated with IL-6, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and disease activity status ( τ=-0.17, -0.18, -0.16, -0.16; P=0.001, P<0.001, P=0.003, P=0.010). In patients with AAV, sCD146 levels were negatively correlated with platelet count (PLT),disease activity status,and the Birmingham Vasculitis Activity Score ( τ=-0.36, -0.27, -0.27; P<0.001, P=0.007, P=0.001). Conclusion:Serum sCD146 levels were significantly lower in patients with active systemic vasculitis than in remission, displaying a negative correlation with disease activity. These findings suggest that sCD146 has potential as a novel biomarker for assessing disease activity in systemic vasculitis.

Objective To analyze the effects of erector spinae plane block(ESPB)on postoperative analgesic consumption,visual analog scale(VAS)pain scores,and postoperative nausea and vomiting(PONV)in breast cancer patients,and to evaluate its advantages and disadvantages compared to general anesthesia(GA),thoracic paravertebral block(TPVB),and pectoral nerve block(PECS),providing a systematic review of its clinical application.Methods We searched English databases including PubMed,Embase,Scopus,Cochrane Library,and Web of Science,as well as Chinese databases such as CNKI,Wanfang,and Weipu,including randomized controlled trials.The Cochrane bias risk assessment tool was used for bias risk evaluation,and RevMan 3.5 software was utilized for meta-analysis.Results A total of 31 randomized controlled trials involving 2296 patients were included.The meta-analysis results indicated that the morphine consumption in the ESPB group was lower than that in the GA group at 24 hours postoperative(MD-17.57,95％CI-23.99 to-11.14,P＜0.05).VAS scores at 2,6,12,and 24 hours postoperative were also lower in the ESPB group compared to the GA group(P＜0.05),and the incidence of PONV in patients was reduced(RR 0.57,95％CI 0.47 to 0.69,P＜0.05),with all differences being statistically significant.No statistically significant differences were found in morphine consumption at 24 hours postoperative between the ESPB and TPVB groups,nor in VAS scores at 2,12,and 24 hours postoperative,and the number of PONV cases showed no statistically significant difference.The morphine consumption in the PECS group at 24 hours postoperative was lower than that in the ESPB group(MD 10.94,95％CI 4.40 to 17.48,P＜0.05),and the VAS score at 12 hours postoperative in the PECS group was lower than that in the ESPB group(MD 0.59,95％CI 0.19 to 0.99,P＜0.05),indicating statistical significance,while no significant differences were observed at other time points.Conclusions The analgesic effect of the ESPB group is superior to that of the GA group and similar to that of the TPVB group,but inferior to that of the PECS group.Compared to the GA group,ESPB significantly reduces the incidence of postoperative PONV,showing similarity with the TPVB and PECS groups.

OBJECTIVE T o carry out the health economics evaluation and cost-benefit analysis of the type b Hae-mophilus influenzae(Hib)vaccination for the children who were hospitalized due to Hib infection so as to provide evidence for public health policies.METHODS The children who were diagnosed with Hib-related respiratory tract infections or meningitis and were hospitalized in respiratory medicine department,infection management depart-ment,emergency rooms and neurology department of Jiangxi Provincial Children's Hospital from Jan.1,2021 to Dec.31,2023 were recruited as the research subjects.Based on a 1∶1 matching condition,the matching variables included four items such as the same age for the admission to the hospital,same gender,same department and same grade of disease severity.The children for whom the primary immunization of Hib vaccination(including Hib monovalent vaccine and Hib-containing combination vaccine)were completed and the integrity of vaccination infor-mation could be checked out were assigned as the intervention group,while the children for whom the primary im-munization of Hib vaccination was not completed were chosen as the control group.The clinical data,vaccination data and the data such as length of hospital stay and hospitalization cost were collected from the children.The cost-benefit of the Hib vaccination among the children with Hib infection was observed.RESULTS A total of 622 hospi-talized children who were detected with Hib-positive respiratory tract infections or meningitis were enrolled in the study,and 73 children(20 children from infection management department,27 children from respiratory medi-cine department,26 children from emergency rooms)were finally included in the intervention group after matc-hing and multiple rounds of screening,73 children were chosen as the control group based on a 1∶1 matching con-dition.The male children accounted for 57.53％(42 cases)in both groups,and the female children accounted for 42.47％(31 cases)in both groups.With the respect to the length of hospital stay,it was 7.00(5.00,8.00)days in the intervention group,7.00(6.00,8.00)days in the control group(Z=-0.341,P=0.733).In terms of the hospitalization cost,it was 7 756.17(6 617.92,10 617.69)yuan in the intervention group,9 040.65(8 033.76,10 935.84)yuan in the control group(Z=-2.795,P=0.005).The cost of Hib vaccination was 343.03 yuan per capita in the intervention group,and the benefit-cost ratio(BCR)was 1∶3.74(343.03 yuan/1 284.48 yuan).CONCLUSIONS The Hib vaccination can save the hospitalization cost and has high cost effectiveness.It is sugges-ted that the Hib vaccination should be promoted and the coverage rate of Hib vaccination should be raised among the age-eligible children.

Objective To explore the influencing factors of readmission within 90 days in frail patients with chronic obstructive pulmonary disease(COPD),construct an early warning model and evaluate its discrimination and effectiveness.Methods A total of 831 COPD patients with frailty were included and divided into the readmission group(290 cases)and the control group(541 cases)based on whether they were readmitted within 90 days after discharge.The electronic medical record data were collected and compared between the two groups of patients.Multivariate Logistic regression analysis was used to screen independent influencing factors for readmission within 90 days in COPD weak patients.A predictive model was established.The column chart was drawn.The discriminability of the predictive model was evaluated through receiver operating characteristic(ROC)curves.The clinical practicality and the predictive model calibration were evaluated through decision curves and calibration curves.Results The body mass index(BMI)of the readmission group was lower than that of the non readmission group,and the proportion of acute exacerbation of COPD hospitalizations≥2 times in the past year,the Edmonton frailty scale(REFS)score and the Chalson comorbidity index(CCI)were higher in the readmission group than those of the non readmission group(P＜0.05).Multivariate Logistic regression analysis showed that BMI(OR=0.721,95%CI:0.636-0.818),the number of acute exacerbations of COPD hospitalizations in the past year(OR=3.040,95%CI:1.944-4.753),REFS score(OR=1.726,95%CI:1.486-2.005)and CCI score(OR=3.917,95%CI:3.079-4.983)were all independent influencing factors for readmission within 90 days in COPD frail patients(P＜0.05).Based on the results of multiple factor Logistic regression analysis,the column chart warning model was constructed.The AUC value of the ROC curve was 0.847(95%CI:0.820-0.874),the specificity was 87.20%and the sensitivity was 64.50%.The calibration curve of the predictive model was close to the diagonal,and the calibrationa degree was good.The decision curve suggested that the prediction model had clinical practicality.Conclusion The early warning model constructed based on the influencing factors of readmission hospitalization within 90 days in weak patients with COPD has good predictive effect and clinical practicability.

Objective To explore the influencing factors of readmission within 90 days in frail patients with chronic obstructive pulmonary disease(COPD),construct an early warning model and evaluate its discrimination and effectiveness.Methods A total of 831 COPD patients with frailty were included and divided into the readmission group(290 cases)and the control group(541 cases)based on whether they were readmitted within 90 days after discharge.The electronic medical record data were collected and compared between the two groups of patients.Multivariate Logistic regression analysis was used to screen independent influencing factors for readmission within 90 days in COPD weak patients.A predictive model was established.The column chart was drawn.The discriminability of the predictive model was evaluated through receiver operating characteristic(ROC)curves.The clinical practicality and the predictive model calibration were evaluated through decision curves and calibration curves.Results The body mass index(BMI)of the readmission group was lower than that of the non readmission group,and the proportion of acute exacerbation of COPD hospitalizations≥2 times in the past year,the Edmonton frailty scale(REFS)score and the Chalson comorbidity index(CCI)were higher in the readmission group than those of the non readmission group(P＜0.05).Multivariate Logistic regression analysis showed that BMI(OR=0.721,95%CI:0.636-0.818),the number of acute exacerbations of COPD hospitalizations in the past year(OR=3.040,95%CI:1.944-4.753),REFS score(OR=1.726,95%CI:1.486-2.005)and CCI score(OR=3.917,95%CI:3.079-4.983)were all independent influencing factors for readmission within 90 days in COPD frail patients(P＜0.05).Based on the results of multiple factor Logistic regression analysis,the column chart warning model was constructed.The AUC value of the ROC curve was 0.847(95%CI:0.820-0.874),the specificity was 87.20%and the sensitivity was 64.50%.The calibration curve of the predictive model was close to the diagonal,and the calibrationa degree was good.The decision curve suggested that the prediction model had clinical practicality.Conclusion The early warning model constructed based on the influencing factors of readmission hospitalization within 90 days in weak patients with COPD has good predictive effect and clinical practicability.

Objective This study aimed to evaluate the interaction between antiretroviral drug efavirenz and anti-tuberculosis 1H3P3(isoniazid plus rifapentine)in people living with HIV.Methods HIV-positive individuals on efavirenz-containing(600 mg)antiretroviral therapy(ART)received 1H3P3 regimen containing rifapentine(450 mg)plus isoniazid(400 mg)3 times a week for 1 month.Efavirenz concentrations were measured at weeks 0,2,4,8.Rifapentine concentration was determined at weeks 2 and 4.HIV RNA load was determined at weeks 0 and 8.Treatment target was efavirenz concentration＞1 mg/L.The anti-TB prevention was considered acceptable if the target of efavirenz concentration was achieved in more than 80％of participants.The participants were followed up for 18 months to evaluate the efficacy of treatment.Results Thirty-one participants living with HIV were enrolled in the study.Two participants were excluded from PK analysis because his/her baseline efavirenz concentration＜1 mg/L,suggesting poor treatment adherence.Evaluable PK data were available for 29 participants,including 23(79.3％)males.The median[interquartile range(IQR)]age of the participants was 43.0(32.5,53.5)years.The median(IQR)efavirenz plasma concentration was 2.33(1.96,2.34)mg/L at week 0,2.32(1.90,3.28)mg/L at week 2,2.07(1.83,3.09)mg/L at week 4,and 2.71(2.14,3.33)mg/L at week 8.Efavirenz concentration did not show significant difference between the 4 time points(P＞0.05).Median(IQR)rifapentine concentration was 9.36(6.23,16.47)mg/L at week 2,and 9.36(6.41,15.56)mg/L at week 4.Rifapentine concentration did not show significant difference between week 2 and week 4(P＞0.05).Efavirenz concentrations was＞1 mg/L in all participants at weeks 2,4,and 8.Furthermore,efavirenz concentration was significantly higher in females and patients with body weight＜60 kg compared with males and those with body weight ≥60 kg(P＜0.05).None of the participants had symptoms or signs of active tuberculosis during 18-month follow-up.Conclusions Isoniazid plus rifapentine(1H3P3 regimen)did not have significant effect on the plasma concentrations of efavirenz.

OBJECTIVE T o carry out the health economics evaluation and cost-benefit analysis of the type b Hae-mophilus influenzae(Hib)vaccination for the children who were hospitalized due to Hib infection so as to provide evidence for public health policies.METHODS The children who were diagnosed with Hib-related respiratory tract infections or meningitis and were hospitalized in respiratory medicine department,infection management depart-ment,emergency rooms and neurology department of Jiangxi Provincial Children's Hospital from Jan.1,2021 to Dec.31,2023 were recruited as the research subjects.Based on a 1∶1 matching condition,the matching variables included four items such as the same age for the admission to the hospital,same gender,same department and same grade of disease severity.The children for whom the primary immunization of Hib vaccination(including Hib monovalent vaccine and Hib-containing combination vaccine)were completed and the integrity of vaccination infor-mation could be checked out were assigned as the intervention group,while the children for whom the primary im-munization of Hib vaccination was not completed were chosen as the control group.The clinical data,vaccination data and the data such as length of hospital stay and hospitalization cost were collected from the children.The cost-benefit of the Hib vaccination among the children with Hib infection was observed.RESULTS A total of 622 hospi-talized children who were detected with Hib-positive respiratory tract infections or meningitis were enrolled in the study,and 73 children(20 children from infection management department,27 children from respiratory medi-cine department,26 children from emergency rooms)were finally included in the intervention group after matc-hing and multiple rounds of screening,73 children were chosen as the control group based on a 1∶1 matching con-dition.The male children accounted for 57.53％(42 cases)in both groups,and the female children accounted for 42.47％(31 cases)in both groups.With the respect to the length of hospital stay,it was 7.00(5.00,8.00)days in the intervention group,7.00(6.00,8.00)days in the control group(Z=-0.341,P=0.733).In terms of the hospitalization cost,it was 7 756.17(6 617.92,10 617.69)yuan in the intervention group,9 040.65(8 033.76,10 935.84)yuan in the control group(Z=-2.795,P=0.005).The cost of Hib vaccination was 343.03 yuan per capita in the intervention group,and the benefit-cost ratio(BCR)was 1∶3.74(343.03 yuan/1 284.48 yuan).CONCLUSIONS The Hib vaccination can save the hospitalization cost and has high cost effectiveness.It is sugges-ted that the Hib vaccination should be promoted and the coverage rate of Hib vaccination should be raised among the age-eligible children.

Objective This study aimed to evaluate the interaction between antiretroviral drug efavirenz and anti-tuberculosis 1H3P3(isoniazid plus rifapentine)in people living with HIV.Methods HIV-positive individuals on efavirenz-containing(600 mg)antiretroviral therapy(ART)received 1H3P3 regimen containing rifapentine(450 mg)plus isoniazid(400 mg)3 times a week for 1 month.Efavirenz concentrations were measured at weeks 0,2,4,8.Rifapentine concentration was determined at weeks 2 and 4.HIV RNA load was determined at weeks 0 and 8.Treatment target was efavirenz concentration＞1 mg/L.The anti-TB prevention was considered acceptable if the target of efavirenz concentration was achieved in more than 80％of participants.The participants were followed up for 18 months to evaluate the efficacy of treatment.Results Thirty-one participants living with HIV were enrolled in the study.Two participants were excluded from PK analysis because his/her baseline efavirenz concentration＜1 mg/L,suggesting poor treatment adherence.Evaluable PK data were available for 29 participants,including 23(79.3％)males.The median[interquartile range(IQR)]age of the participants was 43.0(32.5,53.5)years.The median(IQR)efavirenz plasma concentration was 2.33(1.96,2.34)mg/L at week 0,2.32(1.90,3.28)mg/L at week 2,2.07(1.83,3.09)mg/L at week 4,and 2.71(2.14,3.33)mg/L at week 8.Efavirenz concentration did not show significant difference between the 4 time points(P＞0.05).Median(IQR)rifapentine concentration was 9.36(6.23,16.47)mg/L at week 2,and 9.36(6.41,15.56)mg/L at week 4.Rifapentine concentration did not show significant difference between week 2 and week 4(P＞0.05).Efavirenz concentrations was＞1 mg/L in all participants at weeks 2,4,and 8.Furthermore,efavirenz concentration was significantly higher in females and patients with body weight＜60 kg compared with males and those with body weight ≥60 kg(P＜0.05).None of the participants had symptoms or signs of active tuberculosis during 18-month follow-up.Conclusions Isoniazid plus rifapentine(1H3P3 regimen)did not have significant effect on the plasma concentrations of efavirenz.