Volume 102 ·  Issue 04 ·  2022

Since April 2020, the epidemic of novel coronavirus pneumonia epidemic (COVID-19 epidemic) in China has entered the phase of normalized prevention and control. After the exploration phase of normalized prevention and control, China′s epidemic prevention and control has entered the "dynamic COVID-zero" phase of whole-chain precise prevention and control. The dynamic COVID-zero strategy is to follow the premise of "external prevention of import, internal prevention of rebound" prevention and control strategy, when the emergence of local COVID-19 cases, to take effective comprehensive prevention and control measures, and to "find one, extinguish one", to quickly cut off the chain of epidemic transmission, so that each epidemic is terminated in a timely manner, achieving maximum effectiveness with minimum cost. With the application of new technologies such as large-scale nucleic acid detection and big data tracking, the dynamic COVID-zero strategy was developed, which is China′s novel experience in the prevention and control of COVID-19 epidemic. The dynamic COVID-zero strategy is an innovative prevention and control strategy proposed and implemented in China during the normalized prevention and control phase of the COVID-19 epidemic, whose prevention and control objectives, technical means, and work focus are different from the traditional "containment" strategy and "mitigation" strategy on ending the epidemic. This paper analyzes and summarizes the three phases of COVID-19 epidemic prevention and control in China, the dynamic COVID-zero strategy and its scientific connotation, evolutionary process, theoretical basis, implementation phases and effects, and provides a scientific basis for epidemic prevention and control in winter and spring.

Portal vein tumor thrombosis (PVTT) has a high incidence and poor prognosis, and there is still a lack of effective treatment, resulting in an international consensus on the diagnosis and treatment standards of liver cancer complicated with PVTT. Therefore, the Liver Cancer Professional Committee of the Chinese Medical Doctors Association launched the "Chinese Expert Consensus on Multidisciplinary Diagnosis and Treatment of Hepatocellular Carcinoma Combined with Portal Vein Tumor Thromb" in 2016, which was updated in 2018. In recent years, many new high-level evidence that conforms to the principles of evidence-based medicine has appeared in the diagnosis and treatment of liver cancer complicated with PVTT at home and abroad. The Liver Cancer Professional Committee of Chinese Medical Doctors Association has initiated the update of the guidelines, aiming at providing the latest guiding suggestions for the standardized diagnosis and treatment of patients with liver cancer complicated with PVTT in China.

To investigate whether vestibular-evoked myogenic potentials(VEMPs) can be used to assess brainstem involvement in patients with Kennedy′s disease (KD).

This was a case-control study.Twenty consecutive patients with genetically confirmed KD and 20 age-and sex-matched healthy subjects were enrolled from November 2018 to September 2020.All subjects were tested for three types of VEMPs, including cervical VEMP (c-VEMP) recorded by the sternocleidomastoid muscle (parameter:p13, n23), masseter VEMP (m-VEMP) recorded by the masseter muscle(parameter: p11), and ocular VEMP (o-VEMP) recorded by the inferior oblique muscle (parameter n10, p15).The latency of each wave, interside peak latency and interpeak latency of c-VEMP, the corrected amplitude and amplitude asymmetry ratio were recorded. Bilateral sternocleidomastoid muscle (SCMM) electromyography (EMG) was performed. The spinal cord and bulbous muscular atrophy functional rating scale (SBMAFRS) was used for assessment.

The mean p13 latency of c-VEMP was (15.5±1.4)ms, which was longer than that of the control group[(13.3±0.9)ms](P<0.05); the mean n23 latency was(25.5±1.4)ms, which was also longer than that of the control group[(22.5±1.0)ms] (P<0.05); the difference of bilateral p13[(2.3±0.6)ms] was significantly higher than that of the control group(P<0.05). The abnormal rates of c-, m-, o-VEMP in KD patients were 75%(15/20), 30%(6/20) and 20%(4/20), respectively. There was a significant positive correlation between c-VEMP latency and course of disease in KD patients(left: r=0.715, 0.695, right: r= 0.708, 0.715, both P<0.05). However, c-VEMP latency was negatively correlated with SBMAFRS score (left: r=-0.701, -0.694, right: r=-0.644, -0.685, both P<0.05). Abnormal rates of SCMM EMG in KD group were as follows: 15%(3/20)of patients showed spontaneous potential in resting state and 45% (9/20) of patients exhibited simple recruitment.

The c-VEMP latency is a sensitive tool for detecting lower brainstem involvement in patients with KD, and the degree of damage increases with prolongation of disease course. The o-and m-VEMP abnormalities indicate that some KD patients develop upper brainstem damage.

To verify and evaluate the performance of automated digital image(DIA) for peripheral blood cell morphology examination.

Three hundred and seventy-nine routine peripheral blood smears and 18 plasmodium positive peripheral blood smears were collected. Blood smears were made and stained by Wright -Giemsa method.White blood cell (WBC) differentiation of blood smears were pre-classified by DIA (DIA direct classification), re-classified (manually reviewed after DIA classification), and artificially classified under microscope. the inter-assay and intra-assay coefficients of variation (CV) of DIA were respectively calculated for repeatability verification. Taking the artificial microscopy as the gold standard, the sensitivity、specificity and accuracy of DIA were calculated. The DIA ability of peripheral blood blast cell morphological count, platelet (PLT) morphological count and morphological examination of plasmodium were also verified.

Except for eosinophils and basophils, the inter-assay and intra-assay CV of WBC classification by DIA in normal samples were < 10%. The CV of WBC classification in abnormal samples increased with the decrease of cell percentage. The sensitivity, specificity and accuracy of DIA pre-classification were 90.5%, 99.2%, 98.2%. Through pre-classification and re-classification by DIA,the results of the blood smears which triggered blast cell alarm had a good correlation with manual classification(r=0.812, 0.983, both P<0.01). The PLT morphological count by DIA had high correlation with hematology analyzer (r=0.946, P<0.01). The deviation absolute value of two methods of PLT count was < 15%, while in PLT aggregation or giant thrombocytosis samples,the deviation absolute value of PLT count by two methods was > 15%. After image acquisition by DIA, 17 plasmodium trophozoites were detected in 18 plasmodium-positive peripheral blood smears, and the images were clear.

The DIA system has good repeatability, high sensitivity, specificity and accuracy in peripheral blood WBC classification. Its pre-classification and re-classification results have high correlation with the manual classification results.

To prospectively compare the efficacy and safety of the greenlight laser anatomical vaporization-incision technique (AVIT) and photoselective vaporization of the prostate(PVP)in the treatment of benign prostatic hyperplasia (BPH).

From November 2019 to September 2020, a randomized controlled study was conducted on 136 BPH patients undergoing greenlight laser surgery in the Department of Urology, the Second Affiliated Hospital of Soochow University. The patient′s age ranged from 53 to 85 years and the prostatic volume ranged from 30 to 104 ml. They were divided into two groups by random number table method,including 68 cases of AVIT(observation group)and 68 cases of PVP(control group). The clinical data of the two groups before, during and after operation were collected and analyzed.

Operations were successfully completed in the two groups. At 6 months after operation, 63 cases in the observation group and 66 cases in the control group completed the follow-up. There was no significant difference in the prevalence of hypertension, diabetes, coronary heart disease, atrial fibrillation and renal insufficiency between the two groups before operation (all P>0.05). The differences of preoperative age [(66.8±6.5) vs (67.3±5.4) years], international prostate symptom score (IPSS) [(24.2±4.7) vs (23.5±4.5) ], quality of life score (QOL) [4.7(4.1, 4.9) vs 4.6(4.2, 5.0)], peak urinary flow rate (Qmax) [(6.9±2.8) vs (6. 8±2.6) ml/s], post-void residual volume (PVR) [(137(52.8, 190.9) vs 119(70.6, 172.1) ml], prostate volume (PV) [70.5(60.6, 80.9) vs 68.2(61.2, 80.5) ml], serum prostate specific antigen (PSA) [4.4(3.5, 5.1) vs 4.4(3.4, 5.0) ng/ml] were not statistically significant between the two groups (all P>0.05). There was no significant difference in the amount of intraoperative blood loss, catheterization time and the postoperative hospitalization time between the two groups (all P>0.05). Compared with the control group, the operation time and lasing time of the observation group were longer[69.0(64.6, 75.0) vs 55.8(49.1, 63.4) min,(36.3±9.9) vs (31.3±9.3) min], and the intraoperaive laser energy consumption and laser energy density were higher[(297±20) vs (240±20) kJ,(4.50±1.35) vs (3.73±1.17) kJ/ml]. The differences were all statistically significant (all P<0.05). At the follow-up of 1, 3 and 6 months after operation, IPSS and QOL in the observation group were lower than those in the control group, and the differences were all statistically significant (all P<0.05). Qmax in the observation group was higher and PVR was lower than those in the control group, with statistically significant differences (P<0.05). Six months after operation, PV and PSA in the observation group decreased more significantly than those in the control group (56% vs 47%, 70% vs 60%, both P<0.05). No urethral stricture and urinary incontinence occurred in two groups after operation. The incidence rate of urinary tract irritation in the observation group was 6.3%(4/63),lower than the 18.2%(12/66)in the control group (P<0.05). There was no significant difference in the incidence rates of urinary retention, bladder neck contracture and secondary bleeding between the two groups (all P>0.05).

Greenlight laser anatomical vaporization-incision technique is safe and effective in the treatment of BPH. Compared with PVP, AVIT has more prostate tissue removed and better curative effect, which is worthy of clinical promotion.

To evaluate the clinical value of aspirin as a prophylactic for transplant renal artery stenosis (TRAS).

From January 2017 to November 2019, clinical data of 307 patients who had undergone renal transplant in Zhengzhou University People′s Hospital were collected. Patients were divided into two groups: the treatment group (124 recipients who had taken oral aspirin 100 mg/d after transplant) and the control group (183 recipients who had not taken aspirin after transplant). The general data, incidence of initially diagnosed and confirmed TRAS, type of renal artery anastomosis vessels, duration of stenosis, location of stenosis, and complications were compared between the two groups. The treatment group was further divided into two subgroups, the early group (92 recipients) and the delayed group (32 recipients), according to the time of starting aspirin after operation. Subgroup analysis was performed.

Among all 307 patients included, there were 241 males and 66 females, aged 19-64 years. There were no statistical difference between the treatment and control groups in terms of gender, age, comorbidities, number of arterial vessels, type of graft, and acute rejection all P>0.05. Among 46 initially diagnosed TRAS patients, 13 (10.5%) and 33 (18.0%) cases were in the treatment and control group respectively, with no statistically significant difference in stenosis rate (P>0.05). The number of confirmed TRAS patients was 1 (0.8%) and 24 (13.1%) in the treatment and control group respectively, with statistically significant difference in stenosis rate (P<0.001). The proportion of patients with bleeding disorders in the treatment group was slightly higher than that in the control group (13.7% vs 8.7%), and the proportion of infarct diseases was slightly lower than that in the control group (1.6% vs 4.9%). But there was no significant difference in aspirin-related complications between the two groups (P>0.05). Subgroup analysis showed that there was no significant difference in initially diagnosed and confirmed TRAS and aspirin-related complications between the early group and the delayed group (all P>0.05).

Oral low-dose aspirin after kidney transplantation can effectively reduce the incidence of TRAS, without increasing the risk of aspirin-related complications.

To assess the immunogenicity and safety of a booster vaccination with an inactivated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine.

The phase Ⅱ trial of an inactivated SARS-CoV-2 vaccine was conducted by Jiangsu Provincial Center for Disease Control and Prevention (CDC) since October 2020. The subjects were healthy adults aged 18-59 years, excluding pregnant, and not breastfeeding women. The primary vaccination schedule groups were 0-14 d 5 μg, 0-14 d 10 μg, 0-28 d 5 μg and 0-28 d 10 μg, respectively. And 50 participants in each group, a total of 200, who have received 2-doses primary vaccination were selected in ascending order of the study number and vaccinated with a booster dose (same dosage as primary vaccination) at the 6th months after post the primary vaccination (30-day window period). Blood samples were collected before and after boosting and tested for the geometric mean titers (GMT) and seroconversion of live virus neutralizing antibody, pseudovirus neutralizing antibody and receptor-binding-domain (RBD) IgG antibody. Adverse events (AE) were collected and assessed within 28 days after boosting.

The ages of subjects in group 0-14 d 5 μg, 0-14 d 10 μg, 0-28 d 5 μg and 0-28 d 10 μg were (43.98±9.58), (43.46±9.34), (42.56±9.08) and (43.94±11.05) years old, respectively (P=0.877). Sex ratios were balanced among the 4 groups (P=0.331). The live virus neutralizing antibody GMT (95%CI) in group 0-14 d 5 μg, 0-14 d 10 μg, 0-28 d 5 μg and 0-28 d 10 μg increased from 4.07 (3.30-5.04), 3.75 (3.08-4.55), 8.33 (7.01-11.11) and 7.69 (6.19-9.57) before the booster vaccination to 284.84 (215.28-376.86), 233.05 (178.61-304.08), 274.81 (223.64-337.68) and 280.77 (234.59-336.04) in 28 days after the booster vaccination, respectively. The rates of live virus neutralizing antibody seroconversion were all 100% in the 4 groups. The AE incidences following booster vaccination were 18.0% (9 cases), 4.0% (2 cases), 12% (6 cases), and 12% (6 cases) in the 4 groups(P=0.182). No AE was graded as level 3 or worse. No serious AE was reported.

One booster vaccination of an inactivated SARS-CoV-2 vaccine administered 6 months after primary vaccination showed good immunogenicity and safety.

This study investigated the disease spectrum in 209 patients with different types of scalp scaly cutaneous diseases. The quality of life of patients with the diseases were also analyzed. We found that seborrheic dermatitis (52.6%), dandruff (14.4%), eczema (17.7%) and psoriasis (15.3%) are common scalp scaly diseases. Eczema and psoriasis can be restricted to the scalp. The four diseases occur frequently in 20-40 years. Compared with patients with seborrheic dermatitis, those with dandruff were statistically different in terms of gender (P=0.004), occupation (P=0.010), drinking (P=0.007) and distressing factors (P=0.016). The average quality of life scores for scalp seborrheic dermatitis, dandruff, eczema and psoriasis were 3.00(1.00, 6.00),2.00(1.00, 5.25),4.00(1.00, 8.50)and 3.00(1.25, 6.75), respectively (P=0.42). The difference between the quality of the four diseases were not statistically significant. The diseases reduced patients′ quality of life.

The clinical and pathological features and postoperative outcomes of 49 patients with diffuse low-grade glioma -related epilepsy who were admitted to the Department of Neurosurgery of the First Affiliated Hospital of Fujian Medical University from January 2015 to December 2018 were analyzed. After 1-year follow-up, 33 patients (67.3%) in the good prognosis group and 16 patients (32.7%) in the poor prognosis group were enrolled. Multivariate logistic regression analysis indicatedthat subtotal tumor resection (OR=5.56, 95%CI:1.21-25.44,P=0.027) and no postoperative radiotherapy (OR=9.24, 95%CI:2.05-41.75, P=0.004) were the risk factors for poor prognosis of postoperative epilepsy. Therefore, for patients with diffuse low-grade glioma-related epilepsy, total tumor resection and postoperative radiotherapy are beneficial to the control of epilepsy.

Three cases of synchronous primary bilateral macronodular adrenal hyperplasia(PBMAH) and renal cell carcinoma (RCC) in the Department of Urology of Peking Union Medical College Hospital were retrospectively reviewed. The clinical features, imaging features, treatment methods and pathological features of these patients were analyzed. It was found that the genetic relationship between synchronous PBMAH and RCC needs further research. And RCC is easy to be misdiagnosed. We should pay high attention to imaging features to find out whether there are lesions in bilateral kidneys when we deal with bilateral adrenal lesions. Laparoscopic approach is recommended for PBMAH and RCC. Total or partial nephrectomy should be performed according the tumor size and location of the renal mass. Patients with PBMAH should be closely followed up after bilateral adrenalectomy to avoid delay in diagnosis or treatment of RCC.

This article reports a case of an adolescent female patient with severe anemia, diagnosed with pure red cell aplasia (PRCA) for 3 years. Glucocorticoid and cyclosporine were effective in treatment, but the anemia recurred repeatedly due to repeated reduction or discontinuation of the drug due to digestive adverse reactions. One month after the cyclosporine dose was added, multiple bone pain in the whole body occurred, accompanied by nocturnal outbreak pain and skin hyperalgesia. NSAIDs and opioid analgesics were ineffective, and the diagnosis of calcineurin inhibitor-related pain syndrome was made. After discontinuing calcineurin inhibitors and changing to sirolimus for PRCA, the anemia was corrected, and the patient's pain was quickly relieved after oral administration of amlodipine besylate.

Stroke is the first cause of death and disability in adults in China. The existing diagnosis and treatment system has some problems such as neglecting functional reconstruction, late intervention of rehabilitation treatment and single treatment methods. In view of this situation, we propose a new model of ultra-early functional reconstruction unit for stroke, attach importance to the intervention time of functional reconstruction and make full use of new artificial intelligence technology. Within 24 hours of onset, we implement preventive and therapeutic functional reconstruction training relying on brain-computer interface, robot, virtual reality and other technologies to reduce disease complications and improve patients' function and quality of life.

The clinical benefit of percutaneous coronary intervention (PCI) for chronic totally occlusive coronary lesions (CTO) remains controversial. Randomized controlled clinical trials have shown that CTO-PCI can improve the symptoms of angina pectoris and improve the quality of life, but it has failed to reduce the incidence of cardiovascular and cerebrovascular events, nor has it improved the indexes reflecting the overall function of the left ventricle, such as left ventricular ejection fraction (LVEF). Myocardial strain, as a sensitive index to reflect local myocardial function, can detect the recovery of myocardial function earlier than LVEF. In recent years, myocardial strain has been used to evaluate the improvement of regional myocardial function after CTO-PCI, which is reviewed in this article.

The endocrine and exocrine glands of the pancreas are derived from a common precursor, and the endocrine and exocrine cell types can undergo mutual conversion. There is close communication between the internal and external secretory parts of the pancreas, and the disease of one party will affect the occurrence and development of the other. On the one hand, exocrine diseases such as acute and chronic pancreatitis, pancreatic cancer, and cystic fibrosis increase the risk of diabetes; Diabetes, on the other hand, reduces the volume of exocrine glands and causes their dysfunction, increasing the risk of pancreatitis and pancreatic cancer. The mechanisms of interaction between endocrine and exocrine diseases include cell number reduction, inflammatory infiltration, hormone secretion changes, etc. Clear communication between endocrine and exocrine pancreas can help to reveal the pathogenesis of endocrine and exocrine diseases such as diabetes, and suggest that it is necessary to pay attention to the progression and treatment of the other party's disease simultaneously during the treatment process.

To evaluate the immunogenicity and safety of SARS-CoV-2 inactivated vaccine (KCONVAC) in healthy adults, the Jiangsu Provincial Center for Disease Control and Prevention conducted randomized double-blind controlled phase I and II clinical trials in healthy subjects. A total of 60 subjects were enrolled in the phase I clinical trial and randomly assigned to the vaccine group (5 μ g or 10 μ g) and the placebo control group at a ratio of 4:1, both of which were immunized for 0-14 days. The phase II clinical trial was 0-14 d and 0-28 d immunization program groups, and a total of 500 subjects were enrolled. Subjects in each group were vaccinated with 5 μ g and 10 μ g of experimental vaccine or placebo at a ratio of 2:2:1. The primary safety endpoint of the Phase I trial was the incidence of adverse reactions/events within 28 days after vaccination. The primary immunogenicity endpoints of the phase II trial were SARS-CoV-2 neutralizing antibody titer, positive conversion rate and anti-receptor binding domain immunoglobulin G positive conversion rate 28 days after the second dose of vaccine.

Currently, large-scale vaccination of CoronaVac, an inactivated vaccine against SARS-CoV-2, is underway in many countries. This study aims to evaluate the immunogenicity, safety results after the 3rd dose of CoronaVac booster shot, and the immune durability results of the 2-dose immunization program in healthy adults over 18 years of age. The first single-center, double-blind, randomized, placebo-controlled phase II clinical trial was conducted in Jiangsu Province. It was divided into 0-14 d and 0-28 d immunization programs. Each immunization program was divided into 3 μ g vaccine group, 6 μ g vaccine group and control group, and the ratio of subjects was 2:2:1. Half of the subjects in each immunization program received the 3rd dose (window 30 d) 28 d after the 2nd dose (groups 1a-14d-2m and 2a-28d-2m), and the other half received the 3rd dose (window 60 d) 6 months after the 2nd dose (groups 1b-14d-8m and 2b-28d-8m). Another phase II clinical trial was carried out in Hebei Province. Subjects aged 60 years and older were vaccinated with 1.5 μ g, 3 μ g or 6 μ g vaccine or placebo, respectively. The first two doses were separated by 28 days, and the second and third doses were separated by 6 months (window period 90 days) (group 3-28d-8m). This study mainly evaluated the geometric mean titer (GMT), geometric mean titer growth factor (GMI) and positive conversion rate of SARS-CoV-2 neutralizing antibodies, and focused on the approved 3 μ g vaccine.

Although SARS-CoV-2 infection causes milder symptoms in children and adolescents, there is still a need for effective means to control the spread of SARS-CoV-2 in this group of people to achieve the purpose of controlling infectious diseases. From August to September 2020, Henan Provincial Center for Disease Control and Prevention conducted randomized, double-blind controlled phase I and II clinical trials of novel coronavirus inactivated vaccine in people aged 3-17 years. Three age groups were divided into 3-5, 6-12 and 13-17 years old. Subjects in each age group were randomly divided into 4 groups in the ratio of 1:1:1:1, and were vaccinated with 2 μ g, 4 μ g, 8 μ g vaccine or placebo according to the immunization program of 0-28-56 d. The safety of the vaccine was evaluated by collecting adverse events from the first dose to 30 days after completion of the full course of immunization. The immunogenicity of the vaccine was evaluated by measuring the serum neutralizing antibody levels of the subject after vaccination.