ObjectiveTo understand the seropositivity of neutralizing antibodies (NAb) and low-level NAb against SARS-CoV-2 infection in the community residents, and to explore the impact of COVID-19 vaccination and SARS-CoV-2 infection on the levels of NAb in human serum. MethodsOn the ground of surveillance cohort for acute infectious diseases in community populations in Shanghai, a proportional stratified sampling method was used to enroll the subjects at a 20% proportion for each age group (0‒14, 15‒24, 25‒59, and ≥60 years old). Blood samples collection and serum SARS-CoV-2 NAb concentration testing were conducted from March to April 2023. Low-level NAb were defined as below the 25^th percentile of NAb. ResultsA total of 2 230 participants were included, the positive rate of NAb was 97.58%, and the proportion of low-level NAb was 25.02% (558/2 230). Multivariate logistic regression analysis indicated that age, infection history and vaccination status were correlated with low-level NAb (all P<0.05). Individuals aged 60 years and above had the highest risk of low-level NAb. There was a statistically significant interaction between booster vaccination and one single infection (aOR=0.38, 95%CI: 0.19‒0.77). Compared to individuals without vaccination, among individuals infected with SARS-CoV-2 once, both primary immunization (aOR=0.23, 95%CI: 0.16‒0.35) and booster immunization (aOR=0.12, 95%CI: 0.08‒0.17) significantly reduced the risk of low-level NAb; among individuals without infections, only booster immunization (aOR=0.28, 95%CI: 0.14‒0.52) showed a negative correlation with the risk of low-level NAb. ConclusionsThe population aged 60 and above had the highest risk of low-level NAb. Regardless of infection history, a booster immunization could reduce the risk of low-level NAb. It is recommended that eligible individuals , especially the elderly, should get vaccinated in a timely manner to exert the protective role of NAb.

Thyroid associated ophthalmopathy (TAO) is an organ-specific autoimmune disease. TAO is clinically classified into active and inactive stage, and the accurate judgment is the key point of treatment choice. Clinical activity score (CAS) is often used for the assessment of TAO activity, which is subjective to some extent. With the development of imaging techniques, ultrasonography, CT, MRI and radionuclide imaging have gradually been applied into the diagnosis and treatment of TAO. What′s more, the imaging is an important complement to CAS from the aspects of anatomical and functional metabolism, which can better assess the activity and the therapy response of TAO. The clinical value of medical imaging in activity and treatment efficacy evaluation of TAO is reviewed in this article.

Objective:In chronic hepatitis B (CHB) patients with previous 96-week treatment with tenofovir amibufenamide (TMF) or tenofovir disoproxil fumarate (TDF), we investigated the efficacy of sequential TMF treatment from 96 to 144 weeks.Methods:Enrolled subjects who were previously assigned (2:1) to receive either 25 mg TMF or 300 mg TDF with matching placebo for 96 weeks received extended or switched TMF treatment for 48 weeks. Efficacy was evaluated based on virological, serological, biological parameters, and fibrosis staging. Statistical analysis was performed using the McNemar test, t-test, or Log-Rank test according to the data. Results:593 subjects from the initial TMF group and 287 subjects from the TDF group were included at week 144, with the proportions of HBV DNA<20 IU/ml at week 144 being 86.2% and 83.3%, respectively, and 78.1% and 73.8% in patients with baseline HBV DNA levels ≥8 log10 IU/ml. Resistance to tenofovir was not detected in both groups. For HBeAg loss and seroconversion rates, both groups showed a further increase from week 96 to 144 and the 3-year cumulative rates of HBeAg loss were about 35% in each group. However, HBsAg levels were less affected during 96 to 144 weeks. For patients switched from TDF to TMF, a substantial further increase in the alanine aminotransferase (ALT) normalization rate was observed (11.4%), along with improved FIB-4 scores.Conclusion:After 144 weeks of TMF treatment, CHB patients achieved high rates of virological, serological, and biochemical responses, as well as improved liver fibrosis outcomes. Also, switching to TMF resulted in significant benefits in ALT normalization rates (NCT03903796).

Objective:In chronic hepatitis B (CHB) patients with previous 96-week treatment with tenofovir amibufenamide (TMF) or tenofovir disoproxil fumarate (TDF), we investigated the safety profile of sequential TMF treatment from 96 to 144 weeks.Methods:Enrolled subjects that previously assigned (2:1) to receive either 25 mg TMF or 300 mg TDF with matching placebo for 96 weeks received extending or switching TMF treatment for 48 weeks. Safety profiles of kidney, bone, metabolism, body weight, and others were evaluated.Results:666 subjects from the initial TMF group and 336 subjects from TDF group with at least one dose of assigned treatment were included at week 144. The overall safety profile was favorable in each group and generally similar between extended or switched TMF treatments from week 96 to 144. In subjects switching from TDF to TMF, the non-indexed estimated glomerular filtration rate (by non-indexed CKD-EPI formula) and creatinine clearance (by Cockcroft-Gault formula) were both increased, which were (2.31±8.33) ml/min and (4.24±13.94) ml/min, respectively. These changes were also higher than those in subjects with extending TMF treatment [(0.91±8.06) ml/min and (1.30±13.94) ml/min]. Meanwhile, switching to TMF also led to an increase of the bone mineral density (BMD) by 0.75% in hip and 1.41% in spine. On the other side, a slight change in TC/HDL ratio by 0.16 (IQR: 0.00, 0.43) and an increase in body mass index (BMI) by (0.54±0.98) kg/m 2 were oberved with patients switched to TMF, which were significantly higher than that in TMF group. Conclusion:CHB patients receiving 144 weeks of TMF treatment showed favorable safety profile. After switching to TMF, the bone and renal safety was significantly improved in TDF group, though experienceing change in metabolic parameters and weight gain (NCT03903796).

Objective:To elucidate the etiological and epidemiological characteristics and epidemiological patterns of viral acute respiratory infections (ARI) in Shanghai during 2023, with the aim of providing robust laboratory evidence for effective prevention and control strategies against related respiratory diseases and facilitating risk assessment.Methods:Respiratory pathogens were detected in the clinical surveillance specimens submitted by sentinel hospitals through multiplex PCR, as part of the multi-pathogen surveillance of acute respiratory infections in Shanghai during 2023. The obtained detection result were statistically analyzed in conjunction with sample information.Results:The positive detection rate of viral pathogens in 2023 was 21.17% (984/4 648), with rates of 33.53% (504/1 503) observed in ILI cases and 15.62% (480/3 145) in SARI cases. Influenza A virus (FluA) was the predominant virus detected, accounting for 13.7% (637/4 648). Other viruses identified in the surveillance samples included influenza B virus (Flu B), human rhinovirus/enterovirus (HRV/HEV), respiratory syncytial virus (RSV), human metapneumovirus (HMPV), parainfluenza virus (PIV), adenovirus (ADV) and human bocavirus (HBoV). Regarding temporal distribution, HRV/HEV and RSV exhibited the highest detection rates during the second quarter at 2.27% each (28/1 236). PIV had its peak during the third quarter at a rate of 2.49% (35/1 405), and HMPV showed prevalence mainly during the third and fourth quarters, with detection rates of 2.63% (37/1 405) and 2.35% (32/1 360), respectively.Conclusions:In acute respiratory infection surveillance cases in Shanghai in 2023, Flu A emerged as the predominant respiratory pathogen. The detection rate of HMPV ranked second only to Flu A, while other respiratory viruses such as HRV/HEV, RSV, and PIV were detected during different seasons and co-circulated. The prevalence of various respiratory viruses varied among different infected populations and over times.

Objective:To summarize and analyze the early clinical outcomes of aortic endovascular remodeling device (AERD) for single-stage complete repair of acute aortic dissection.Methods:A total of 19 patients with acute aortic dissection who underwent proximal aortic dissection repair combined with distal AERD implantation at the Center for Aortic Surgery of Beijing Anzhen Hospital, Capital Medical University between May 2023 and October 2023, of whom 6 had type A aortic dissection and 13 had type B aortic dissection, were retrospectively analyzed. One-month postoperative follow-up and aortic CTA were completed to compare pre- and postoperative abdominal branch outcomes and aortic wall remodeling.Results:The success rate of AERD implantation in this patient cohort was 100%, and no complications such as paraplegia or visceral ischemia were observed during the perioperative and postoperative follow-up periods. All abdominal branches were patent postoperatively, and 15 branches had preoperative " high-risk" subtype malperfusion, 14 of which improved postoperatively. All patients showed significant increase of the true lumen volume compared with the preoperative one, and 89.5% (17/19) had a postoperative true lumen/overall volume ratio of more than 70%.Conclusion:The single-stage complete repair of proximal aortic dissection repair combined with distal AERD implantation is simple, safe and effective, associated with satisfactory early outcomes.

Objective:This study aims to summarize the pathological anatomy characteristics of residual aortic dissection (RAD) in patients with acute aortic dissection (AAD) during the perioperative period by measuring and analyzing the preoperative and postoperative 60-day computed tomography angiography (CTA) images of the aorta, with the intention of guiding further clinical treatment.Methods:A retrospective cohort study design was adopted. A total of 224 patients hospitalized with acute aortic dissection from December 2021 to October 2022 at a single center were included according to inclusion and exclusion criteria and divided into two groups based on Stanford classification. Computed tomography angiography (CTA) images of the aorta during the perioperative period (preoperative or postoperative 60 days) were collected, and relevant indicators were measured to describe the pathological anatomy characteristics of residual aortic dissection.Results:Among the measured range, there were 4 patients (1.8%) without distal tears, with a total of 648 identified distal tears. The numbers of tears in the A, B, and C segments were 211 (32.6%), 203 (31.3%), and 234 (36.1%), respectively. The average numbers of tears in the A, B, and C segments were 0.9±1.1, 0.9±0.9, and 1.0±1.2 per person, respectively. The corresponding average tear areas were(34.9±46.7)mm 2, (29.0±30.5)mm 2, and(18.6±23.9)mm 2, respectively. The average distances from tears to the upper and lower edges of the celiac trunk were(36.8±33.2)mm and(2.3±3.8)mm, respectively; to the upper and lower edges of the superior mesenteric artery (SMA) were(2.3±4.1 )mm and(1.2±2.6) mm, respectively; to the upper and lower edges of the left renal artery were(0.1±0.6) mm and(38.5±24.4) mm, respectively; and to the upper and lower edges of the right renal artery were(0.7±2.6) mm and(8.1±17.3) mm, respectively. True lumen blood supply for the celiac trunk was observed in 151 cases (67.4%); dual luminal supply in 49 cases (21.9%); and false lumen supply in 24 cases (10.7%). True lumen blood supply for the SMA was observed in 187 cases (83.5%); dual luminal supply in 32 cases (14.3%); and false lumen supply in 5 cases (2.2%). True lumen blood supply for the left renal artery was observed in 150 cases (67.0%); dual luminal supply in 27 cases (12.1%); and false lumen supply in 47 cases (21.0%). True lumen blood supply for the right renal artery was observed in 148 cases (66.1%); dual luminal supply in 30 cases (13.4%); and false lumen supply in 46 cases (20.5%). True lumen blood supply for both renal arteries was observed in 83 cases (37.1%); dual luminal supply in 4 cases (1.8%); and false lumen supply in 1 case (0.5%). Conclusion:The results of this study suggest that the average number of distal tears per person in patients with AAD is 2.9±1.9, with only 1.8% of patients having no distal tears. The average tear areas in the A, B, and C segments are(34.9±46.7) mm 2, (29.0±30.5) mm 2, and (18.6±23.9) mm 2, respectively. 61.2% of patients have tears in the abdominal aortic branch segment, and the tears are located at the same level as the abdominal aortic branches. Among the branches of the abdominal aorta, the renal arteries are most commonly affected by dissection, while the SMA is least affected. This study elucidates the anatomical basis for the limitations of existing repair methods and provides a theoretical basis for the design of subsequent repair techniques.

Objective To clarify the influencing factors of defensive medicine and provide ideas for preventing and re-solving defensive medicine.Methods Literature related to defensive medicine was searched,personnel related to de-fensive medicine were interviewed,and literature and interview data were coded with the method of grounded theo-ry,and related concepts and categories were summarized.Results After three levels of coding,52 initial concepts,23 initial categories,7 sub-categories and 3 main categories were sorted out,and the correlation among influencing factors was analyzed to build a three-dimensional model of"doctor-patient relationship-institutional system-social environment"influencing factors and their mechanism of action.Conclusion The influencing factors of defensive medi-cine mainly include doctor-patient relationship,institutional system and social environment.The three factors have an impact on defensive medicine through different mechanisms of action,which provides qualitative evidence for comprehensive analysis of factors in related studies of defensive medicine.

Objective To understand the status of behavioral intentions of defensive medical treatment in medical students,and explore the relationship between practice environment and behavioral intentions of defensive medical treatment.To provide reference for reducing the tendency of defensive medicine(DM)behavior of medical students and improving the negative effects of DM.Methods A web-based questionnaire survey was conducted among medi-cal students in four medical colleges in Heilongjiang Province.The structural equation modeling of the relationship be-tween practice environment and behavioral intentions of defensive medical treatment in medical students was con-structed by Amos 26.0 software.Results The mean score of medical students'behavioral intentions of positive and negarive defensive medical treatment was 44.49-6.90 and 20.06-6.83,respectively.The behavioral intention of posi-tively defensive medical treatment was positively associated(β=0.892,P＜0.05)with cognition of doctor-patient relationship.While the behavioral intention of negative defensive medical treatment was positively correlated(β=0.403,0.343,P＜0.05)with environment cognition,perception of risk and negatively correlated(β=-0.726,P＜0.05)with cognition of doctor-patient relationship.As an intermediary variable,the direct and indirect effects of cog-nition of doctor-patient relationship on negative defensive medical behavior tendency were-0.470 and 0.043,the difference was statistically significant(P＜0.05).Conclusion Improving cognition of medical students'doctor-pa-tient relationship is beneficial to understand defensive medical treatment for medical students.The negative defen-sive medical behavior tendency of medical students should be reduced by reducing their negative cognition of environ-ment or improving their cognition of doctor-patient relationship.

Objective To clarify the influencing factors of defensive medicine and provide ideas for preventing and re-solving defensive medicine.Methods Literature related to defensive medicine was searched,personnel related to de-fensive medicine were interviewed,and literature and interview data were coded with the method of grounded theo-ry,and related concepts and categories were summarized.Results After three levels of coding,52 initial concepts,23 initial categories,7 sub-categories and 3 main categories were sorted out,and the correlation among influencing factors was analyzed to build a three-dimensional model of"doctor-patient relationship-institutional system-social environment"influencing factors and their mechanism of action.Conclusion The influencing factors of defensive medi-cine mainly include doctor-patient relationship,institutional system and social environment.The three factors have an impact on defensive medicine through different mechanisms of action,which provides qualitative evidence for comprehensive analysis of factors in related studies of defensive medicine.