Objective:To analyze the features of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) co-infected with other common respiratory pathogens among coronavirus disease 2019 (COVID-19) patients in Shanghai City, and to provide a reference for scientific prevention and control of COVID-19 and other respiratory infectious diseases.Methods:Descriptive epidemiological approaches were used to analyze the data of COVID-19 reported cases in Shanghai City from January 2020 to February 2021 in the information system of Chinese Disease Prevention and Control. Clinical data of the participants were collected, and their SARS-CoV-2 nucleic acid-positive respiratory specimens were collected at the time of illness onset or admission. Multiplex reverse transcription-polymerase chain reaction (RT-PCR) was performed to detect the 22 respiratory pathogens. Independent-samples t test was used for statistical analysis. Results:Of the 272 patients with COVID-19, 15(5.5%) had co-infection of SARS-CoV-2 with other respiratory pathogens, all of which were double infection. There were three cases infected with enterovirus/rhinovirus, two of each with adenovirus, human metapneumovirus and coronavirus NL63/HKU1, and one of each with coronavirus 229E, influenza A virus H1N1, parainfluenza virus 1 and respiratory syncytial virus B. Two cases infected with Mycoplasma pneumoniae. Among the 272 COVID-19 patients, 212(77.9%) had fever, 117(43.0%) had cough, 46(16.9%) had fatigue, and 35(12.9%) had sore throat. The white blood cell count of co-infection cases was higher than that of non-co-infection cases ((6.8±1.7)×10 9/L vs (5.3±1.6)×10 9/L), and the difference was statistically significant ( t=3.09, P=0.008). Conclusions:There is a certain proportion of co-infection of SARS-CoV-2 with other respiratory pathogens among the COVID-19 cases in Shanghai City, mainly viral pathogens, especially enterovirus/rhinovirus. A rational combination of drugs was recommended to improve the cure rate. Surveillance of acute respiratory infection should be further strengthened as well.

Objective:To explore whether prophylactic anti-viral therapy is needed for hepatitis B virus (HBV) infection resolvers with high titer of hepatitis B surface antibody (anti-HBs) receiving rituximab treatment.Methods:This study was a prospective cohort study. Nine patients with hepatitis B surface antigen(HBsAg) negative/hepatitis B core antibody (anti-HBc) positive/anti-HBs positive receiving rituximab treatment in Chinese Academy of Medical Science, Peking Union Medical College Hospital from June 2017 to June 2018 were enrolled. Patients were divided into two groups according to baseline anti-HBs titers. Patients with anti-HBs≥100 mIU/mL did not receive prophylactic treatment after informed consent. Patients with anti-HBs<100 mIU/mL were prescribed with entecavir before the treatment of rituximab. All patients were followed up every month after the first use of rituximab. Liver function, HBV DNA and HBV serology markers were tested. Descriptive statistical analysis was used.Results:Of the nine patients, six patients were diagnosed with diffuse large B cell lymphoma (DLBCL), one with Waldenstrom′s macroglobulinemia, one with indolent B-cell lymphoma, and one with membranous nephropathy. There were seven patients with anti-HBs≥100 mIU/mL who did not receive prophylactic anti-HBV therapy, and two patients with anti-HBs<100 mIU/mL who received entecavir (0.5 mg/d) prophylactic treatment before chemotherapy. The anti-HBs titer of the patient with indolent B cell lymphoma decreased from 21.27 mIU/mL to 6.33 mIU/mL during the third course of rituximab treatment. After the fourth course of treatment, the anti-HBs titer of one patient with DLBCL decreased from 172.25 mIU/mL to 57.76 mIU/mL. One patient with membranous nephropathy was followed up for one year and the anti-HBs titer increased from 141.47 mIU/mL to 328.98 mIU/mL.No significant changes of anti-HBs titer were observed in other patients. No HBV reactivation occurred in all patients and HBV DNA remained negative during the follow-up.Conclusions:The anti-HBs titer may drop after rituximab treatment in resolved HBV patients. High titer of anti-HBs may protect resolved HBV patients from HBV reactivation. Patients with high titer of anti-HBs may not need prophylactic anti-viral therapy.

Objective: To understand the epidemiological and pathogenic characteristics of hospitalized severe acute respiratory infections (SARI) in Shanghai, China. Methods: From 2015 to 2017, one Tertiary hospital and one Secondary hospital were chosen as the surveillance sites. Two respiratory tract specimens per case were collected from SARI cases aged 15 years and older. One specimen was tested for 22 respiratory pathogens by RT-PCR, and the other specimen was cultured for 6 respiratory bacteria. Results: A total of 287 SARI cases were enrolled for sampling and lab testing. 70.73% of the cases were aged 60 years and older, with 41.46% (119/287) were positive for at least one pathogen. Influenza virus was the predominant pathogen, accounting for 17.77% (51/287) of all SARI cases. Human rhinovirus/Enterovirus and Coronavirus were both accounting for 7.32% (21/287), followed by Mycoplasma pneumoniae (5.57%, 16/287). The positive rates of parainfluenza virus, bocavirus, adenovirus, respiratory syncytial virus and human metapneumo virus were all less than 5%. Bacterial strains were identified in seven SARI cases, including Klebsiella pneumoniae (3 strains), Staphylococcus aureus (2 strains), Streptococcus pneumoniae (1 strain) and Pseudomonas aeruginosa (1 strain). Two or Three pathogens were co-detected from 40 cases, accounting for 33.61% of 119 positive cases. The most common co-detected pathogens were influenza virus and Mycoplasma pneumoniae (10 cases). Influenza cases peaked in winter-spring and summer. Mycoplasma pneumoniae peaked in winter-spring season and overlapped with influenza. The positive rates of pathogens were not significantly different between different age groups. Conclusions Various respiratory pathogens can be detected from SARI cases aged 15 years and older. Influenza virus was the predominant pathogen and the co-detection of influenza virus with Mycoplasma pneumoniae the most common one.

To prepare RGD peptide modified perfluorohexane ( PFH ) polymer nanoparticles RGD‐PFH‐NPs and investigate its basic characteristics ,targeting ability and combine with low‐intensity focused ultrasound ( LIFU ) for ultrasonic imaging in vivo and vitro . Methods Targeted nanoparticles RGD‐PFH‐NPs were prepared by double emulsifying method and carbodiimide method . T heir morphology and distribution were observed . T he particle size ,zeta potential and connection probability were measured . T he phase‐changed properties and the LIFU‐induced imaging ability in contrast‐enhanced ultrasound mode of RGD‐PFH‐NPs were investigated in vivo and vitro . T he tagetability of nanoparticles to human gastric cancer cell line M GC803 and tumor‐bearing nude mouse were observed through targeting group and non‐targeting group . Results T he prepared sample was milky w hite suspension liquid . T he RGD‐PFH‐NPs were spherical uniform size ,good dispersion w hen observed through the optical microscope and transmission electron microscopy . T he particle size was ( 259 .3 ± 42 .6) nm and the Zeta potential was ( －17 .6+5 .4) mV . T he connection probability of RGD peptide was 89 .13% . With 70℃ water bath and LIFU stimulation RGD‐PFH‐NPs can remarkably change phase and show good imaging performance in both conventional ultrasound and contrast‐enhanced ultrasound mode in vivo and vitro . The connection probability to M GC803 cells in targeting group ( RGD‐PFH‐NPs ) and the non‐targeting group( PFH‐NPs) were 82 .59% and 2 .96% . T he accumulation of nanoparticles in the RGD‐PFH‐NPs group in tumor tissues was significantly higher than that in the non‐targeted PFH‐NPs group( P) . Conclusions The constructed nanoparticles RGD‐PFH‐NPs ,providing contrast‐enhanced ultrasonic imaging and excellent targeting ability to human gastric cancer cells M GC803 and gastric cancer tissue ,is expected to become a new type of gastric cancer targeted ultrasound contrast agent .

Objective To prepare RGD peptide modified perfluorohexane ( PFH ) polymer nanoparticles RGD-PFH-NPs and investigate its basic characteristics ,targeting ability and combine with low-intensity focused ultrasound ( LIFU ) for ultrasonic imaging in vivo and vitro . Methods Targeted nanoparticles RGD-PFH-NPs were prepared by double emulsifying method and carbodiimide method . Their morphology and distribution were observed . The particle size ,zeta potential and connection probability were measured . The phase-changed properties and the LIFU-induced imaging ability in contrast-enhanced ultrasound mode of RGD-PFH-NPs were investigated in vivo and vitro . The tagetability of nanoparticles to human gastric cancer cell line MGC803 and tumor-bearing nude mouse were observed through targeting group and non-targeting group . Results The prepared sample was milky white suspension liquid . The RGD-PFH-NPs were spherical uniform size ,good dispersion when observed through the optical microscope and transmission electron microscopy . The particle size was ( 259 .3 ± 42 .6) nm and the Zeta potential was ( -17 .6+5 .4) mV . The connection probability of RGD peptide was 89 .13％ . With 70℃ water bath and LIFU stimulation RGD-PFH-NPs can remarkably change phase and show good imaging performance in both conventional ultrasound and contrast-enhanced ultrasound mode in vivo and vitro . The connection probability to MGC803 cells in targeting group ( RGD-PFH-NPs ) and the non-targeting group( PFH-NPs)were 82 .59％ and 2 .96％ . The accumulation of nanoparticles in the RGD-PFH-NPs group in tumor tissues was significantly higher than that in the non-targeted PFH-NPs group( P) . Conclusions The constructed nanoparticles RGD-PFH-NPs ,providing contrast-enhanced ultrasonic imaging and excellent targeting ability to human gastric cancer cells MGC803 and gastric cancer tissue ,is expected to become a new type of gastric cancer targeted ultrasound contrast agent .

OBJECTIVE:To provide reference for developing zero-profit drug policy and compensation mechanism better in ur-ban public hospitals. METHODS:Taking a public hospital in a city as an example,effects of zero-profit drug policy on hospitals, patients,health insurance fund and single diseases with different drug proportions [cataract (2.94%) vs. chronic renal failure (38.77%)] were investigated by analyzing the canceled drug addition costs and adjusted medical service price data after developing zero-profit drug policy. RESULTS:After developing zero-profit drug policy,the overall compensation rate in the public hospital was 95.20%. The overall burden of urban patients was reduced,average burden cost was decreased 197.73 yuan every time;while the overall burden of urban and rural residents had increased,average burden cost was increased 17.39 yuan every time;and the overall burden of all patients had decreased. Health insurance fund had decreased,in which,the urban workers were decreased 151185500 yuan,and urban and rural residents were increased 4550400 yuan. In medical insurance for urban workers and health insurance for urban and rural residents,hospital increased by 7.00% and 8.99% in income in the treatment of cataract,the medical insurance fund increased by 12.07% and 13.67%,and patients'burden increased by 0.58% and 3.43%,respectively. For chronic renal failure,hospital income increased by 3.23% and 3.93%,medical insurance fund decreased by 3.19% and 3.96%,and pa-tients'burden decreased by 4.27% and 3.63%,respectively. CONCLUSIONS:Zero-profit drug policy is the ideal measure for get-ting rid of"drug-maintaining-medicine". When developing the policy,it should be combined with actual situation and different dis-eases to explore adjustment of medical service prices,reasonable financial compensation models and medical insurance payment mechanism.

Objective To analyze the basics and influencing factors for the medical expenditure of poor patients of tumor and end-stage renal diseases in Hubei province,and put forward policy recommendations for the critical illness insurance and health poverty alleviation.Methods 535 patients with tumor and end-stage renal diseases in Wuhan,Xiangyan and Shiyan in Hubei province were selected for a questionnaire survey,with 415 of the questionnaires subject to data analysis.Single factor variance analysis and multiple linear regression were used to analyze the influencing factors for their medical expenditure.Results 83.9% of the patients held their medical costs as too high;84.6% of them complaining significant drop of their annual family income due to their diseases; disposable household income of urban patients higher than their rural counterparts both before and after their disease; types of medical insurance and diseases are significant influencing factors for medical expenditure.Conclusions Poverty rate is high among patients of such patients.To reduce their financial burden,the government is recommended to cover more major diseases,enhance support for those of critical illness and improve the medical assistance system.

This paper introduced the measures to construct the hierarchical medical system in Yichang city. The authors identified problems found and proposed the city to take the following countermeasures. Such steps included service capacity building at primary level, motivating primary medical workers, attracting patients to primary care, and improving policies of hierarchical medical system.

Hierarchical medical system empowers the current healthcare reform on the medical supply side in China, a key to resolving the contradictions in the healthcare sector. This study analyzed the necessity and obstacles for such a system with synergy between hospitals, insurance and pharmacy, putting forward suggestions for building a scientific and rational hierarchical system.

Medical alliance refers to a medical consortium innovating the existing medical and health service model ( alliance as below ) , which is key to improving the unbalanced distribution of medical resources and promoting the hierarchical diagnosis and treatment in our country .This article analyzed the practice of alliances development in China and pointed out existing problems including insufficient inter -agency collaboration , poor progress of the hierarchical diagnosis and treatment system , and shortage of general practitioners and supporting policies .In the end, a series of measures is proposed namely building a compact alliance , creating a model integrating hierarchical diagnosis and treatment-prevention-rehabilitation-aging care , strengthening general practitioner training , and improving relevant supporting measures .