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 investigate the efficacy of fibrosis-4 index (FIB-4), NAFLD fibrosis score (NFS), aspartate aminotransferase to platelet count ratio (APRI), liver stiffness value (LSM), and Agile 3+ score and their combined model in predicting advanced-stage liver fibrosis in patients with chronic hepatitis B (CHB) combined with metabolic-associated fatty liver disease (MAFLD).Methods:A multicenter retrospective cohort study was conducted on the BMOVE population.Nine hundred twenty CHB cases combined with MAFLD who underwent liver biopsy at seven medical centers in China from April 2006 to December 2023 were included. The patients were divided into advanced-stage liver fibrosis (159 cases) and non-advanced-stage liver fibrosis (761 cases) according to the Scheuer's scoring system.The area under the receiver operating characteristic curve (AUROC), decision curve, and calibration curve analysis were used to evaluate the efficacy of the firbrosis-4 index (FIB-4) score, NFS score, APRI index, LSM, and Agile 3+ score and their combined model in predicting advanced-stage fibrosis. The liver fibrosis grade of all patients was diagnosed by liver biopsy. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of each scoring model and combined model, as well as the proportion of correctly classified patients, were calculated based on different cutoff values.Results:AUROC analysis showed that Agile 3+ (0.814, 95% CI: 0.787-0.838) and LSM (0.805, 95% CI: 0.778-0.829) had similar accuracy and were superior to FIB-4 (0.721, 95% CI: 0.691-0.749), NFS (0.687, 95% CI: 0.656-0.716) and APRI ( 0.689, 95% CI: 0.658-0.718); however, HBV DNA level and HBV e antigen status had no effect on this outcome. Decision curve analysis showed that interventions based on LSM and Agile 3+ had provided higher net benefits compared with serological scores. Calibration curves showed that Agile 3+ had better predicitive accuracy than all other models. Agile 3+ had the highest PPV (0.54), minimal uncertainty interval (11.6%), and the highest proportion of correctly classified patients (76%); followed by LSM (PPV: 0.43, uncertainty interval: 15.5%, correct classification rate: 66%), and FIB-4 (PPV: 0.42, uncertainty interval: 26.1%, correct classification rate: 62.6%) in terms of identifying advanced-stage liver fibrosis. Combined model analysis demonstrated that FIB-4 combined with Agile 3+ had improved the correct classification rate and reduced the proportion of missed patients compared with FIB-4 combined with LSM. Conclusion:The Agile 3+ score is superior than LSM, FIB-4, NFS, and APRI index at identifying advanced-stage fibrosis in patients with CHB combined with MAFLD. This study supports the use of FIB-4 index combined with Agile 3+ for risk stratification in patients with CHB combined with MAFLD.

Objective:To investigate the clinicopathological characteristics of lung transplantation and post-transplantation changes in patients with pneumoconiosis.Methods:A retrospective study was conducted to analyze the clinical and pathological data of 28 patients with pulmonary silicosis who underwent lung transplantation and were managed at the Department of Internal Medicine, Henan Provincial People′s Hospital, Zhengzhou, China from January 2015 to December 2024. Among them, 8 patients underwent lung biopsy 6-20 months after transplantation to evaluate the histopathological changes of the recipient and the donor lungs post-transplantation. The expression of relevant indicators was examined using immunohistochemical EnVision staining, while presence of microorganisms was assessed using histochemical special staining. The patients were all followed up.Results:Among the 28 patients with pneumoconiosis who underwent lung transplantation, 26 were male and 2 were female, with a male-to-female ratio of 13∶1. Their ages ranged from 23 to 68 years, median 50.0 (46.0, 53.5) years. They were diagnosed with pneumoconiosis at local occupational disease prevention and control centers for 3 to 15 years (mean, 9.65 years), including 13 left single lung transplants and 15 right single lung transplants. Gross examination showed fleshy nodules with irregular cystic cavities at the periphery. The cut surfaces exhibited gray-brown color and firm texture. Microscopically, most alveolar structures of the lung were obliterated, with nodular or diffuse proliferation of collagen fibers accompanied by hyaline degeneration. Focal massive carbon dust deposition and massive silicotic fibrosis were observed, surrounded by lung parenchyma with emphysematous changes and localized bullae formation. Seven patients underwent re-biopsy after transplantation that showed extensive infiltration of inflammatory cells. In 4 cases, microscopy revealed complete coagulative necrosis, with negative acid-fast staining and TB-DNA results. Of the 4 cases, 3 cases exhibited Aspergillus infection confirmed by Grocott′s methenamine silver and PAS stains, while 2 cases showed chronic bronchitis with squamous metaplasia. Follow-up revealed that 8 patients died of acute respiratory failure due to severe infection, while the remaining 20 demonstrated significant postoperative improvement in lung function.Conclusions:For patients with advanced pulmonary dust deposition disease who undergo lung transplantation, it is necessary to conduct standardized sampling and pathological assessment of the recipient lungs. In the early post-transplant period, the complications of re-biopsy tissues are mainly fungal infections. The combination of morphological manifestations and immunohistochemical detection is helpful to distinguish infection from rejection reactions. At the same time, it is essential to integrate clinical information and laboratory results to provide post-transplantation pathological assessment for individualized treatment.

Objective To investigate the causes and factors affecting unplanned reoperation,and to provide a reference basis for reducing the incidence of unplanned return of the patient to the operating room for reoperation.Methods Surgical data from the hospital was extracted spanning from January to December 2022,and subjected to a descriptive analysis of the overall situation,departmental distribution,primary reasons,and patient referrals related to unplanned reoperations in the hospital,and analyzed factors contributing to unplanned reoperations in the hospital using binary logistic regression.Results In 2022,130 unplanned reoperations were reported in this hospital,corresponding to an incidence of 0.35％.Patients who required unplanned reoperation were predominantly male(63.08％).The majority had surgical incision grade of category 0(46.92％),and surgeries were classified as levels 3 and 4(80.77％).Furthermore,88.46％of the surgeries were performed by surgeons with advanced degrees or higher.The common causes were postoperative bleeding,failure to achieve the desired result,need for the condition,probing for the cause,and occurrence of leakage or fistula,collectively accounting for 50.00％of the cases.Key factors contributing to unplanned reoperations were sex,type of surgical incision,and incision healing grade;among which male patients(OR=1.733,P=0.006),patients with class Ⅰ surgical incision(OR=2.909,P=0.004),and patients with incision grade B healing(OR=6.565,P＜0.001)showed a higher propensity for unplanned reoperations.Conclusion Hos-pitals should emphasize monitoring and managing unplanned reoperations by improving perioperative supervision,conducting thorough root cause analyses,and focusing on continuous quality improvement to enhance surgical outcomes and patient safety.

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 investigate the causes and factors affecting unplanned reoperation,and to provide a reference basis for reducing the incidence of unplanned return of the patient to the operating room for reoperation.Methods Surgical data from the hospital was extracted spanning from January to December 2022,and subjected to a descriptive analysis of the overall situation,departmental distribution,primary reasons,and patient referrals related to unplanned reoperations in the hospital,and analyzed factors contributing to unplanned reoperations in the hospital using binary logistic regression.Results In 2022,130 unplanned reoperations were reported in this hospital,corresponding to an incidence of 0.35％.Patients who required unplanned reoperation were predominantly male(63.08％).The majority had surgical incision grade of category 0(46.92％),and surgeries were classified as levels 3 and 4(80.77％).Furthermore,88.46％of the surgeries were performed by surgeons with advanced degrees or higher.The common causes were postoperative bleeding,failure to achieve the desired result,need for the condition,probing for the cause,and occurrence of leakage or fistula,collectively accounting for 50.00％of the cases.Key factors contributing to unplanned reoperations were sex,type of surgical incision,and incision healing grade;among which male patients(OR=1.733,P=0.006),patients with class Ⅰ surgical incision(OR=2.909,P=0.004),and patients with incision grade B healing(OR=6.565,P＜0.001)showed a higher propensity for unplanned reoperations.Conclusion Hos-pitals should emphasize monitoring and managing unplanned reoperations by improving perioperative supervision,conducting thorough root cause analyses,and focusing on continuous quality improvement to enhance surgical outcomes and patient safety.

Objective:To investigate the efficacy of fibrosis-4 index (FIB-4), NAFLD fibrosis score (NFS), aspartate aminotransferase to platelet count ratio (APRI), liver stiffness value (LSM), and Agile 3+ score and their combined model in predicting advanced-stage liver fibrosis in patients with chronic hepatitis B (CHB) combined with metabolic-associated fatty liver disease (MAFLD).Methods:A multicenter retrospective cohort study was conducted on the BMOVE population.Nine hundred twenty CHB cases combined with MAFLD who underwent liver biopsy at seven medical centers in China from April 2006 to December 2023 were included. The patients were divided into advanced-stage liver fibrosis (159 cases) and non-advanced-stage liver fibrosis (761 cases) according to the Scheuer's scoring system.The area under the receiver operating characteristic curve (AUROC), decision curve, and calibration curve analysis were used to evaluate the efficacy of the firbrosis-4 index (FIB-4) score, NFS score, APRI index, LSM, and Agile 3+ score and their combined model in predicting advanced-stage fibrosis. The liver fibrosis grade of all patients was diagnosed by liver biopsy. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of each scoring model and combined model, as well as the proportion of correctly classified patients, were calculated based on different cutoff values.Results:AUROC analysis showed that Agile 3+ (0.814, 95% CI: 0.787-0.838) and LSM (0.805, 95% CI: 0.778-0.829) had similar accuracy and were superior to FIB-4 (0.721, 95% CI: 0.691-0.749), NFS (0.687, 95% CI: 0.656-0.716) and APRI ( 0.689, 95% CI: 0.658-0.718); however, HBV DNA level and HBV e antigen status had no effect on this outcome. Decision curve analysis showed that interventions based on LSM and Agile 3+ had provided higher net benefits compared with serological scores. Calibration curves showed that Agile 3+ had better predicitive accuracy than all other models. Agile 3+ had the highest PPV (0.54), minimal uncertainty interval (11.6%), and the highest proportion of correctly classified patients (76%); followed by LSM (PPV: 0.43, uncertainty interval: 15.5%, correct classification rate: 66%), and FIB-4 (PPV: 0.42, uncertainty interval: 26.1%, correct classification rate: 62.6%) in terms of identifying advanced-stage liver fibrosis. Combined model analysis demonstrated that FIB-4 combined with Agile 3+ had improved the correct classification rate and reduced the proportion of missed patients compared with FIB-4 combined with LSM. Conclusion:The Agile 3+ score is superior than LSM, FIB-4, NFS, and APRI index at identifying advanced-stage fibrosis in patients with CHB combined with MAFLD. This study supports the use of FIB-4 index combined with Agile 3+ for risk stratification in patients with CHB combined with MAFLD.

Objective:To investigate the clinicopathological characteristics of lung transplantation and post-transplantation changes in patients with pneumoconiosis.Methods:A retrospective study was conducted to analyze the clinical and pathological data of 28 patients with pulmonary silicosis who underwent lung transplantation and were managed at the Department of Internal Medicine, Henan Provincial People′s Hospital, Zhengzhou, China from January 2015 to December 2024. Among them, 8 patients underwent lung biopsy 6-20 months after transplantation to evaluate the histopathological changes of the recipient and the donor lungs post-transplantation. The expression of relevant indicators was examined using immunohistochemical EnVision staining, while presence of microorganisms was assessed using histochemical special staining. The patients were all followed up.Results:Among the 28 patients with pneumoconiosis who underwent lung transplantation, 26 were male and 2 were female, with a male-to-female ratio of 13∶1. Their ages ranged from 23 to 68 years, median 50.0 (46.0, 53.5) years. They were diagnosed with pneumoconiosis at local occupational disease prevention and control centers for 3 to 15 years (mean, 9.65 years), including 13 left single lung transplants and 15 right single lung transplants. Gross examination showed fleshy nodules with irregular cystic cavities at the periphery. The cut surfaces exhibited gray-brown color and firm texture. Microscopically, most alveolar structures of the lung were obliterated, with nodular or diffuse proliferation of collagen fibers accompanied by hyaline degeneration. Focal massive carbon dust deposition and massive silicotic fibrosis were observed, surrounded by lung parenchyma with emphysematous changes and localized bullae formation. Seven patients underwent re-biopsy after transplantation that showed extensive infiltration of inflammatory cells. In 4 cases, microscopy revealed complete coagulative necrosis, with negative acid-fast staining and TB-DNA results. Of the 4 cases, 3 cases exhibited Aspergillus infection confirmed by Grocott′s methenamine silver and PAS stains, while 2 cases showed chronic bronchitis with squamous metaplasia. Follow-up revealed that 8 patients died of acute respiratory failure due to severe infection, while the remaining 20 demonstrated significant postoperative improvement in lung function.Conclusions:For patients with advanced pulmonary dust deposition disease who undergo lung transplantation, it is necessary to conduct standardized sampling and pathological assessment of the recipient lungs. In the early post-transplant period, the complications of re-biopsy tissues are mainly fungal infections. The combination of morphological manifestations and immunohistochemical detection is helpful to distinguish infection from rejection reactions. At the same time, it is essential to integrate clinical information and laboratory results to provide post-transplantation pathological assessment for individualized treatment.

The aim of this study is to investigate the immune effect of H9 subtype avian influenza virus(AIV)NP protein on mice and lay the foundation for the development of avian influenza vi-rus(AIV)vaccine.The H9N2 virus NP gene amplification product was cloned into the pET-32a expression vector,and the protein expression was verified by SDS-PAGE and Western blot,and the immune effect was evaluated by measuring the secretion of supernatant multicytokines in mouse splenocytes culture.The results showed that the total length of the coding region sequence of NP gene was 1 497 bp,NP recombinant proteins exist in both soluble and insoluble protein forms,and the specific bands were visible in Western blot.After immunizing mice,serum produces IgG-bind-ing antibodies with antibody titers of 1∶40 000.Compared with the control group,IL-2,IL-5 and IL-13 were significantly increased(P＜0.001),and the secretion of IL-6 was significantly increased compared with the control group.IL-4 and IL-12 p70 secretions were elevated compared with con-trols,but there was no significant difference.Compared with the control group,the secretions of IL-1β,IL-18,GM-CMF,TNF-α and IFN-γ were inhibited,but the difference was not significant(P＞0.05).The results showed that NP recombinant protein is a good immunogen,laying a foundation for in-depth research on influenza vaccine.

Objective:To investigate the correlation of LymphGen genotyping with the clinicopathologic characteristics, efficacy and prognosis in patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL).Methods:A retrospective case series study was conducted. The clinicopathological data and follow-up information of 132 DLBCL patients diagnosed and treated in the First Affiliated Hospital of Soochow University from January 2016 to January 2022 were collected. LymphGen genotyping was made based on the results of second-generation sequencing. The distributions of the main subtypes in the whole group and the stratification of all clinicopathological features were analyzed. The short-term efficacy of patients with different gene subtypes was compared. Survival analysis of patients with different gene subtypes was performed by using the Kaplan-Meier method.Results:Among the 132 patients, 69 were males and 63 were females. The median age was 60 years, with the age ranging from 13 to 87 years. Hans typing: germinal center B cell (GCB) type was detected in 49 cases, non-GCB type was detected in 81 cases, and the remaining 2 cases were unknown. Ann Arbor staging: 31 cases with stage Ⅰ-Ⅱ, 89 cases with stage Ⅲ-Ⅳ, and 9 primary central nervous system lymphoma (PCNSL) cases without stage, and the remaining 3 cases with unknown stage. Among the 132 patients, 64 cases (48.5%) were genotyped with LymphGen, including 6 cases (4.5%) of MCD subtype, 18 cases (13.6%) of A53 subtype, 17 cases (12.9%) of BN2 subtype, 3 cases (2.3%) of EZB subtype, 5 cases (3.8%) of ST2 subtype, and 15 cases (11.4%) of composite subtype, and 68 cases (51.5%) of the other subtypes; N1 subtype was not detected. The differences in the proportion of MCD subtype [5.0% (3/60) vs. 4.2% (3/71)], A53 subtype [16.7% (10/60) vs. 11.3% (8/71)], BN2 subtype [6.7% (4/60) vs. 18.3% (13/71)], EZB subtype [5.0% (3/60) vs. 0 (0/71)], ST2 subtype [5.0% (3/60) vs. 2.8% (2/71)], composite subtype [18.3% (11/60) vs. 5.6% (4/71)], other types [43.3% (26/60) vs. 57.7% (41/71)] were statistically significant between the patients with lactate dehydrogenase (LDH) < 245 U/L and those with LDH ≥245 U/L ( P = 0.023). There were no statistically significant differences in genotype distribution among subgroups with different age, gender, B symptoms, Hans typing, primary site, involvement site, Ann Arbor stage, international prognostic index score/international extranodal lymphoma study group score (all P > 0.05). After 4-6 courses treatment in PCNSL patients and 6-8 courses of standard first-line treatment in non-PCNSL patients, 17 patients with BN2 subtype [including 9 cases of complete remission (CR) and 4 cases of partial remission (PR)] and 3 patients with EZB subtype (including 2 cases of CR) had the higher proportion of those achieving good treatment outcomes. However, 15 patients with the composite subtype showed the worst outcomes including 5 cases of CR, 4 cases of PR, 1 case of stable disease, 3 cases of disease progression, and 2 death cases. The CR rates of the composite subtype group, non-composite subtype group, and other groups were 33.3% (5/15), 44.9% (22/49), and 66.2% (45/68), respectively; and the difference among these groups was statistically significant ( P = 0.034). The CR rate of composite type patients with BN2 subtype was higher compared to composite subtype patients without BN2 subtype (5/8 vs. 0/7), and the difference was statistically significant ( P = 0.023); 7 patients with A53 subtype combined with other subtypes except BN2 subtype did not achieve CR; 2 cases had PR, 3 cases had disease progression and 2 cases died. The median follow-up time was 26 months (ranging from 1 to 86 months) until the last follow-up in March 2023. There were no statistically significant differences in overall survival and progression-free survival among patients with different gene subtypes (all P > 0.05). Conclusions:The distribution of gene subtypes in DLBCL patients may be correlated with LDH levels. Patients with different gene subtypes show variations in short-term efficacy. The composite type patients with A53 subtype and without BN2 subtype have poor treatment outcomes, but no differences in overall survival and progression-free survival of patients with different gene subtypes are observed.