ObjectiveTo identify the rate， population characteristics， and vaccination history of repeat infections among previously infected people in the current epidemic based on the rate of repeat infection and population characteristics of different mutant strains at different times in Pudong New Area of Shanghai， and to provide reference for the prevention and control strategies of novel coronavirus repeat infections. MethodsA total of 9 250 investigated subjects were randomly selected from the new cases of asymptomatic infection and confirmed cases reported by Pudong New Area from March to May 2022. The investigation mainly focused on demographic characteristics， nucleic acid or antigen test results， and symptoms after infection. The repeat infection rates among different populations were compared， and logistic regression was used to analyze the impact of gender， age， and vaccination status on repeat infections. ResultsThe survey sample of 9 250 people had a response rate of 81.85%. There were 4 043 males （53.40%） and 3 528 females （46.60%）， with a median age of 34 years old （P₂₅， P₇₅： 7， 61）. The overall vaccine uptake rate was 59.44% （4 500/7 571）. In December of 2022， there were 563 cases of repeat infection， with an infection rate of 7.44%. The lowest rate of repeat infection was seen in the 3‒ year-old group （2.86%） and the highest rate in the 30‒ year-old group （12.42%）， with significant differences between different age groups. The repeated infection rate for those who had completed their vaccinations was significantly lower （6.57%） compared to those who had not （7.11%）. The age groups of 3‒ years， 70‒79 years， as well as individuals who completed full vaccination and received booster shots were protective factors against repeat infections. ConclusionThe overall rate of reinfection among the infected in Shanghai during the spring of 2022 was low in the outbreak of the Omicron variant， and the rate of reinfection in the 3‒ year-old group was significantly lower than in other age groups. Completing the full course of vaccination significantly reduces the risk of reinfection. Although the reinfection rate is high in individuals who received booster shots， it remains a mitigating factor compared to those who do not receive the vaccine. It is recommended to continue monitoring reinfections in key populations and further strengthen immunization efforts.

Objective:To explore the clinical characteristics of tumor necrosis factor-α (TNF-α) inhibitors-related optic neuritis.Methods:The database at home and abroad (as of November 2022) were searched and the case reports on optic neuritis induced by TNF-α inhibitors were collected. Clinical data including gender, age, use of TNF-α inhibitors, combination drugs, time to onset of optic neuritis, clinical manifestations, results of ancillary examinations, treatment and outcome were extracted and analyzed descriptively.Results:A total of 37 patients were enrolled in the study, including 16 males and 21 females, with an average age of 44 years; 11 patients were treated with adalimumab, 16 with infliximab, 8 with etanercept, 1 with golimumab, and 1 with peselizumab. Among them, 5 patients had previously been treated with other TNF-α inhibitors. The primary disease was rheumatoid arthritis in 15 patients, Crohn′s disease and ulcerative colitis disease in 8 patients, psoriatic arthritis in 3 patients, anterior uveitis in 2 aptients, and other rheumatic and inflammatory diseases in 9 patients. Of them, 4 patients were complicated with other diseases. The median time from TNF-α inhibitors use to optic neuritis occurrence was 4.5 months (3 days to 2 years). The most common clinical manifestations were decreased vision and ocular movement pain. Of the 37 patients, cerebrospinal fluid (CSF) analysis was performed in 8 patients, and 6 were abnormal. CSF oligoclonal bands were detected in 7 patients, and 4 were positive. Magnetic resonance imaging of the brain or orbit was performed in 32 patients, 11 patients showed optic nerve enhancement, 14 patients had brain lesions, and 5 patients had cervical or spinal cord lesions. Visual acuity was examined in 30 patients, 29 of which showed decreased vision. Of the 37 patients, 24 patients stopped the suspected drugs and were treated with glucocorticoid (GC), 6 patients only stopped medication but not treated with GC, and it was not described in 7 patients, 5 of whom were treated with GC. Of the 37 patients, 30 patients recovered partially or completely after discontinuation of the drugs and/or treated with GC, 6 patients were not improved and 1 patient was deteriorated.Conclusions:TNF-α inhibitors-related optic neuritis mostly occurs within the first 6 months of treatment, and more common clinical manifestation is visual acuity loss, with or without brain MRI lesions. Early detection and intervention usually lead to a better prognosis.

Objective:To explore the clinical characteristics of tumor necrosis factor-α (TNF-α) inhibitors-related optic neuritis.Methods:The database at home and abroad (as of November 2022) were searched and the case reports on optic neuritis induced by TNF-α inhibitors were collected. Clinical data including gender, age, use of TNF-α inhibitors, combination drugs, time to onset of optic neuritis, clinical manifestations, results of ancillary examinations, treatment and outcome were extracted and analyzed descriptively.Results:A total of 37 patients were enrolled in the study, including 16 males and 21 females, with an average age of 44 years; 11 patients were treated with adalimumab, 16 with infliximab, 8 with etanercept, 1 with golimumab, and 1 with peselizumab. Among them, 5 patients had previously been treated with other TNF-α inhibitors. The primary disease was rheumatoid arthritis in 15 patients, Crohn′s disease and ulcerative colitis disease in 8 patients, psoriatic arthritis in 3 patients, anterior uveitis in 2 aptients, and other rheumatic and inflammatory diseases in 9 patients. Of them, 4 patients were complicated with other diseases. The median time from TNF-α inhibitors use to optic neuritis occurrence was 4.5 months (3 days to 2 years). The most common clinical manifestations were decreased vision and ocular movement pain. Of the 37 patients, cerebrospinal fluid (CSF) analysis was performed in 8 patients, and 6 were abnormal. CSF oligoclonal bands were detected in 7 patients, and 4 were positive. Magnetic resonance imaging of the brain or orbit was performed in 32 patients, 11 patients showed optic nerve enhancement, 14 patients had brain lesions, and 5 patients had cervical or spinal cord lesions. Visual acuity was examined in 30 patients, 29 of which showed decreased vision. Of the 37 patients, 24 patients stopped the suspected drugs and were treated with glucocorticoid (GC), 6 patients only stopped medication but not treated with GC, and it was not described in 7 patients, 5 of whom were treated with GC. Of the 37 patients, 30 patients recovered partially or completely after discontinuation of the drugs and/or treated with GC, 6 patients were not improved and 1 patient was deteriorated.Conclusions:TNF-α inhibitors-related optic neuritis mostly occurs within the first 6 months of treatment, and more common clinical manifestation is visual acuity loss, with or without brain MRI lesions. Early detection and intervention usually lead to a better prognosis.

Objective:To systematically evaluate the risk of severe gastrointestinal events in patients with cancer caused by vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR-TKI).Methods:Randomized controlled trials of VEGFR-TKI in the treatment of tumors were collected by searching relevant databases at home and abroad (up to March 2, 2019). The patients who were treated with a VEGFR-TKI were enrolled into the trial group, and those who received placebo or another VEGFR-TKI were enrolled into the control group. The outcomes included the incidence of serious gastrointestinal events. The Jadad scoring method was used to assess the quality of included studies. The Review Manager 5.3 software was used for direct meta-analysis on the risk of severe gastrointestinal events. Stata 13.0 software and linear mixed model based on frequency framework were used for network meta-analysis on severe gastrointestinal events at the highest risk. The results were expressed by relative risk ( RR) and its 95% confidence interval ( CI). Results:A total of 38 studies were included in the analysis, all of which were high-quality studies (Jadad score 4-7), comprising a total of 15 217 patients (9 130 in the trial group and 6 087 in the control group). The results of direct meta-analysis showed that the risks of severe diarrhea, severe anorexia, and severe nausea in the trial group were higher than those in the control group respectively, and the differences were statistically significant [6.8% (602/8 894) vs. 0.7% (49/6 584), RR=6.62 (95 %CI: 5.00-8.76), P<0.001; 2.5% (201/7 937) vs. 0.7% (41/5 831), RR=2.14 (95 %CI: 1.40-3.25), P<0.001; 1.5% (92/6 343) vs. 0.4% (21/4 870), RR=1.95 (95 %CI: 1.23-3.12), P=0.005]; the risk of severe diarrhea was the highest [6.8% (602/8 894)]. There was no significant difference in the risk of severe vomiting and severe abdominal pain compared with the control group [1.4% (79/5 788) vs. 0.7% (32/4 428), RR=1.49 (95 %CI: 0.90-2.47), P=0.120; 1.7% (82/4 766) vs. 1.1% (40/3 628), RR=1.35 (95 %CI: 0.84-2.16), P=0.210]. The results of network meta-analysis on risk of severe diarrhea events showed that the relative risks of severe diarrhea caused by varieties of VEGFR-TKI were axitinib>anlotinib>cabozantinib≈vandetanib≈sunitinib≈lenvatinib≈sorafenib≈pazopanib>regorafenib>fruquintinib>apatinib in the order. Conclusion:The application of VEGFR-TKIs, especially axitinib, can increase the risk of severe diarrhea in patients with tumors, which deserves clinical attention and vigilance.

Objective:To systematically evaluate the risk of severe gastrointestinal events in patients with cancer caused by vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR-TKI).Methods:Randomized controlled trials of VEGFR-TKI in the treatment of tumors were collected by searching relevant databases at home and abroad (up to March 2, 2019). The patients who were treated with a VEGFR-TKI were enrolled into the trial group, and those who received placebo or another VEGFR-TKI were enrolled into the control group. The outcomes included the incidence of serious gastrointestinal events. The Jadad scoring method was used to assess the quality of included studies. The Review Manager 5.3 software was used for direct meta-analysis on the risk of severe gastrointestinal events. Stata 13.0 software and linear mixed model based on frequency framework were used for network meta-analysis on severe gastrointestinal events at the highest risk. The results were expressed by relative risk ( RR) and its 95% confidence interval ( CI). Results:A total of 38 studies were included in the analysis, all of which were high-quality studies (Jadad score 4-7), comprising a total of 15 217 patients (9 130 in the trial group and 6 087 in the control group). The results of direct meta-analysis showed that the risks of severe diarrhea, severe anorexia, and severe nausea in the trial group were higher than those in the control group respectively, and the differences were statistically significant [6.8% (602/8 894) vs. 0.7% (49/6 584), RR=6.62 (95 %CI: 5.00-8.76), P<0.001; 2.5% (201/7 937) vs. 0.7% (41/5 831), RR=2.14 (95 %CI: 1.40-3.25), P<0.001; 1.5% (92/6 343) vs. 0.4% (21/4 870), RR=1.95 (95 %CI: 1.23-3.12), P=0.005]; the risk of severe diarrhea was the highest [6.8% (602/8 894)]. There was no significant difference in the risk of severe vomiting and severe abdominal pain compared with the control group [1.4% (79/5 788) vs. 0.7% (32/4 428), RR=1.49 (95 %CI: 0.90-2.47), P=0.120; 1.7% (82/4 766) vs. 1.1% (40/3 628), RR=1.35 (95 %CI: 0.84-2.16), P=0.210]. The results of network meta-analysis on risk of severe diarrhea events showed that the relative risks of severe diarrhea caused by varieties of VEGFR-TKI were axitinib>anlotinib>cabozantinib≈vandetanib≈sunitinib≈lenvatinib≈sorafenib≈pazopanib>regorafenib>fruquintinib>apatinib in the order. Conclusion:The application of VEGFR-TKIs, especially axitinib, can increase the risk of severe diarrhea in patients with tumors, which deserves clinical attention and vigilance.

Objective To understand the spatial epidemic characteristics of hand-foot-mouth disease in Pudong New Area of Shanghai from 2015 to 2018, and to provide reference for prevention and control. Methods SPSS 21.0 software was used for statistical analysis of the reported incidence of hand-foot-mouth disease, ArcGIS 10.2 software was used to make geographic distribution map, and OpenGeoDa software was used to make spatial autocorrelation analysis. Results The global Moran's I autocorrelation coefficient of the reported incidence rate of hand-foot-mouth disease in various streets and towns in Pudong New Area of Shanghai was 0.38, which was statistically significant (P=0.001). Local spatial autocorrelation analysis found that 5 streets were in high-high area. Conclusion The geographical distribution of reported incidence of hand-foot-mouth disease in various streets and towns of Pudong New Area in Shanghai was spatially aggregated, and the reported incidence decreased from north to south.

Background and aim:Real-world data on the effectiveness and safety of treatment with the direct-acting antiviral agent-based regimen are limited on the Chinese mainland.The aim of this study was to conduct a multicenter,prospective,real-world study of ombitasvir/paritaprevir/ritonavir(OBT/PTV/r)combined with dasabuvir(DSV)in hepatitis C virus(HCV)genotype 1b-infected non-cirrhotic or compensated cirrhotic Chinese adult patients. Materials and methods:Genotype 1b-infected patients were enrolled at eight sites in China.Patients received 25/150/100 mg of OBT/PTV/r once daily combined with 250 mg of DSV twice daily for 8 weeks or 12 weeks.Sustained virological response at 12 weeks post-treatment(SVR12)and the incidence of adverse events were assessed.We have also evaluated the effect of intensive questioning of patients who were overdue for SVR12 testing.Intention-to-treat(1TT)and modified 1TT(mITT)populations were used in the analysis. Results:One hundred forty patients were included,among whom 90.0％(126/140)were newly diag-nosed,9.3％(13/140)had compensated cirrhosis,92.9％(130/140)received 12 weeks of treatment,and 7.1％(10/140)received 8 weeks of treatment.In the mITT population,the virological response rate at week 4 was 96.4％(108/112),and at the end of treatment was 100％(102/102).Among these patients,139 patients completed 12 weeks of treatment,and 73 patients were followed-up.All followed-up patients achieved SVR12.There was no adverse event-related discontinuation.Serious adverse events during treatment were reported in two(1.4％)patients,and none were considered to be drug-related.Sixty-six(47.1％)patients did not return to receive the HCV RNA test at 12 weeks post-treatment. Conclusions:The rate of SVR12 was consistent with Phase Ⅲ clinical studies.OBT/PTV/r combined with DSV showed effectiveness in Chinese adult patients,and both tolerability and safety profile were favorable.However,patient compliance should be further improved in the real world.

OBJECTIVE: To analyze the incidence and risk factors of benign liver space-occupying mass in patients with chronic hepatitis B (CHB) and the ultrasound features that differentiate these masses from small hepatocellular carcinoma. METHODS: We retrospectively analyzed the color Doppler and clinical data of 17 721 patients with CHB treated in the Hepatology Unit of Nanfang Hospital between January, 2016 and December, 2017. The data were compared with those of 21629 healthy control subjects undergoing routine physical examination in the Center of Heath Management of Nanfang Hospital during the same period. RESULTS: Compared with the control subjects, the patients with CHB had significantly higher incidences of hepatic cysts (11.8% 8.7%, < 0.05), hepatic hemangioma (8.2% 1.6%, < 0.05) and hepatic cirrhosis nodules (20.6% 2.4%, < 0.05). The incidences of hepatic cysts and cirrhosis nodules increased with age and was significantly higher in male than in female patients ( < 0.001). The highest incidence of hepatic hemangioma was found in CHB patients aged 30-49 years without a gender difference (>0.05). Sonographically, the benign liver masses commonly showed homogeneous echo within the lesion with clear boundaries and regular shape. Hepatic hemangioma was distinctively hyperechoic in 83.32% (1579/1895) of the patients, while small hepatocellular carcinoma presented with weaker peripheral and internal blood flow signals with a lower flow velocity in the arteries and a higher flow velocity in the portal vein. Liver cirrhosis nodules mostly showed a mixture of strong and weak echoes (79.60%; 7637/9595) without blood flow signal within or around the nodule; an increased volume of the nodule accompanied by heterogeneous echoes within the nodule indicated an increased probability of malignant lesion. Hepatic cysts often displayed no echo within the lesion, but the echo could be enhanced posteriorly. CONCLUSIONS The patients with CHB are at a significantly higher risk of developing hepatic cysts, hepatic hemangiomas and hepatic cirrhosis nodules than the control population, and an older age and the male gender are associated with a higher incidence of hepatic cysts or cirrhosis. The differences in the sonographic and hemodynamic features can help to differentiate hepatic benign mass from malignant lesions, and kinetic changes in sonography can be used to monitor potential malignant transformation of the cirrhotic lesions.

Objective To explore the imaging characteristics and make the differential diagnosis of intraspinal extramedullary epidural lesions. Methods 23 cases with intraspinal extramedullary epidural lesions confirmed by puncture or surgical pathology were selected for retrospective analysis of the lesion morphology,MRI signs and the relationship between the lesion and surrounding tissues.Results Intraspinal extramedullary epidural lesions were more often located at thoracic spinal canal.The shapes of lesions were always various.The malignant tumors were irregular.It could damage the adjacent bone and grew surrounding the spinal cord.Leaping growth and multiple vertebral involvements could be seen in metastasis.The complex components of lesions were related to heterogeneous signal intensity on MRI,which could be presented with hypoGto hyperGintense on T1 WI and T2 WI.The angiolipoma showed hypoGto hyperGintense on T1 WI,and the hyperGintense signal could be suppressed with fatGsuppressed sequence.Meningioma tended to present with homogeneous signal on both T1 WI and T2 WI, with dural tail on contrast MRI.All of the lesions were moderately or significantly enhanced on contrast MRI.Conclusion Intraspinal extramedullary epidural lesions include a wide range of lesions,and the components of lesions are very complex.Among them,the distinctive MRI characteristics include the lesions containing fat and vascular components,besides malignant lesions invading adjacent tissues.Comprehensive analysis of the shape and signal of lesions,as well as the relationship between lesions,and surrounding structures is very helpful in differential diagnosis of intraspinal extramedullary epidural lesions.

Objective To evaluate the relationship between proton pump inhibitor (PPI) and the risk of spontaneous bacterial peritonitis (SBP) in cirrhosis patients systematically.Methods The literature on the related databases as of February 2019 was searched.Case-control studies,cohort studies,and randomized controlled studies (RCT),which set the theme as the relationship between PPI and SBP in cirrhosis patients,whose main outcome indicator was SBP incidence,and which had high quality assessed by Newcastle-Ottawa Scale or modified Jadad scoring method,were collected.The meta-analysis was performed using Rev Man 5.3 software.Results A total of 18 studies were enrolled in the meta-analysis.Of the 18 studies,8 were case-control studies,9 were cohort studies,and 1 was RCT;6 were prospective studies and 12 were retrospective studies;13 were single-center studies and 5 were multi-center studies.A total of 6 961 patients were included,3 353 in the trial group and 3 608 in the control group.The patients in the trial group received PPI alone and the patients in the control group did not receive any acid-suppressing drug.Overall analysis of the 18 studies showed that the risk of SBP in patients in the trial group was markedly higher than that in the control group (OR =1.83,95％ CI:1.43-2.33,P ＜ 0.001).The results of subgroup analysis for 8 case-control studies showed that the risk of SBP in patients in the trial group was markedly higher than that in the control group(OR =2.38,95％ CI:1.69-3.36,P ＜ 0.001).The results of subgroup analysis for 9 cohort studies showed that the risk of SBP of patients in the trial group was markedly higher than that in the control group (OR =1.27,95％ CI:1.04-1.55,P =0.020).The results of subgroup analysis for 12 retrospective studies showed that the risk of SBP in patients in the trial group was markedly higher than that in the control group (OR =1.81,95％CI:1.34-2.45,P=0.001).The results of subgroup analysis for 6 perspective studies showed that the risk of SBP in patients in the trial group was markedly higher than that in the control group (OR =1.88,95％ CI:1.27-2.79,P =0.002).The results of subgroup analysis for 13 single-center studies showed that the risk of SBP in patients in the trial group was markedly higher than that in the control group (OR =1.97,95％ CI:1.41-2.76,P ＜ 0.001).The results of subgroup analysis for 5 multicenter studies showed that the risk of SBP in patients in the trial group was markedly higher than that in the control group (OR =1.69,95％CI:1.33-2.13,P＜0.001).Conclusions PPI can increase the risk of SBP in patients with liver cirrhosis.It is suggested that PPI be used cautiously in patients with liver cirrhosis.