Objective:To analyze the effectiveness of antiviral therapy on adolescents and adults with infectious mononucleosis (IM).Methods:The clinical data of patients aged≥16 years old with IM who were hospitalized in Peking University First Hospital from January 1, 2005 to December 31, 2018 were analyzed retrospectively, and the patients were divided into antiviral treatment group and non-antiviral treatment group. The duration of hospitalization day, fever duration, ratio of lymphocytes and duration for normalization of Epstein-Barr virus (EBV) markers were compared between the two groups through single factor and propensity score matching analysis. Statistical analysis was conducted by independent sample t test, Mann-Whitney U test, chi-square test or Fisher exact probability method. Results:A total of 274 cases were enrolled and 176 cases (64.23%) were divided into antiviral treatment group and 98 cases (35.77%) into non-antiviral treatment group. The proportion of male (56.25%(99/176) vs 56.12%(55/98)), age (21.0(18.0, 26.0) years old vs 21.0(18.0, 27.0) years old), the ratio of fever (98.30%(173/176) vs 93.88%(92/98)), sore throat (90.34%(159/176) vs 88.78%(87/98)), lymphocyte ratio (0.648(0.568, 0.707) vs 0.663(0.581, 0.711)), atypical lymphocyte ratio (0.150(0.100, 0.235) vs 0.135(0.060, 0.250)) and serum EBV DNA level (2.71(2.70, 3.47) lg copies/mL vs 2.70(2.70, 3.28) lg copies/mL) were comparable between two groups at admission, and the differences were all not statistically significant(all P>0.05). The durations of hospitalization and fever in antiviral treatment group were 14.0(10.0, 18.0) d and (14.91±7.24) d, respectively, which were both significantly longer than those in non-antiviral treatment group (11.0(7.0, 15.0) d and (9.95±5.67) d, respectively). The differences were both statistically significant ( Z=-3.294 and t=-5.035, respectively, both P<0.01). Twenty-six patients each in the antiviral treatment group and non-antiviral treatment group were included in the propensity score matching assessment. The fever days of the two groups were 15.0(10.0, 18.0) d and 7.5(5.0, 12.5) d, respectively, and the hospitalization days were (15.4±5.5) d and (12.0±5.7) d, respectively. The differences were both statistically significant ( Z=-3.781 and t=-2.187, respectively, both P<0.05). However, there were no significant differences in the time required for the ratio of lymphocytes returning to normal, the time required for the ratio of atypical lymphocytes decreasing to <0.100, and the time required for serum EBV DNA becoming negative(all P>0.05). Conclusion:The antiviral treatment could not improve the prognosis of adolescent and adult IM patients.

Objective To explore the possible associations between EBV capsid antigen-immunoglobulin M antibody (EBV-VCA-IgM ) ,serum EBV DNA load and clinical severity ,laboratory results in adolescent and adult patients with infectious mononucleosis (IM ).Methods Clinical data of 250 adolescent and adult IM patients were retrospectively analyzed .Patients were divided into two groups by EBV-VCA-IgM titer (＞160 U/mL or≤160 U/mL) and serum EBV DNA level (＞3 .38 lg copies/mL or ＜3.38 lg copies/mL) ,respectively . Clinical data were compared between the two groups ,respectively .The t test was used for intergroup comparison and the Mann-Whitney U test was used for non-normally distributed data .Results Compared with those with lower VCA-IgM antibody titer (≤160 U/mL) ,sore throat (83.0%[122/147] vs 67.2%[43/64] ,χ2＝ 6.534 ,P＝0 .011) ,pharynx secretion (59 .9%[88/147] vs 40 .6%[26/64] ,χ2＝6.645 , P＝0 .010) ,and swollen tonsils (78 .9%[116/147] vs 59.4%[38/64] ,χ2＝8.631 , P＝0.003) were more common in those with higher VCA-IgM antibody titer (＞160 U/mL).ALT level was higher as well in those with higher VCA-IgM antibody titer (290 .5 [168.0 ,460.5] U/L vs 221 .0[113 .0 ,440.5] U/L ,Z＝ －2.251 ,P＝0.024).The peak body temperature ([39.2 ± 0.7]°C vs [38.7 ± 0 .7]°C ,t＝ －3 .150 ,P＝0.002) ,maximum WBC counts (16 .2 [12 .2 ,20.4]×109/L vs 13.4[11 .1 ,17.3]×109/L ,Z＝ －2 .098 , P＝0.036) ,maximum percentage of lymphocyte ([72.0 ± 7.8]% vs [68.2 ± 7 .0]%,t＝ －2.238 ,P＝0.028) ,and lymphocyte EBV DNA load ([5 .5 ± 0.9] lg copies/mL vs [4 .8 ± 1 .0] lg copies/mL ,t＝ －2 .602 ,P＝0.012)in those with higher serum EBV DNA load ＞3 .38 lg copies/mL were higher than those with serum EBV DNA load ＜3.38 lg copies/mL . Regression analysis showed that serum EBV DNA load was associated with the peak body temperature (regression coefficient 0.368 , P＝0.003) and lymphocyte EBV DNA load (regression coefficient 0.389 , P＝0.002).Conclusions In adolescents and adults ,EBV-VCA-IgM antibody titer and serum EBV DNA load are associated with severity of patients with infectious mononucleosis .

Objective To investigate the effect of peripheral blood MDC on predicting adverse cardiac events of patients with acute STEMI. Methods Thirty-nine patients with acute ST segment elevation myocardial infarction admitted in the People′s Hospital of Deyang from February 2016 to August 2017 were selected by random sampling. According to 7-day adverse cardiac events, the patients were divided into non-combination adverse cardiac events group (uncomMI group, 23 patients) and combination adverse cardiac events group (comMI group, 16 patients), and 24 healthy persons were selected as normal control group. The general situation, clinical characteristics and MDC, PDC, analysis of uncomMI group and comMI group in the 1st and 3rd day after the onset of acute ST segment elevation myocardial infarction was compared. Factors influencing adverse cardiac events in patients with acute ST segment elevation myocardial infarction were analyzed. Results The peripheral blood MDC and plasmacytoid dendritic cell (PDC) counts in patients with STEMI were significantly lower than those in normal controls in early time(at the time of day 1)(P<0.05), but the peripheral blood MDC and PDC counts in uncomMI group was not significantly different from that in normal control group at the time of day 3 (P>0.05). The peripheral blood MDC and PDC counts in comMI group were lower than those in uncomMI group and control group. The Logistic analysis showed that the elderly patients, total cholesterol (TC), MDC (at the time of day 3) were all risk factors of 7-day adverse cardiac events (P < 0.05). The receiver operating characteristic (ROC) results showed that the maximum area under curve(AUC) was 0.8286 when the MDC truncation point was 7 mg/L, and the sensitivity was 80.0% and the specificity was 85.7% . Conclusions For STEMI patients, MDC of peripheral blood is associated with 7-day adverse cardiac events. The percentage of MDC in peripheral blood of patients with acute STEMI has a certain clinical value in the diagnosis of 7-day adverse cardiac events. In addition, elderly patients with STEMI have an increased risk of 7-day adverse cardiac events.

[Objective] To explore the relationship between anti-HEV antibody reactivity rate and different age groups in Chinese voluntary blood donors by Meta-analysis. [Methods] Literatures on anti-HEV IgG reactivity rate and anti-HEV IgM reactivity rate of voluntary blood donors in different age groups in China were searched from China National Knowledge Infrastructure (CNKI), PubMed and Wanfang Medicine database, with a search time from January 1, 2007 to December 31, 2023. Risk difference (RD) was selected as the effect size after grouping the included literature according to age, and meta-analysis was performed using Review Manager 5.3 software. [Results] A total of 17 articles were included, among which 16 were about anti-HEV IgG and 15 about anti-HEV IgM. Based on different age grouping methods, they were divided into two groups. The age groups of group A were divided into ≤ 20 years old, 21-30 years old, 31-40 years old, 41-50 years old and >50 years old. The age groups of group B were divided into 18-25 years old, 26-35 years old, 36-45 years old, and ≥46 years old. The pooled results of Meta-analysis showed that the RD value of anti-HEV IgG reactivity rate in group A was 22.92% [95% CI (19.02%, 26.82%)], and the RD value of anti-HEV IgM reactivity rate was 0.67% [95% CI (0.51%, 0.82%)]. The RD value of anti-HEV IgG reactivity rate in group B was 33.03% [95% CI (28.01%, 38.05%)], and the RD value of anti-HEV IgM reactivity rate was 1.13% [95% CI (1.05%, 1.21%)]. The results of subgroup analysis showed that in both group A and B, the anti-HEV IgG reactivity rate in voluntary blood donors increased with age. In group A, no increase in the reactivity rate of anti-HEV IgM with age was found in voluntary blood donors. In group B, the anti-HEV IgM reactivity rate increased with age. Further analysis showed that in the two groups of A and B, the anti-HEV IgM reactivity rate increased with age in areas where the anti-HEV IgM reactivity rate was greater than 1%. [Conclusion] The anti-HEV IgG reactivity rate and anti-HEV IgM reactivity rate in voluntary blood donors increased with age.

Objective:To analyze common respiratory pathogens epidemiology in hospitalized children with lower respiratory tract infection (LRTI) in a single center in Shanghai, and to provide the basic data support for clinical diagnosis and treatment of children with LRTI in Shanghai.Methods:Children with LRTI in Children′s Hospital of Fudan University were enrolled from January 1, 2015 to December 31, 2019, and respiratory samples were collected and tested by direct immunofluorescence assay and real time polymerase chain reaction. The epidemiological characteristics of different respiratory pathogens were analyzed. Chi-square test was used for statistical analysis.Results:A total of 18 716 children were included, the total detection rate of respiratory pathogens was 36.96% (6 918/18 716), and the most frequent detected pathogen was Mycoplasma pneumoniae (MP) (15.31%(2 866/18 716)), followed by respiratory syncytial virus (RSV) (10.40%(1 946/18 716)) and parainfluenza virus Ⅲ (PIV-Ⅲ) (4.65%(871/18 716)). The detection rate of pathogens in female was significantly higher than that in male (38.48%(2 936/7 630) vs 35.92%(3 982/11 086), χ2=12.72, P<0.001). RSV and influenza virus A (Flu-A) infections peaked in winter. The detection rates of influenza virus B (Flu-B) and human metapneumovirus (MPV) were higher in winter and spring. PIV-Ⅲ infection peaked in spring and summer. The peak of PIV-Ⅱ infection occurred in summer and autumn. The infections of adenovirus (ADV), MP, Chlamydia trachomatis (CT) and PIV-Ⅰ were prevalent throughout the year without significant seasonality. The detection rate of RSV declined with age, while the detection rate of MP increased with age. The co-infection rate was 1.65%(309/18 716), and the predominant co-infection type was MP and RSV (0.37%(70/18 716)). Conclusions:A variety of pathogens lead to children′s LRTI in Shanghai from 2015 to 2019, with the common infection of MP, RSV and PIV-Ⅲ. Different pathogens showed different epidemiological characteristics in age and season distributions.

ObjectiveTo investigate the features of liver injury and related influencing factors in adolescents and adults with infectious mononucleosis (IM). MethodsA retrospective analysis was performed to investigate the features of liver injury in adolescents and adults with IM who were hospitalized in Peking University First Hospital from January 2005 to December 31 2018, and the patients were divided into subgroups based on age, Epstein-Barr virus (EBV) DNA level, and presence or absence of jaundice or infection with cytomegalovirus or hepatitis E virus (HEV). The t-test was used for comparison of continuous data meeting analytical conditions between two groups, and the Mann-Whitney U test was used for comparison of continuous data which did not meet analytical conditions between two groups; the chi-square test was used for comparison of categorical data between two groups, and the Fisher’s exact test was used for comparison of categorical data which did not meet the analytical conditions of the chi-square test. A logistic regression analysis was used for multivariate analysis. ResultsA total of 274 patients were enrolled, with 154 male patients (56.2%) and 120 female patients (43.8%), and the mean age of onset was 22.3±67 years. The incidence rate of liver injury ［defined as alanine aminotransferase (ALT) ＞50 U/L and/or aspartate aminotransferase (AST)＞40 U/L］ was 97.4% (267/274), and that of jaundice was 27.6% (74/268). The patients, aged ≥20 years, tended to have a higher level of gamma-glutamyl transpeptidase (GGT) (Z=2.070, P=0.038). Serum EBV DNA was measured for 167 patients, among whom 90 had positive results and 77 had negative results. The positive serum EBV DNA group had significantly higher levels of GGT (Z=3.005, P=0.003) and lactate dehydrogenase (Z=2.162, P=0.031) than the negative serum EBV DNA group. The patients with cytomegalovirus infection tended to have a higher level of alkaline phosphatase (Z=2.351, P=0.019), and the patients with HEV infection presented with a higher level of GGT (Z=1.988, P=0.047). AST (odds ratio ［OR］=1.006, 95% confidence interval ［CI］: 1.002-1.010, P=0.005) and ALP (OR=1.012, 95%CI: 1.005-1.020, P=0.001) were independent risk factors for jaundice. ConclusionThere is a high incidence rate of liver injury in adolescents and adults with IM, and the patients with an older age or positive serum EBV DNA tend to have more severe liver injury.

Colorectal cancer is currently one of the most common malignant tumors in the world,and its incidence and mortality rates have gradually increased in recent years.As insidious symptoms characterize early colorectal cancer,most of the patients have already developed into late or advanced stages in the primary survey.For stage Ⅳ metastatic colorectal cancer(mCRC),surgery supplemented with chemotherapy or radiotherapy for mCRC patients has a low 5-year survival rate.With the development of immunology in recent years,PD-1/PD-L1 inhibitors have made breakthroughs in treating malignant tumors.They also have improved the therapeutic efficacy of some mCRC patients,especially those with microsatellite instability-high/mismatch repair deficient.The guidelines recommend this approach.However,patients with microsatellite stable/mismatch repair proficiency,which accounts for more than 90%,are poorly treated with PD-1/PD-L1 inhibitors.Fortunately,there are several clinical studies that reported that some of this type of mCRC can gain some benefit.In this review,we examined the anti-tumor mechanism of PD-1/PD-L1 inhibitors and the latest progress of PD-1/PD-L1 inhibitor's clinical application in patients of mCRC with different genotypes.We discussed the prospect of PD-1/PD-L1 inhibitor combination therapy to provide a reference to the benefit of this type of patients and provide information for optimizing the dosing regimen of PD-1/PD-L1 inhibitors in the treatment of mCRC.