Zero-COVID policy or Living-with-COVID policy? Analysis Based on Percent Excess Mortality

IntroductionWith the economic recession and pandemic fatigue, milder viral variants and higher vaccine coverage along the time lay the basis for lifting anti-COVID policies to restore COVID-19 normalcy. However, when and how to adjust the anti-COVID policies remain under debate in many countries. MethodsIn this study, four countries (Singapore, South Korea, Australia, and New Zealand) and one region (Hong Kong SAR), that have shifted from the zero-COVID (ZC) policy to or close to the living-with-COVID (LWC) during or after the Omicron outbreak, were selected as research objects. All-cause mortality data were collected for these objects from 2009-2019. The expected mortality was estimated by a simple linear regression method. Excess mortality over time was calculated as the difference between the expected mortality and the observed mortality. Finally, percent excess mortality (PEM) was calculated as the excess mortality divided by the expected mortality. ResultsIn the examined four countries, PEM fluctuated around 0% and was lower than 10% most of the time under the ZC policy before 2022. After shifting to the LWC policy, all the examined countries increased the PEM. Briefly, countries with high population density (Singapore and South Korea) experienced an average PEM of 20-40% during the first half of 2022, and followed by a lower average PEM of 15-18% during the second half of 2022. For countries with low population density under the LWC policy, Australia experienced an average PEM of 39.85% during the first half of 2022, while New Zealand was the only country in our analysis that achieved no more than 10% in average PEM all the time. On the contrary, Hong Kong SAR under their ZC policy attained an average PEM of 71.14% during the first half of 2022, while its average PEM decreased to 9.19% in the second half of 2022 with LWC-like policy. ConclusionPEM under different policies within each country/region overtime demonstrated that the mortality burden caused by COVID-19 had been reduced overtime. Moreover, anti-COVID policies are suggested to control the excess mortality to achieve as low as 10% in PEM. Contribution to the fieldO_LIThis study compared excess mortality within the same country/region, instead of among countries, thus, PEM during the outbreaks of different SARS-cov-2 variants overtime could reflect the effectiveness of regional specific anti-pandemic policies in protecting the lives of citizens locally. C_LIO_LIOur analysis demonstrated that Singapore, South Korea and Australia might implement the LWC policy without sufficient preparation, which resulted in a very high mortality burden during the first half of 2022. C_LIO_LIThe reduced PEM in late 2022 in the examined countries/regions suggested that the mortality burden caused by COVID-19 was reduced overtime, laying a great foundation to call for a further relief of LWC policy in the world in the near future. C_LIO_LIThis study delineated a threshold of percent excess mortality, which is 10%, as a criterion to assess the effectiveness of anti-COVID policies. C_LI

Value of renal CT scan in the evaluation of split renal function / 中华泌尿外科杂志

Objective　To study the value of renal CT scan in evaluating split renal function.Methods　147 patients undergone CT scan from June 2009 to June 2011 were involved in this study.There were 73 cases of obstructive hydronephrosis and 74 cases of renal tumors.66 patients were males and 81 were females with a mean age of 53 years ( range 17 - 87 years).GFR detected by single-photon emission computed tomography (SPECT) was used as the reference of split renal function.The kidneys were divided into 3 groups according to the GFR:normal renal function (113 cases,GFR ≥ 34 ml/min),mildly impaired renal function (66 cases,GFR:20 -34 ml/min) and severely impaired renal function (41 cases,GFR ＜20 ml/min).One-way ANOVA and linear regression analysis were used to analyze the relationship between the results of CT scan and split renal functions.　Results　There were significant differences in the cortical thickness among the normal renal function,mildly impaired renal function and severely impaired renal function groups.The cortical thicknesses were (0.62 ±0.11) cm,(0.45 ±0.10) cm and (0.26 ±0.07) cm,respectively (P ＜ 0.01 ).The renal cortical thickness was strongly correlated with GFR (r =0.806,P ＜0.01 ).There were significant differences in the enhancement during the cortical phase among the 3 groups,which were (162.1 ±25.3) HU,(121.6 ±21.0) HU and (63.5 ±20.0) HU,respectively (P＜0.01).The enhancement during the cortical phase was strongly correlated with the GFR (r =0.851,P ＜ 0.01 ).The enhancement during the parenchymal phase and excretory phase was moderately correlated with the GFR ( r =0.467 and r =0.451,P ＜ 0.01 ).　Conclusions　The renal cortical tbickness and the enhancement during the cortical phase detected by CT scan might be useful for the clinical evaluation of split renal function.

Protein kinase C-alpha is expressed and activated during the development of renal cell carcinoma.

OBJECTIVES: To evaluate protein kinase C-alpha (PKCalpha) expression in human renal cell carcinoma (RCC) tissues and cell lines, and its clinical significance. METHODS: Expression of PKCalpha was analyzed by Western blot in 90 clinical specimens. The expression of PKCalpha in the cytoplasm or plasma membrane was correlated to clinical stage and grade to assess for potential relationships. A human renal cell carcinoma (RCC) cell line (786-O/PKCalpha) was generated with stable expression of a fusion protein of green fluorescent protein (GFP) and PKCalpha, to facilitate analysis of in situ compartmentalization of PKCalpha during activation. RESULTS: PKCalpha expression and the ratio of PKCalpha expression in the membrane (M) to that in cytosol (C) were greater in cancerous tissues than in normal tissues (P <.05). With an increase in tumor grade and stage, the level of PKCalpha increased significantly in membrane (P <.01) and decreased in cytosol (P <.01). Consistently, there was an increase of M/C with increasing malignancy of tumor. As expected, the translocation of PKCalpha between plasma membrane and cytosol could be observed in 786-O renal carcinoma cells with the treatment of PKCalpha agonist or inhibitor. CONCLUSIONS: We demonstrated differential PKCalpha expression in RCC tissues, indicating that abnormal PKCalpha activation may contribute to the development of RCC.

Steroid Replacement Therapy Following Adrenalectomy in Patients with Cushing Syndrome / 中国医科大学学报

Objective To investigate the methods of steroid supplement following adrenalectomy in the patients with Cushing syndrome.Methods The methods and outcome of steroid supplement following adrenalectomy in 75 cases of Cushing syndrome were retrospectively reviewed.Results Supraphysiological doses of glucocorticoid was given during the perioperative period,and the dosage was reduced gradually.Prednisone with a dosage of 5 to 7.5 mg was given once a day on discharge.In the patients with adrenocortical adenoma,4 to 15 month of steroid supplement was required.The patients undergoing bilateral adrenalectomy required lifelong steroid supplementation.Steroid withdrawal syndrome occurred during steroid tapering in 8 patients with adrenocortical adenoma,2 of them had normal plasma cortisol level.Conclusion In the patients with Cushing syndrome,even those with normal plasma cortisol level might have steroid withdrawal syndrome episodes during steroid tapering.

Expression of multidrug resistance-related markers in renal pelvic and ureteral carcinoma / 中华泌尿外科杂志

Objective To evaluate the expression of multidrug resistance-related markers in renal pelvic and ureteral carcinoma. Methods The immunohistochemical expression of P-glycoprotein (P-gp), multidrug resistance-associated protein (MRP), lung-resistance protein (LRP) and glutathione S-transferase Pi (GST-?) were examined in 51 patients with renal pelvic or ureteral carcinoma.The correlation between the expression and some clinicopathological parameters was analyzed. Results The positive expression rate of P-gp、MRP、LRP and GST-? in renal pelvic or ureteral carcinoma was 35.3%(18/51),39.2%(20/51),58.8%(30/51) and 43.1%(22/51) respectively.The rate of P-gp positive staining was increased with the advance of tumor grade (P

Bladder soft calculus with emphysematous cystitis(a case report) / 中华泌尿外科杂志

Objective To understand the pathogenesis and the clinical features of the bladder soft calculi. Methods A case of bladder soft calculi with emphysematous cystitis was reported.The patient,who had underwent partial cystectomy for bladder cancer,was 53 years old with diabetes and prostate hyperplasia. E.coli was found in his urine.KUB showed negative result.B-us and cystoscopy showed bladder mass.Some of other cases were also reviewed. Results The patient underwent surgical operation,and during the procedure a multilamellar yellow/brown internal structure of the calculi was observed.It presented as something like cellulose in the pathological study.The patient received antibiotic therapy after operation for two weeks,and recovered very well. Conclusions The formation of soft calculi is typically associated with urinary infection caused by proteus species.Diabetes mellitus is believed to be the most important predisposing factor for the formation of soft calculi.In most cases, surgical manipulation is required for their removal because they are not dissolved by any means yet known, and the antibiotic therapy is necessary too.