The world is suffering from the monkeypox epidemic, and China is facing a great risk of monkeypox importation. Understanding and mastering clinical manifestations, diagnosis and treatment of monkeypox is one of the important measures to respond to future crises. This review summarizes updated guidelines and relevant studies, and covers main clinical manifestations, diagnosis, treatment and follow-up of monkeypox patients, as well as management of special populations, aiming to provide references for clinicians and prevention workers.

Monkeypox is a zoonotic disease caused by monkeypox virus, and human cases infected with the virus have been reported in more than 100 countries. To respond to the potential of case importation and consequent spread of the infection in the country, it is urgent for China to strengthen its comprehensive surveillance efforts consisting of case detection through country-entering check, symptom screening, and investigation among priority populations, and to implement comprehensive strategies to control the source of infection, interrupt the transmission and protect the people at risk.

Closed-loop hospital management can effectivly cope with the COVID-19 pandemic. In order to ensure the continuity of treatments for hemodialysis patients under closed-loop management and minimize possible medical and infection risks, Huashan Hospital affiliated to Fudan University and 9 hospitals in Shanghai established a hemodialysis alliance in January 2021.The alliance optimized hemodialysis resources within the region through overall planning by preparing sites, materials and personnel shifts in advance, and establishing management systems and work processes to ensure that patients could be quickly and orderly diverted to other blood dialysis centers for uninterrupted high-quality hemodialysis services, in case that some hemodialysis centers in the alliance under closed-loop management.From November 2021 to April 2022, 317 of 1 459 hemodialysis patients in the alliance were diverted to other centers for treatment, accumulating 1 215 times/cases of treatments without obvious adverse reactions. The practice could provide a reference for medical institutions to quickly establish mutual support mode under major public health events.

Mother-to-child transmission (MTCT) of syphilis remains a leading cause of stillbirth and death among neonates in many developing countries. In 2007, World Health Orgernization launched the global elimination of MTCT (EMTCT) of syphilis. Given the high burden of congenital syphilis, China subsequently released the specific national EMTCT policies and programs to reduce MTCT of syphilis. The congenital syphilis incidence rate per 100,000 live births in China has markedly decreased from 69.9 in 2013 to 11.9 in 2019. However, due to the global pandemic of COVID-19, the current measures for eliminating MTCT of syphilis are greatly challenged. In this article, we summarize the strategies and measures for the EMTCT of syphilis in China in the past 20 years, the remarkable achievements by the policy support under the leadership of the government. In the context of COVID-19 pandemics, strengthening emergency response to the regional outbreaks of COVID-19, adopting safe, rapid, early and high-quality clinical care for 100％ of pregnant women to receive prenatal syphilis testing services, ensuring the availability of Benzathine penicillin for the treatment, and strengthening the closed-loop management of pregnant women and newborns infected with syphilis are the key measures to determine the effectiveness of MTCT for syphilis. Lessons from China may be valuable for other countries that are planning to eliminate MTCT of syphilis.

Objective:To investigate the phagocytosis of Treponema pallidum (Tp) by macrophages and the polarization direction of macrophages after Tp stimulation. Methods:Human THP-1 monocyte-derived M0 macrophages were stimulated with the Tp Nichols strain, and the phagocytosis of Tp by macrophages and changes in the intracellular structure of macrophages were observed by transmission electron microscopy and immunofluorescence staining. After 12-hour stimulation by Tp, Tp was removed, the M0 macrophages continued to be cultured for 24, 48, 72 hours and 6 days. Western blot analysis and immunofluorescence staining were performed to determine the expression of the M1 macrophage marker CD86 and M2 macrophage marker CD163, and enzyme-linked immunosorbent assay was conducted to detect levels of M1-type cytokines interleukin (IL) -12 p70, interferon (IFN) -γ, chemokine ligand 10 (CXCL10) , IL-6, tumor necrosis factor (TNF) -α and IL-1β, as well as the M2-type cytokine transforming growth factor (TGF) -β1 in the culture supernatant of macrophages. Dunnett- t test was used for multiple comparisons. Results:As transmission electron microscopy showed, after the stimulation by Tp, the macrophages extended pseudopodia and engulfed Tp, leading to swelling and obviously irregular hyperplasia of endoplasmic reticulum as well as enlargement of mitochondria. Moreover, after additional culture for 24, 48, 72 hours and 6 days, CD86 was highly expressed, but CD163 was lowly expressed in the Tp-treated macrophages; at 24 hours, the supernatant levels of IL-12 p70, IFN-γ, CXCL10, IL-6, TNF-α and IL-1β were significantly higher in the Tp-treated group than in the control group (all P<0.001) , but there was no significant difference in the TGF-β1 supernatant level between the 2 groups ( P>0.05) . Conclusions:After engulfment of Tp, the structures of endoplasmic reticulum and mitochondria in THP-1-derived macrophages markedly changed. Tp could induce the polarization of M0 macrophages into M1 macrophages, and phenotypic switch from M1 to M2 macrophage polarization was not observed within 6 days after Tp stimulation.

Neurosyphilis is one of the most serious clinical manifestations of syphilis. In recent years, more and more neurosyphilis cases have been reported in Chinese literature. However, the exact incidence of neurosyphilis is unknown, and there are still some key scientific problems urgent to be solved in clinical diagnosis and treatment, pathogenesis, and prevention and control of neurosyphilis. Therefore, in order to provide a reference for the prevention and treatment of neurosyphilis, this article proposes the CARE-NS strategy, including the following 6 aspects: Comprehensive management including multiple disciplinary treatment (C) , Alleviating neurological impairment and sequelae (A) , Risk factors and clinical epidemiology (R) , Etiology and pathogenesis (E) , New diagnostic indicators and strategies (N) , Social impact and cost-effectiveness analysis (S) .

Neurosyphilis is a serious clinical stage of syphilis caused by Treponema pallidum invading the nervous system, and risk and predictive factors of neurosyphilis are different between syphilis patients with and without HIV infection. The risk factors for neurosyphilis in HIV-negative patients with syphilis mainly include gender, age, clinical stage of syphilis, treatment, etc.; the predictive factors include serological titers, changes in some indicators of cerebrospinal fluid, neurological or ophthalmic symptoms. HIV viral load, CD4 + T cell counts and antiretroviral treatment are the main predictors and risk factors for neurosyphilis in HIV-positive patients with syphilis.

Neurosyphilis is an infection of the central nervous system caused by Treponema pallidum with complex and atypical clinical manifestations. As no gold standard has been established, the diagnosis of neurosyphilis mainly relies on a comprehensive analysis of epidemiological history, clinical manifestations and laboratory examinations. This review discussed the advances in laboratory examinations of neurosyphilis in order to provide reference for clinical diagnosis of neurosyphilis.

Objective: To analyze the impact of dual antiplatelet (DAPT) therapy combining with or without proton pump inhibitors (PPI) on the main outcomes after percutaneous coronary intervention (PCI). Methods: The PubMed, EMBASE and Cochrane Library were searched for relevant literature and the references obtained from these sources were retrieved manually from inception till September 2017. Inclusion and exclusion criteria were established follow the Cochrane review standard. A total of 977 literatures were included, 193 duplicates were excluded, 74 reviews, case reports, letters and systematic reviews were excluded, 667 literatures were excluded after reading the title and abstract, 34 literatures were excluded due to non-randomized control studies and unrelated outcome indicators, and 9 literatures were finally included with a total of 16 589 patients. RevMan 5.3 software was used to compare the incidence of major adverse cardiovascular events (MACE), cardiogenic death, recurrent myocardial infarction, target vessel revascularization, all-cause death, stent thrombosis, stroke, gastrointestinal bleeding and gastrointestinal events in patients with DAPT combining with or without PPI after PCI. Results: MACE was observed in 8 out of the 9 included literatures, and the results showed that MACE occurred in 561 out of 6 282 patients receiving DAPT combining with PPI therapy and in 951 out of 9 632 patients using DAPT alone (OR=1.15, 95%CI 0.88-1.51, P>0.05). Cardiogenic death was observed in 7 out of the 9 included literatures, and the results showed that cardiogenic death occurred in 172 out of 6 453 patients receiving DAPT combining with PPI treatment and in 321 out of the 9 839 patients using DAPT alone (OR=0.97, 95%CI 0.80-1.18, P>0.05). Recurrent myocardial infarction was observed in 7 out of the 9 included literatures, the results showed 416 out of 6 282 cases in DAPT combining with PPI therapy group experienced recurrent myocardial infarction and 691 out of 9 632 cases in DAPT group experienced recurrent myocardial infarction (OR=1.01, 95%CI 0.89-1.16, P>0.05). Four out of 9 literatures observed revascularization. The results showed that revascularization was performed in 64 out of 2 173 patients receiving DAPT combining with PPI therapy and in 105 out of the 2 770 patients using DAPT alone (OR=1.33, 95%CI 0.55-3.24, P>0.05). All-cause death was observed in 7 out of the 9 included literatures, and the results showed that all-cause death occurred in 172 out of the 6 453 patients in DAPT combining with PPI therapy group and in 321 out of the 9 839 patients using DAPT alone (OR=0.97, 95%CI 0.80-1.18, P>0.05). Three out of the 9 included articles observed stent thrombosis, and the results showed that stent thrombosis occurred in 99 out of 2 997 patients receiving DAPT combining with PPI therapy and in 245 out of the 6 198 patients treated with DAPT (OR=1.07, 95%CI 0.83-1.37, P>0.05). Stroke was observed in 2 out of the 9 included literatures. The results showed that stroke occurred in 5 out of 2 019 patients receiving DAPT combining with PPI therapy, and in 4 out of the 2 033 patients treated with DAPT (OR=1.00, 95%CI 0.29-3.49, P>0.05). Gastrointestinal bleeding was observed in 6 out of the 9 included literatures. The results showed that gastrointestinal bleeding occurred in 26 out of 3 517 patients receiving DAPT combined with PPI therapy, and in 93 out of the 3 506 patients treated with DAPT, gastrointestinal bleeding was significantly lower in the DAPT combining with PPI group than DAPT alone group (OR=0.27, 95%CI 0.17-0.41, P<0.01). Gastrointestinal events were reported in 6 out of the 9 included articles. Similarly, gastrointestinal events were observed in 51 out of 3 517 patients receiving DAPT combined with PPI therapy, and in 190 out of the 3 506 patients treated with DAPT alone, the incidence of gastrointestinal events in the DAPT combined with PPI group was significantly lower than DAPT alone group (OR=0.24, 95%CI 0.14-0.42, P<0.01). Conclusions The incidence of MACE, cardiogenic death, recurrent myocardial infarction, target vessel revascularization, all-cause death, stent thrombosis and stroke are not affected by DAPT combined with PPI therapy after PCI, while the incidence of gastrointestinal bleeding and gastrointestinal events could be reduced by adding PPI to DAPT in patients undergoing PCI.

Objective To investigate characteristics of Treponema pallidum (Tp)-induced macrophage-derived exosomes and its effect on the proliferation of human umbilical vein endothelial cells (HUVEC).Methods Tp strains were collected from the testis of male rabbit,which were infected with Tp (Nichols strain).The human mononuclear macrophages (THP-1) were induced into macrophages by incubation with propylene glycol methyl ether acetate (PMA),and then the macrophages were divided into 2 groups:experimental group incubated with Tp for 12 hours followed by 48-hour normal culture,and control group receiving normal culture.After the treatment,exosome suspensions were collected,and exosomes were extracted by differential centrifugation and exoEasy Maxi Kit.Transmission electron microscopy and Western blot analyses were performed to identify the exosomes,and nanoparticle tracking analysis (NTA) was conducted to measure the diameters and concentrations of exosomes.In vitro cultured HUVECs were divided into 3 groups,which were cultured with the 10 μl of suspensions containing exosomes derived from Tp-stimulated macrophages at a concentration of 4.5 × 108/ml (experimental group),10 μl of suspensions containing exosomes derived from untreated macrophages at a concentration of 4.5 × 108/ml (control group),and 10 μl of exosome eluents (exosome eluent group),respectively.After the treatment,confocal laser scanning microscopy was performed to observe the phagocytosis of exosomes of HUVECs,and cell counting kit-8 to evaluate the proliferative activity of HUVECs.Results The exosomes were saucer-like microvesicles with diameters of 30-100 nm under the transmission electron microscope.Western blot analyses showed that membrane proteins CD63,CD9 and CD81 were abundantly expressed by exosomes.Under the same conditions,NTA revealed that there were no significant differences in the particle diameter (u =1.90,P ＞ 0.05) and concentration of exosomes (Z =-1.604,P =0.109) between the experimental group and the control group.After co-culture with HUVECs for 5 hours,confocal laser scanning microscopy showed scatteredly distributed exosomes with green fluorescence in the HUVECs in the experimental group and control group.After 12-hour co-culture with the exosome suspensions,the proliferative activity of HUVECs was significantly higher in the experimental group and the control group than in the exosome eluent group (both P ＜ 0.05).After 24-and 48-hour treatment with exosome suspensions,the proliferative activity of HUVECs in the control group was still significantly increased compared with that in the exosome eluent group,and peaked at 48 hours (all P ＜ 0.05).Moreover,there were no significant differences in the proliferative activity of HUVECs between the experimental group and exosome eluent group at 24 and 48 hours (both P ＞ 0.05).At 72 hours,no significant differences in the proliferative activity of HUVECs were observed among the experimental group,the control group and the exosome eluent group (all P ＞ 0.05).Conclusions The exosomes secreted by THP-1 cells-derived macrophages evidently increased the proliferative activity of HUVECs within 48 hours,which peaked at 48 hours.After the stimulation with Tp,the exosomes secreted by THP-1 cells-derived macrophages were similar to those without Tp stimulation in morphology,size and concentration,and only increased the proliferative activity of HUVECs within 12 hours.