The monopoly of minor group rhinovirus in respiratory virus infection in children during the SARS-CoV-2 pandemic

Rhinovirus (RV) is one of the pathogens causing acute and chronic respiratory illnesses worldwide in paediatric patients. Compulsory mask-wearing and high stringency of social distancing were executed in Hong Kong since the SARSCoV-2 outbreak. While other common respiratory viruses vanished in routine surveillance programme, two sudden upsurges of RV associated upper respiratory tract infections were observed from Oct. to Nov. 2020 after schools reopening, and Apr. to Aug. 2021. We aimed to investigate if these RVs have a prominent role in transmission by analysing the RV genotype composition, assessing their replication competence, and the clinical features of paediatric patients. RV specimens collected from the hospitalised patients were genotyped, with clinical features of the patient documented and compared to those obtained in the pre-COVID-19 period. The replication competence of the RVs was examined in the well-differentiated human nasopharyngeal epithelial cells (HNPEC), and the stability of the RVs on different materials was tested. We identified the monopoly of minor group RV in each of the study duration, namely RV-A47 (80%) and RV-A49 (51%), respectively. In contrast to a diversified RV genotype composition in 2018-19. Without prior in vitro adaptation, the two minor-group RVs replicated in the HNPECs effectively to a comparable level as in the laboratory strain RVA16. The rise of minor-group RVs and dominance of single RV genotype under strict social distancing and hand hygiene is remarkable. Further investigation of the viral determinant, with an assessment of transmissibility in an animal model, will be needed to validate the specific role of these RVs.

Clinical value of outpatient screening in department of general surgery during the COVID-19 outbreak.

Objective: To investigate the clinical value of outpatient screening in department of general surgery during the Corona Virus Disease 2019 (COVID-19) outbreak. Method(s): The retrospective and descriptive study was conducted. The clinical data of 57 patients who visited surgery clinic and emergency department of Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology between February 1st and 26th in 2020 were collected. There were 30 males and 27 females, aged (53+/-16)years, with a range from 17 to 87 years. All the 57 patients were measured score of outpatient screening in department of general surgery. The score >=3 indicated high risk and the score < 3 indicated low risk. Observation indicators: (1) clinical data of patients;(2) score of outpatient screening for COVID-19 of patients. Measurement data with normal distribution were represented as Mean+/-SD, and comparison between groups was analyzed by the t test. Measurement data with skewed distribution were described as M (IQR), and comparison between groups was analyzed by the rank sum test. Count data were described as absolute numbers, and comparison between groups was analyzed using the chi-square test. Result(s): (1) Clinical data of patients: of the 57 patients, there were 12 males and 14 females of the 26 confirmed or suspected cases, versus 18 males and 13 females of the 31 non-infection cases, showing no significant difference between the two groups (chi2=0.805, P>0.05). The 26 confirmed or suspected cases of COVID-19 had an age of (57+/-16)years, and 31 non-infection cases had an age of (50+/-16) years, with no significant difference between the two groups (t=-1.646, P>0.05). (2) Score of outpatient screening for COVID-19 of patients: the score of outpatient screening for COVID-19 of the 26 confirmed or suspected cases was 3.0(4.0), versus 1.0(1.0) of the 31 non-infection cases, showing a significant difference between the two groups (Z=-3.695, P<0.05). There were 17 and 9 of the 26 confirmed or suspected cases with high risks and low risks, respectively, versus 3 and 28 of the 31 non-infection cases, with a significant difference between the two groups (chi2=19.266, P<0.05). Conclusion(s): During the COVID-19 outbreak, outpatient screening in department of general surgery can effectively screen out high-risk patients.Copyright © 2020 by the Chinese Medical Association.

Short-course radiotherapy and subsequent CAPOX pluscamrelizumab followed by delayedsurgery for locally advanced rectalcancer: Short-term results of aphase II trial

Background: Chemoradiotherapy followed byradical surgery is standard treatment for patients with locally advanced rectal cancer(LARC). Short-course radiotherapy (SCRT), either with immediate or delayed surgery, providessimilar oncological results compared with long-course radiotherapy with delayed surgery.Delayed surgery with the addition of neoadjuvant immunotherapy may bring betterdownstaging effect and minimize the risk of distant relapse. We conducted this single-armphase 2 trial to investigate the efficacy and safety of SCRT combined with subsequentcapecitabine and oxaliplatin (CAPOX) plusCamrelizumab (anti-PD-1 antibody) followed bydelayed surgery in patients with LARC. Methods: Patients with histologically confirmed T3-4 N0 M0 or T1-4 N+ M0 rectal cancer, previouslyuntreated disease, and ECOG performancestatus of 0-1, received SCRT (5×5 Gy) withsubsequent two 21-day cycles of CAPOX(oxaliplatin 130 mg/m2 ivgtt, d1;capecitabine1000 mg/m2 po bid, d1-14) plus Camrelizumab(200 mg iv drip, d1) after 1 week, followed byradical surgery after 1 week. Adjuvant therapy was decided by the investigator. The primaryendpoint was pathological complete response(pCR) rate, defined as the absence of viabletumor cells in the primary tumor and lymphnodes. The study is ongoing to follow up thesurvival outcomes and obtain the results of nextgeneration sequencing and PD-L1 expression.The data cutoff date was September 8, 2020. Results: From November 2019 to September2020, a targeted number of patients (n = 29)were enrolled and are expected to complete thesurgery by November 2020. The median age was 57 (range 31-73) years, 55% (16/29) of patients had ECOG performance status of 1, and the median distance from tumor to the anal verge was 5 (range, 1.9-9) cm. At data cutoff, 10 patients had undergone the surgery, with R0 resection rate of 100%. The pCR rate was 60% (6/10), including 56% (5/9) for those with mismatch repair-proficient, and 100% (1/1) for those with mismatch repair-deficient. Of 4 patients without pCR, 2 only received one cycle of CAPOX plus Camrelizumab due to the outbreak of COVID-19 in Wuhan, and 1 had signet-ring cell rectal carcinoma. At data cutoff, 20 patients had received at least one dose of Camrelizumab. Immune-related adverse events (irAEs) were all grade 1-2, and the most common irAE was reactive cutaneous capillary endothelial proliferation in 10 (50%) of 20 patients. Postoperative bleeding and infection occurred in 1 (10%) and 2 (20%) of 10 patients, respectively. No treatment-related death was observed. Conclusions: SCRT combined with subsequent CAPOX plus Camrelizumab followed by delayed surgery showed promising pCR rate with good tolerance in patients with LARC, regardless of the mismatch repair status, suggesting a candidate strategy for the neoadjuvant therapy.

Clinical value of outpatient screening in department of general surgery during the COVID-19 outbreak

Objective: To investigate the clinical value of outpatient screening in department of general surgery during the Corona Virus Disease 2019 (COVID-19) outbreak. Methods: The retrospective and descriptive study was conducted. The clinical data of 57 patients who visited surgery clinic and emergency department of Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology between February 1st and 26th in 2020 were collected. There were 30 males and 27 females, aged (53±16)years, with a range from 17 to 87 years. All the 57 patients were measured score of outpatient screening in department of general surgery. The score ≥3 indicated high risk and the score <3 indicated low risk. Observation indicators: (1) clinical data of patients;(2) score of outpatient screening for COVID-19 of patients. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed by the t test. Measurement data with skewed distribution were described as M (IQR), and comparison between groups was analyzed by the rank sum test. Count data were described as absolute numbers, and comparison between groups was analyzed using the chi-square test. Results: (1) Clinical data of patients: of the 57 patients, there were 12 males and 14 females of the 26 confirmed or suspected cases, versus 18 males and 13 females of the 31 non-infection cases, showing no significant difference between the two groups (χ2=0.805, P>0.05). The 26 confirmed or suspected cases of COVID-19 had an age of (57±16)years, and 31 non-infection cases had an age of (50±16) years, with no significant difference between the two groups (t=-1.646, P>0.05). (2) Score of outpatient screening for COVID-19 of patients: the score of outpatient screening for COVID-19 of the 26 confirmed or suspected cases was 3.0(4.0), versus 1.0(1.0) of the 31 non-infection cases, showing a significant difference between the two groups (Z=-3.695, P<0.05). There were 17 and 9 of the 26 confirmed or suspected cases with high risks and low risks, respectively, versus 3 and 28 of the 31 non-infection cases, with a significant difference between the two groups (χ2=19.266, P<0.05). Conclusion: During the COVID-19 outbreak, outpatient screening in department of general surgery can effectively screen out high-risk patients. Copyright © 2020 by the Chinese Medical Association.

[Recommendations for general surgery clinical practice in 2019 coronavirus disease situation].

The 2019 coronavirus disease(COVID-19) is a highly infectious disease, has a long incubation period and a variety of clinical manifestations, which has a significant impact on public health and life. Afterwards, scientific and standardized work processing during the epidemic is of great significance for prevention and control. In order to implement the central government's decision-making deployment and defeat the COVID-19 as soon as possible, we had focused on the key points in the clinical work of general surgery according to latest relevant guidelines, literature and experience in epidemic prevention. Finally, we drafted the prevention and control strategies and recommendations to make a reference for medical staff of general surgery to fight against COVID-19.

[Recommendations for general surgery clinical practice in novel coronavirus pneumonia situation].

Novel coronavirus pneumonia (NCP) is a highly infectious disease, has a long incubation period and a variety of clinical manifestations, which has a significant impact on public health and life. Afterwards, scientific and standardized work processing during the epidemic is of great significance for prevention and control. In order to implement the central government's decision-making deployment and defeat the NCP as soon as possible, we had focused on the key points in the clinical work of general surgery according to latest relevant guidelines, literature and experience in epidemic prevention. Finally, we drafted the prevention and control strategies and recommendations to make a reference for medical staff of general surgery to fight NCP.