Objective:To evaluate the immunogenicity and immune persistence of human rabies vaccine (Vero cell) in healthy people aged 10-17 years and compare it with a group of adults aged 18-60 years.Methods:This study was conducted between July 2021 and November 2022 with Shangyu district and Shengzhou city of Shaoxing city, Zhejiang Province selected as the research sites. Zagreb regimen (2-1-1 schedule) and Essen regimen (1-1-1-1-1 schedule) were used for rabies vaccine administration. Serum samples were collected at different time points before and after immunization to compare the differences in seropositivity rates and geometric mean concentrations (GMC) between the 10-17 age group and the 18-60 age group.Results:A total of 1 200 healthy participants aged 10-60 were included, with 157 individuals (13.1%) in the 10-17 age group and 1 043 individuals (86.9%) in the 18-60 age group. Both groups displayed a nearly 100% seropositivity rate at 3, 6 and 12 months, and the participants in the same age group had similar antibody levels. The GMC of antibodies gradually increased after vaccination and peaked on 14 d. The 10-17 age group showed higher GMC of antibodies than the 18-60 age group at 14 d after the first dose (Zagreb regimen: 81.85 IU/ml vs 63.15 IU/ml, t=2.411, P=0.018; Essen regimen: 86.61 IU/ml vs 69.24 IU/ml, t=3.906, P<0.001). Similar differences were observed in the GMC of antibodies at 14 d and 3 months after the full vaccination course, but these differences gradually decreased and disappeared at 6 and 12 months after vaccination. Conclusions:Human rabies vaccine (Vero cell) has lasting immune protection in all participants within one year after vaccination, with no significant differences between the two vaccination regimens. Participants aged 10-17 have higher antibody levels compared to adults aged 18-60, but there is no significant difference in immune persistence between the two age groups.

Against the backdrop of the global acceleration of cervical cancer elimination, China has been promoting pilot programs offering free or subsidized HPV vaccination for eligible girls. In 2022, Zhejiang Province initiated a free bivalent HPV vaccination program for eligible girls, expanding from pilot areas to the whole province. Through key measures such as effective multi-sectoral collaboration, full financial support, comprehensive health education and high-quality vaccination services, the program was successfully implemented. However, challenges were encountered during the implementation of the program, including difficulties in target population definition and HPV vaccine selection, as well as significant gap between vaccination intention and behavior. This article systematically analyzes the practices and challenges faced by Zhejiang Province, and proposes corresponding strategies and suggestions based on the best practices both domestically and internationally. It aims to provide references for the implementation of similar programs in other regions or even integrating HPV vaccine into the immunization program.

Since the introduction of human papillomavirus (HPV) vaccines, countries around the world have actively promoted large-scale vaccination with HPV vaccines to improve their coverage for target populations. This study conducts a multidimensional analysis to quantify the policies, implementation models and evaluation outcomes of the free HPV vaccination program across countries at high, upper-middle and lower-middle income levels. The results reveal distinct patterns in implementation and evaluation among these countries. The results also suggest that China can learn from successful international experiences to explore more effective vaccination strategies to increase coverage. In parallel, it is essential to develop a scientifically grounded evaluation framework and conduct systematic evaluations to effectively support the continuous implementation of the free HPV vaccination program for target populations in China. Furthermore, China may consider incorporating appropriate HPV vaccines into the National Immunization Program and dynamically adjusting vaccine types as needed to accelerate the elimination of cervical cancer.

Objective To evaluate the effectiveness of implementing precise management for Da Vinci robotic surgical consumables under the Diagnosis Related Group(DRG)payment system.Methods This retrospective case-control study ana-lyzed 200 patients undergoing Da Vinci robotic lung resection surgery in a tertiary hospital:100 cases from May to June 2022 as the control group,and 100 cases from May to June 2023 with implemented precision management as the observation group.The control group did not implement the payment according to DRG,while the observers implemented payment according to DRG and optimized refined management of Da Vinci robotic surgical consumables.Hospitalization duration,intraoperative costs,and utili-zation of high-value consumables were compared between the two groups.Results No statistically significant differences(P＞0.05)were observed between the two groups in terms of gender,age,medical insurance status,operative time,or intraoperative blood loss.The observation group exhibited a significantly shorter hospitalization duration(8.29±4.13 vs.10.47±4.57 days;P＜0.05),and higher surgical costs[(11 366.81±2 504.23)RMB vs.(8 716.07.78±256.34)RMB,P＜0.05]compared with the control group.Conclusion DRG-oriented precision management optimizes resource utilization through shortened hospi-talization time and rationalizes cost allocation,and sustainable consumable consumption patterns,demonstrating effective balance between clinical quality and economic efficiency under healthcare payment reforms.

Objective:To use machine learning to predict the efficacy of accelerated corneal collagen cross-linking (A-CXL) surgery, identify prognostic factors, and construct models to predict postoperative disease progression.Methods:A single-center retrospective study was conducted.A total of 82 keratoconus patients (112 eyes) who underwent A-CXL surgery at the West China Hospital of Sichuan University between March and December 2021 were enrolled.Preoperative and follow-up examinations included anterior segment evaluation by slit-lamp microscopy, corneal topography using Pentacam, and corneal biomechanical indices using Corvis ST.Disease progression was defined as an increase in maximum keratometry (Kmax) of ≥1 D from the preoperative level at the last follow-up.Various machine learning algorithms were employed to analyze corneal topography, biomechanical parameters and corneal densitometry values to identify prognostic factors and construct models for predicting postoperative disease progression.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of West China Hospital, Sichuan University (No.2023496).Written informed consent was obtained from each subject.Results:During follow-up, 15.1% (17/112) of the eyes showed progression after A-CXL.The preoperative astigmatism and stress-strain index (SSI) in the progression group were (-5.41±2.72)D and 1.41±0.78, respectively, which were significantly higher than (-3.30±2.54)D and 0.95±0.98 in the non-progression group ( t=2.80, 2.03; both P<0.05).Cox regression analysis identified preoperative astigmatism (hazard ratio [HR]=1.20), SSI (HR=1.10), and anterior corneal densitometry of 2-6 mm (CDA6) (HR=2.10) as significant risk factors for post-A-CXL progression.Among various machine learning models developed and validated, the area under the curve (AUC) values for logistic regression, multilayer perceptron (MLP) model, and random forest (RF) exceeded 0.700.For F1-score, the AUC values for logistic regression, MLP, and RF were 0.870, 0.880, and 0.880, respectively.The network structure of the visualized MLP was a single-layer, 24-neurons neural network with 80% accuracy in predicting whether progression occurred after A-CXL.The clinical nomogram developed in conjunction with astigmatism, SSI, and CDA6 predicted the cumulative probability of progression at 0.5, 1, and 2 years postoperatively based on the sum of the specified values for each variable, and based on the optimal cutoff value, keratoconus corneas could be classified into high-, intermediate-, and low-risk groups, respectively.The time-dependent subject operating characteristic curves of the nomogram showed AUCs of 0.734, 0.685, and 0.935 at 0.5, 1, and 2 years postoperatively, respectively, all of which performed well in predicting progression. Conclusions:Preoperative astigmatism, SSI, and CDA6 are significant risk factors for post-A-CXL progression in keratoconus.The MLP model can accurately predict postoperative disease progression, and the clinical nomogram combining preoperative astigmatism, SSI, and CDA6 can effectively differentiate between low-, medium-, and high-risk postoperative progression outcomes.

Objective:To understand the current situation of the ability to screen health information of the elderly in rural areas and analyze its influencing factors, so as to provide a basis for taking targeted measures.Methods:A cross-sectional survey was adopted, and rural elderly people in Yonghe Town, Dahu Town and Dayao Town of Liuyang City, Hunan Province were selected as the survey subjects by the convenience sampling method. The investigation was conducted using the general information Questionnaire, the Health Information Discrimination Ability Scale, the filial Piety Expectation Scale and the two-way Social Support Scale.Results:A total of 228 questionnaires were distributed, and 215 valid questionnaires were retrieved, with an effective recovery rate of 94.30%. Among the 215 rural elderly people surveyed, 86 were male and 129 were female. The ability to discriminate health information was (69.19 ± 13.41) points, the expectation of filial piety was (37.67 ± 6.12) points, and the two-way social support was (46.82 ± 8.11) points. The ability of rural elderly people to discriminate health information was positively correlated with filial piety expectations and two-way social support ( r = 0.340, 0.456; both P<0.01). The results of hierarchical regression analysis showed that educational level, filial piety expectations and two-way social support were the influencing factors of the current status of health information discrimination ability of rural elderly people ( t values were 2.60 to 5.35, all P<0.05). Conclusions:The ability of discriminating health information of the elderly in rural areas is affected by the educational level, filial piety expectation and two-way social support. The health information of rural elderly people with low education level should be screened and targeted, so as to enrich their cultural life and combine education with fun. Actively build a filial piety culture to promote children′s attention to their parents. In addition to providing social support for the elderly, we should promote their interpersonal and social communication and exert their self-value, so as to improve the health information screening ability of the elderly in rural areas.

Objective:To use machine learning to predict the efficacy of accelerated corneal collagen cross-linking (A-CXL) surgery, identify prognostic factors, and construct models to predict postoperative disease progression.Methods:A single-center retrospective study was conducted.A total of 82 keratoconus patients (112 eyes) who underwent A-CXL surgery at the West China Hospital of Sichuan University between March and December 2021 were enrolled.Preoperative and follow-up examinations included anterior segment evaluation by slit-lamp microscopy, corneal topography using Pentacam, and corneal biomechanical indices using Corvis ST.Disease progression was defined as an increase in maximum keratometry (Kmax) of ≥1 D from the preoperative level at the last follow-up.Various machine learning algorithms were employed to analyze corneal topography, biomechanical parameters and corneal densitometry values to identify prognostic factors and construct models for predicting postoperative disease progression.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of West China Hospital, Sichuan University (No.2023496).Written informed consent was obtained from each subject.Results:During follow-up, 15.1% (17/112) of the eyes showed progression after A-CXL.The preoperative astigmatism and stress-strain index (SSI) in the progression group were (-5.41±2.72)D and 1.41±0.78, respectively, which were significantly higher than (-3.30±2.54)D and 0.95±0.98 in the non-progression group ( t=2.80, 2.03; both P<0.05).Cox regression analysis identified preoperative astigmatism (hazard ratio [HR]=1.20), SSI (HR=1.10), and anterior corneal densitometry of 2-6 mm (CDA6) (HR=2.10) as significant risk factors for post-A-CXL progression.Among various machine learning models developed and validated, the area under the curve (AUC) values for logistic regression, multilayer perceptron (MLP) model, and random forest (RF) exceeded 0.700.For F1-score, the AUC values for logistic regression, MLP, and RF were 0.870, 0.880, and 0.880, respectively.The network structure of the visualized MLP was a single-layer, 24-neurons neural network with 80% accuracy in predicting whether progression occurred after A-CXL.The clinical nomogram developed in conjunction with astigmatism, SSI, and CDA6 predicted the cumulative probability of progression at 0.5, 1, and 2 years postoperatively based on the sum of the specified values for each variable, and based on the optimal cutoff value, keratoconus corneas could be classified into high-, intermediate-, and low-risk groups, respectively.The time-dependent subject operating characteristic curves of the nomogram showed AUCs of 0.734, 0.685, and 0.935 at 0.5, 1, and 2 years postoperatively, respectively, all of which performed well in predicting progression. Conclusions:Preoperative astigmatism, SSI, and CDA6 are significant risk factors for post-A-CXL progression in keratoconus.The MLP model can accurately predict postoperative disease progression, and the clinical nomogram combining preoperative astigmatism, SSI, and CDA6 can effectively differentiate between low-, medium-, and high-risk postoperative progression outcomes.

Against the backdrop of the global acceleration of cervical cancer elimination, China has been promoting pilot programs offering free or subsidized HPV vaccination for eligible girls. In 2022, Zhejiang Province initiated a free bivalent HPV vaccination program for eligible girls, expanding from pilot areas to the whole province. Through key measures such as effective multi-sectoral collaboration, full financial support, comprehensive health education and high-quality vaccination services, the program was successfully implemented. However, challenges were encountered during the implementation of the program, including difficulties in target population definition and HPV vaccine selection, as well as significant gap between vaccination intention and behavior. This article systematically analyzes the practices and challenges faced by Zhejiang Province, and proposes corresponding strategies and suggestions based on the best practices both domestically and internationally. It aims to provide references for the implementation of similar programs in other regions or even integrating HPV vaccine into the immunization program.

Since the introduction of human papillomavirus (HPV) vaccines, countries around the world have actively promoted large-scale vaccination with HPV vaccines to improve their coverage for target populations. This study conducts a multidimensional analysis to quantify the policies, implementation models and evaluation outcomes of the free HPV vaccination program across countries at high, upper-middle and lower-middle income levels. The results reveal distinct patterns in implementation and evaluation among these countries. The results also suggest that China can learn from successful international experiences to explore more effective vaccination strategies to increase coverage. In parallel, it is essential to develop a scientifically grounded evaluation framework and conduct systematic evaluations to effectively support the continuous implementation of the free HPV vaccination program for target populations in China. Furthermore, China may consider incorporating appropriate HPV vaccines into the National Immunization Program and dynamically adjusting vaccine types as needed to accelerate the elimination of cervical cancer.