As we all know, infection is almost inevitable in plasma cell disorders (PCD). Although infection is not the diagnostic standard of PCD, it is a common complication of most patients, and it is also an important cause of morbidity and mortality of patients, especially the elderly and immunocompromised patients. In addition, the increasing use of immune-based therapeutic drugs in multiple myeloma may also have a negative impact on infection epidemiology and clinical outcome.

　 　 　 　According to statistics, the risk of infection in patients with multiple myeloma is 7 times higher than that in the general population; 10% patients died within 60 days after diagnosis, of which 45% were attributed to infection, and most of them occurred in elderly patients; 17% of multiple myeloma deaths are attributed to infection, and before the first-line treatment, the highest death rate was caused by infection (46%)1.

　 　 　 　In addition, infection, inflammation and pathogens also play an important role in the pathogenesis of plasma cell disease. Infectious cancer factors can be divided into direct carcinogens and indirect carcinogens. The former expresses viral oncogenes that directly contribute to carcinogenic transformation, while the latter causes cancer through chronic inflammation and acquired driven mutation. The mechanism of pathogen carcinogenesis includes pathogen as the direct carcinogen of PCD (oncogenic virus assists the occurrence of immunosuppressive cancers, such as Kaposi sarcoma and HHV8) and pathogen as the indirect carcinogen of PCD (chronic inflammation can enhance cell proliferation, and abnormal immune response to self-protein or infectious pathogens increases the risk of gene change and subsequent malignant transformation into dominant MM, Long-term antigen stimulation may also promote the genomic instability of MM by combining cytidine deaminase) and pathogens as regulators of PCD immune monitoring (Th17 cells secrete inflammatory cytokines, and promote the growth of plasma cells through IL-6-STAT3 signaling pathway and local activation of eosinophils; Intestinal flora may affect the response and toxicity of immunotherapy, and the principle is that immunosuppressants and broad-spectrum antibiotics can significantly change the composition of microbial flora.

　 　 　 　As mentioned earlier, infection is still the main cause of morbidity and mortality of patients with multiple myeloma due to the cumulative effect of disease, treatment and host-related factors. In view of the cumulative risk of infection in the whole course of disease, it is very important to prevent infection. At present, the best prevention strategies include vaccination against common pathogens, antibacterial prevention, infection management and immunoglobulin replacement for a small number of patients. But in general, there is no universally accepted infection prevention guideline for multiple myeloma.

　 　 　 　In view of this, the International Myeloma Association convened 36 experts from all over the world to jointly review the existing literature and guidelines, and solve the problems related to the infection risk and prevention of infectious complications of multiple myeloma under the emerging treatment background, including providing personalized infection treatment strategies for MM and providing suggestions for preventing infectious complications. The consensus statement was published in Lancet Haematology in February.

　

Panel1: Summary of key points and key suggestions for preventing infection in patients with multiple myeloma

Infection is still the main cause of death in patients with multiple myeloma. Risk factors include immunosuppression, treatment, age and complications (such as renal failure and weakness) of multiple myeloma.

The period with the highest risk of infection is the first 3 months after diagnosis and when treating relapsed/refractory multiple myeloma.

Patients with newly diagnosed multiple myeloma are more likely to prevent potential infections (such as Streptococcus pneumoniae or Haemophilus influenzae).

Most infections in patients with multiple myeloma are caused by viruses and bacteria: bacterial infections are most often manifested as pneumonia and bacteremia, while viral infections are usually manifested as seasonal viruses, especially influenza and herpes zoster.

If the risk of infection increases, levofloxacin can be considered for prevention (NCCN 2A level). Patients with seropositive herpes simplex virus and varicella-zoster virus (such as detection) can be given acyclovir for prevention. It is recommended that patients who receive proteasome inhibitors or targeted monoclonal antibodies, especially CD38 targeted monoclonal antibodies, use acyclovir for prevention (NCCN level 1). Trimethoprim-sulfamethoxazole can be reserve for patients at risk of pneumocystis Yersinia pneumonia, such as patients with relapsed/refractory myeloma or patients receiving large doses of dexamethasone (for example, ≥40 mg/ day, 4 days a week). For patients with sulfur allergy, alternative drugs such as dapsone (NCCN 2A grade) can be considered.

It is suggested that patients with multiple myeloma should be vaccinated with inactivated influenza vaccine (preferably with two doses of influenza vaccine, regardless of age) and inactivated streptococcus pneumoniae vaccine (PCV13) every year, and then with PPSV23(NCCN 2A level) every five years.

Only patients with multiple myeloma are recommended to be vaccinated with inactivated vaccine.

The ability to produce protective response after immunization depends on the immunosuppressive status of patients (such as disease load, remission status, cumulative immunosuppression of anti-tumor treatment) and vaccination time.

Conventional chemotherapy can significantly impair the response of patients with multiple myeloma to vaccination.

Vaccination at the early stage of the disease (such as MGUS or SMM), before the start of treatment or when it reaches remission can get the best protection.

Lenalidomide monotherapy can improve the response of patients with multiple myeloma to vaccination, provided that dexamethasone is not given at the same time. At present, the immune response after receiving new drugs (such as monoclonal antibody, panobinostat and Cellini) has not been determined.

After autologous hematopoietic stem cell transplantation, patients with multiple myeloma may lose immunity to the pathogens they were vaccinated against, and these patients should be vaccinated again 6-24 months after HSCT. The data show that it is safe and effective to inoculate recombinant herpes zoster vaccine after autologous HSCT. Therefore, it is recommended to inoculate recombinant herpes zoster vaccine after autologous HSCT (NCCN level 1).

It is suggested that the recombinant herpes zoster vaccine should be extended to all patients with multiple myeloma. It is suggested to continue to use varicella-zoster vaccine for prevention according to the indications, regardless of the vaccination status (NCCN 2b level).

It is suggested that patients with multiple myeloma should use passive immunization after being exposed to hepatitis A, chickenpox or measles (NCCN 2b).

It is suggested that close contacts of patients with multiple myeloma should be routinely vaccinated with inactivated vaccine, and patients should avoid close contact with live vaccine vaccinators as much as possible (NCCN 2A level).

Encourage the medical care and family members of patients with multiple myeloma to receive all designated immunization, especially seasonal influenza virus (NCCN 2A level).

Intravenous immunoglobulin is suitable for specific situations, such as life-threatening infection and IgG concentration below 400mg/dL with recurrent infection (NCCN 2A level).

For patients with multiple myeloma who go to infected epidemic areas, it is recommended to receive vaccines and antibacterial prevention at the destination, and consult infectious disease experts or medical institutions at the destination.

Risk factors of infection in patients with multiple myeloma

Disease factors

　 　 　 　Plasma cell diseases can increase the susceptibility of patients to viral and bacterial infections. The increased risk of infection in newly diagnosed patients with multiple myeloma is caused by the common global immune insufficiency paralysis in this patient, including the dysfunction of B cells in hypogammaglobulinemia, the destruction of global T cell diversity, and the significant changes in the functional activities of dendritic cells, natural killer cells and alternative complement pathways.

　 　 　 　Although rare at the time of seeing a doctor, neutropenia associated with bone marrow infiltration can also increase this risk. Of course, other related complications such as renal failure are also risk factors. The highest risk of infection is in the first 3 months after diagnosis and when treating recurrent or refractory multiple myeloma.

Therapeutic factors

Basic principles of treatment and infection of multiple myeloma

　 　 　 　The main therapeutic drugs for multiple myeloma are shown in Table 1. These treatments significantly improved the patient’s outcome, and transformed myeloma from a rapidly fatal disease to a chronic disease with multiple recurrences (usually successfully saved), but it also led to cumulative immunosuppression and increased risk of infection. For example, CD4 cell count drops sharply with the increase of chemotherapy cycle, which is closely related to opportunistic infection. Even so, the deep and lasting remission achieved by the combined regimen will generally lead to the reversal of immunosuppression and improvement of outcome.

　 　 　 　The immune status of patients with multiple myeloma is related to many factors, including the disease state and treatment stage (such as induction, remission vs first relapse vs relapse or refractory to multiple types and drugs), the degree of previous treatment (such as single drug vs multiline) and the intensity of treatment (such as triple induction vs autologous HSCT myeloablative regimen). In addition, continuous treatment can cause mild persistent immune suppression, which leads to an increase in the risk of infection. Immunomarkers can be used to determine whether there is cumulative immunosuppression.

glucocorticoid

　 　 　 　The cumulative dose of dexamethasone is an independent risk factor for infection, both during induction and at the time of recurrence. In addition, high-dose accumulation of glucocorticoids (for example, dexamethasone ≥40 mg/ day, 4 days per week) will increase the risk of opportunistic infections, including pneumocystis Yersinia.

Cytotoxic chemotherapy

　 　 　 　Conventional chemotherapy drugs, such as cyclophosphamide, etoposide, cisplatin, anthracyclines, melphalan and bendamustine, can enhance the susceptibility of patients with multiple myeloma to infection by inducing neutropenia, T cell dysfunction and mucosal damage.

Autologous hematopoietic stem cell transplantation

　 　 　 　High-dose melphalan combined with autologous HSCT (the standard treatment of multiple myeloma) can cause severe neutropenia and gastrointestinal mucositis, thus making patients susceptible to severe infections (mainly bacterial infections). Long-term T cell immune deficiency after implantation is rare, but it can increase the risk of virus infection and pneumocystis acquisition and reactivation.

Proteasome inhibitor

　 　 　 　Bortezomib can deplete T cells and impair viral antigen presentation, and the incidence of reactivation of varicella-zoster virus is relatively high in seropositive patients, so the preventive treatment of acyclovir is very important (NCCN grade 1). Caffezomib and Isazomib are also powerful immunosuppressants and have the same risk of viral infection. EMN guidelines recommend stopping antiviral preventive treatment 6 weeks after stopping PI. The authors suggest that the duration of prevention should be adjusted according to the immunosuppressive status of patients and whether other immunosuppressants (such as glucocorticoids or monoclonal antibodies) that increase the risk of varicella-zoster virus are given subsequently.

immunomodulator

　 　 　 　Lenalidomide and pomadomide can cause neutropenia, especially when combined with monoclonal antibodies. Granulocyte colony stimulating factor does not seem to reduce the risk of infection during lenalidomide treatment, but it can be used intermittently to fight chronic neutropenia. Thalidomide alone will not increase the risk of infection in patients with newly diagnosed multiple myeloma unless it is combined with other immunosuppressants (especially dexamethasone).

monoclonal antibody

　 　 　 　Monoclonal antibodies are associated with severe lymphopenia, pneumonia, reactivation of viral infection (especially varicella zoster virus) and opportunistic infection (especially in patients with intensive pretreatment). Clinical neutropenia may occur when monoclonal antibody is used in combination with lenalidomide or pomadumide, so the dosage needs to be adjusted. The neutropenia rate of CD38-targeted monoclonal antibody was higher than that of elotuzumab.

Selinexor in Cellini.

May lead to neutropenia-related infections.

New immune drugs

　 　 　 　Methods of targeting mature antigens of B cells, such as cell therapy (e.g. chimeric antigen receptor T cells), bispecific T cell adapters and antibody drug conjugates (e.g. belanatmab mafodotin), will all lead to immunosuppression because of targeting antibody-producing B cells and plasma cells. Therefore, patients with multiple myeloma who receive this treatment may need immunoglobulin replacement therapy. In addition, these treatments can lead to neutropenia and bone marrow suppression, and in some cases preventive use of antibiotics, antiviral coverage and antifungal coverage are needed.

Inhibition of bone resorption therapy

　 　 　 　Most patients with multiple myeloma will use anti-bone resorption therapy to prevent bone diseases. Rarely infected mandible and maxilla lead to jaw necrosis. Poor oral hygiene, poor denture fit, advanced periodontal disease and recent alveolar surgery are the risk factors. If infection occurs in the case of jaw necrosis, it is suggested to start using broad-spectrum antibiotics active against anaerobic bacteria, including actinomycetes spp46 and drug-resistant Bacteroides fragilis, such as clindamycin, carbapenems or β -lactamases or β -lactamase inhibitors. If the response to antibiotics is slow or unsatisfactory, or osteomyelitis is suspected, it is suggested to biopsy the lesion through staining and culture. Limited debridement may be required at this time; However, for refractory multiple myeloma, surgical resection should be reserve.

Kyphoplasty and vertebroplasty

　 　 　 　Vertebral kyphoplasty and vertebroplasty are generally well tolerated and are essential to control the pain associated with multiple myeloma of the vertebral body. In rare cases, spondylitis caused by Gram-positive bacteria (such as Staphylococcus aureus) can develop and evolve into paravertebral abscess. It is suggested that antibacterial prevention should be used 24 hours before operation and during operation when planning such operations for patients with high risk of infection.

Host factor

　 　 　 　Multiple myeloma mainly affects elderly patients with aging immune system (age ≥65 years old), whose antibody responses to pneumococcal and influenza vaccines are reduced, and the possibility of clinically significant complications is increased.

What factors can predict early and severe infection in MM patients?

　 　 　 　A considerable number of newly diagnosed patients with multiple myeloma will die prematurely before they can benefit from effective treatment, and the main reason is infection. Predictors of early and severe infection in newly diagnosed patients with multiple myeloma include high tumor load (ISS score II–III), abnormal increase of IDH, poor physical fitness and renal insufficiency.

　 　 　 　The prognosis model developed in 2018 divided patients into high-risk (infection rate was 24% during tertiary treatment) and low-risk (infection rate was 7%). In addition, men and high tumor load (ISS scores II-III and IDH increased) were risk factors for pneumonia, while high tumor load (ISS scores II-III) and increased serum creatinine concentration could independently predict the risk of sepsis.

Immune reconstruction after successful treatment

　 　 　 　Effective control of multiple myeloma can usually improve immunity. Immune reconstruction after autologous HSCT may provide an opportunity window for vaccination that may produce protective response.

Infection spectrum of patients with multiple myeloma

　 　 　 　With the introduction of new therapy, the types, severity and time of infection complications in patients with multiple myeloma have changed, and the complications mostly occur in the first few months of induction therapy and reach the peak in 4-6 months. The pathogens are mainly Gram-positive bacteria (such as coagulase-negative Staphylococcus, Staphylococcus aureus, Streptococcus pneumoniae and Enterococcus faecalis) and Gram-negative bacteria (such as Haemophilus influenzae and Escherichia coli). In addition, tracheobronchitis and pneumonia caused by respiratory viruses (such as influenza and respiratory syncytial virus) are also common.

　 　 　 　Infection can reach its peak again during the treatment of recurrent diseases, so the immunity of patients with multiple myeloma is seriously damaged. In addition, the uncommon infections in patients with multiple myeloma include invasive pulmonary aspergillosis and viral infections, such as cytomegalovirus, hepatitis B virus (HBV) or hepatitis C virus (HCV) and parvovirus B19, and tuberculosis and other opportunistic infections are also rare.

Prevention and treatment strategies of multiple myeloma infection

　 　 　 　The key to reduce the burden of infection complications in patients with multiple myeloma is to carry out comprehensive staging in diagnosis and recurrence, so as to adjust individualized treatment strategies according to risks. Staging includes collecting clinical history (especially vaccination and past infection), checking physical health and evaluating the functional status of patients over 65 years old (that is, healthy, moderately healthy or weak).

　 　 　 　It is suggested to optimize the dose intensity in patients with high risk of severe infection (that is, high disease load or increased IDH) and clinically significant complications (especially renal insufficiency). In addition, it is suggested that the preventive strategies of immunosuppression state should be considered when using various previous treatment lines to treat recurrent patients, including vaccination against common pathogens (Table 2), paying attention to the time of vaccination (panel 2), and educating patients and nurses to take measures to reduce exposure to potential pathogen sources, including traveling (panel 3). In addition, it is suggested to carry out risk-adaptive antibacterial prevention in a small number of patients (Table 3), and consider immunoglobulin replacement and possible myeloid growth factor support. Careful monitoring during high immunosuppression therapy and after autologous HSCT may predict the risk and type of infection.

　

　

Panel 2: Vaccination Opportunity of Inactivated Vaccine for Multiple Myeloma Patients

MGUS, SMM or asymptomatic MM

These patients can respond to immunization.

Vaccination may be more effective for the following patients: MGUS with low concentration of M protein and SMM may need to be vaccinated repeatedly to be effective.

MM in need of treatment

MM status is related to insufficient immune response, and the precautions are as follows:

Inoculate as soon as possible

Vaccinate patients 14 days before starting treatment (preferred)

In partial remission (especially immune reconstruction)

Good remission is usually associated with immune reconstitution, with unaffected immunoglobulin returning to normal.

Inhibition of uninvolved immunoglobulin is a risk factor for insufficient response to repeated vaccination.

When the immunomodulator is used alone or in combination with proteasome inhibitor,

Immunomodulators alone or in combination with proteasome inhibitors are associated with increased possibility of serological response.

Maintenance therapy with a single immunomodulator (lenalidomide) can enhance immunity to some pathogens, but it will not enhance immunity when combined with dexamethasone.

Non-influenza respiratory tract infection in influenza season

Avoid immunization for the time being, because the response to the vaccine may not be sufficient, and the overall infection risk of patients with active multiple myeloma may increase.

During routine chemotherapy

Avoid vaccination until the disease is controlled, because the response of cancer patients may be insufficient, and the higher the load of multiple myeloma, the higher the risk of infection.

When high-dose myeloablative therapy combined with autologous HSCT

Avoid vaccination before autologous HSCT, because the response to the vaccine cannot be sufficient.

Patients were replanted 6-12 months after autologous HSCT, because patients would have severe humoral and cell-mediated immune deficiency after autologous HSCT, but the immune reconstruction was rapid.

The recovery of ?CD4 cell count is a marker of immune recovery.

Recurrent/Refractory Multiple Myeloma

Avoid immunization during active diseases, because the response to vaccines cannot be sufficient, especially in patients who have received several lines of treatment in the past.

Cumulative immunosuppression after extensive treatment can increase the net state of immunosuppression and the risk of severe infection.

The possibility of vaccine response decreases in descending order. There are no vaccine response data for monoclonal antibodies, Papi and Cellini.

　

Panel 3: Travel Notes for Patients with Multiple Myeloma

To evaluate the immune status, it is not recommended for patients with severe immune dysfunction to travel to potentially severe infection epidemic areas.

Update the patient’s immune status and verify the drug.

Patients are advised to use general protective measures, insect repellents, mosquito nets and protective clothing to minimize the risk of mosquito bite infection (such as malaria, dengue virus, Chikungunya fever, Zika virus and West Nile encephalitis) and ticks (such as Borrelia Lyme disease, tick-borne encephalitis and relapsing fever).

Provide relevant country-specific and region-specific vaccination according to the risk, including drugs against Neisseria meningitidis, hepatitis A virus and hepatitis B virus, and poliovirus.

Provide antibacterial prevention in specific countries and regions, including malaria and tuberculosis.

Provide antibiotics (such as fluoroquinolones or macrolides) that can be used for self-administration for persistent diarrhea with fever (> 48h), and actively encourage patients to seek medical treatment when the situation occurs.

Immunoglobulin seronegative and high-risk groups of hepatitis A virus infection should consider hepatitis A immunoglobulin, including those who go to areas where hepatitis A virus is prevalent.　

Educate patients and nursing staff as follows:

Understand specific risk areas, focusing on malaria and tuberculosis.

Avoid raw food, eat peelable fruits and vegetables, prevent travelers from diarrhea, and only drink bottled or boiled drinks.

Avoid bad cooking of meat

Avoid close contact or long-term contact with crowded tuberculosis patients and closed environments (such as hospitals or clinics); If you plan to travel, check for tuberculosis (skin or blood) before leaving and after returning home.

Avoid activities that increase the risk of fungal infection (such as digging) to prevent endemic fungal pneumonia.

Detection of infection

　 　 　 　Fever is regarded as the most important sign of infection in patients with multiple myeloma. Patients without fever should be highly suspicious, especially those receiving corticosteroids. It is suggested to obtain the vaccination history, past infection, virus serum status, disease status, recent treatment and related complications of patients to determine possible pathogenic pathogens, and of course, local epidemiology should also be considered.

　 　 　 　It is suggested that patients with febrile neutropenia and patients with infection should start empirical broad-spectrum antibiotic treatment when they are diagnosed and tested. In addition, it is suggested to choose drugs active against Streptococcus pneumoniae and Gram-negative pathogens, especially Escherichia coli and Pseudomonas aeruginosa. Antibacterials should be recommended according to clinical, imaging and microbiological results.

　 　 　 　Diagnostic tests of infection include complete blood cell count and classification, liver and kidney function examination, electrolyte examination and microscopic examination or culture of blood and other parts according to clinical indications. It is also recommended to obtain rapid pneumococcal antigen detection in urine, blood and cerebrospinal fluid samples when there are indications.

　 　 　 　For patients with respiratory manifestations, it is suggested to scan the chest and sinuses with CT, collect nasopharyngeal samples for respiratory pathogens detection, microscopic examination or culture of respiratory secretions, and detect Legionella urine antigen. For persistent fever with lung infiltration for more than 3-4 days, it is suggested to consider bronchoscopy combined with bronchoalveolar lavage or bronchial biopsy to determine conditional pathogens. Fungal infection markers, such as galactomannan and β-glucan, can be used when there are clinical indications.

　 　 　 　For abdominal symptoms and diarrhea, it is recommended to start using broad-spectrum antibiotics immediately. In addition, it is suggested that the infection of Clostridium difficile can be confirmed by stool samples. If it can be confirmed, it is suggested to add oral vancomycin because its activity is better than metronidazole. There is evidence that fidamycin is at least as effective as oral vancomycin for the confirmed Clostridium difficile infection, and may be related to the lower risk of recurrent infection, especially when it is used as extended pulse therapy for 25 days. Empirical treatment should be considered when severe colitis exists, especially when the infection index of Clostridium difficile is suspected to be high, until the diagnosis and detection results are obtained.

　 　 　 　It is suggested that the abdomen and pelvis should be scanned by CT to find severe focal signs and symptoms. According to local epidemiology, it is suggested to obtain PCR of fecal culture and intestinal pathogens, as well as other tests of intestinal parasites (such as Giardia and Cryptosporidium).

　 　 　 　If the fever persists and the cause is unknown, further diagnostic imaging examination is suggested to determine the existence, location and degree of infection. Once an infection cause is ruled out, other causes of fever diseases related to multiple myeloma should be considered, such as tumor fever, venous thromboembolism, adrenal insufficiency or implantation syndrome synchronized with bone marrow recovery after autologous HSCT. Other patients with stable clinical signs should consider non-infectious causes if their fever persists after the best exploration and antibacterial treatment. Tumor fever should be considered when the concentration of serum LDH and other markers of multiple myeloma in blood and urine increases abnormally. Fever associated with venous thromboembolism should be excluded by Doppler or ultrasound examination of limbs, ventilation or perfusion scanning or CT scanning, especially in patients at risk of venous thromboembolism, such as patients receiving immunomodulatory imide drugs or recombinant erythropoietin, patients with restraint (due to fracture or spinal cord compression) or patients with other known risk factors. Patients with fever of unknown origin should always consider drug-induced fever. Fever under the background of new immunization strategy may also be a symptom of cytokine release syndrome and should be treated appropriately.

Consider infection treatment according to the disease state and treatment period.

Newly diagnosed MM

　 　 　 　Because pneumococcus is a common pathogen when multiple myeloma is first diagnosed, it is suggested that pneumococcus vaccine should be inoculated as soon as possible (Table 2), and if there is fever or other infection, broad-spectrum antibacterial drugs active against pneumococcus should be given.

Induction treatment period of newly diagnosed MM

　 　 　 　A considerable proportion of newly diagnosed patients with multiple myeloma died in the first few months after diagnosis, mainly due to infection complications, so we should actively manage them by starting fast active drugs and treating complications related to multiple myeloma, such as renal failure. Levofloxacin can be considered for antibacterial prevention in the first 3 months of treatment, especially in patients with high risk of early infection, although its benefits are still unknown under the current triple and quadruple treatment strategies (NCCN 2A level). The benefits of using fluoroquinolones (such as levofloxacin) should be weighed, because these drugs are rarely associated with tendinopathy with rupture, especially Achilles tendon. The risk factors of tendinopathy include old age (> 60 years old), concomitant use of corticosteroids and renal insufficiency. Table 3 lists other antibacterial prevention suggestions according to disease stages and anti-tumor treatment types. The use of quinolones should be considered according to the degree and duration of neutropenia.

Autologous HSCT consolidation period

　 　 　 　Multiple myeloma patients with autologous HSCT are at risk of serious infection (mainly bacterial infection), so it is suggested to use antibacterial drugs to prevent it, and the immune deficiency after autologous HSCT may lead to clinically significant infection. It is recommended to monitor infection and prevent pneumocystis carinii for 3 months and prevent herpes simplex virus or varicella zoster virus for 1 year (NCCN 2A level) according to global guidelines. Antibacterial prevention is not a routine practice in all transplant centers around the world. Although its use reduces the incidence of fever and bloodstream infection, it does not translate into a reduction in mortality. Antibacterial prevention also needs to consider the risk of drug resistance.

Maintenance treatment period

Severe infection during maintenance treatment is mainly due to neutropenia, but the risk is low and the mortality rate is lower than 1%.

Treatment period of recurrent MM

　 　 　 　Patients with recurrent and refractory myeloma are at high risk of life-threatening broad-spectrum pathogen infection, including bacterial and viral infections (such as herpes simplex virus or varicella-zoster virus, cytomegalovirus, HBV and HCV). Fungal pneumonia, including invasive pulmonary aspergillosis and pneumocystis, may also occur.

Infection screening

　 　 　 　For relapsed/refractory MM with positive cytomegalovirus serum reaction, it is suggested to detect HBV (cytomegalovirus antigenemia or quantitative PCR) or circulating HBV DNA(NCCN 2B grade) before starting treatment. Patients with high suspicion suggest that serum Aspergillus galactomannan antigen should be tested before symptoms appear to detect invasive pulmonary aspergillosis. The effect of serum (1,3)-β-D- glucan on invasive pulmonary aspergillosis is not clear, but it may be a useful auxiliary means to diagnose pneumocystis disease.

　 　 　 　According to the patient’s serum status, HBV reactivation can lead to severe complications and death in patients with multiple myeloma, and usually occurs after autologous HSCT. In addition, HBV reactivation was rarely observed after treatment with CD38-targeted monoclonal antibody. It is suggested that patients should be managed according to their HBV serum status and the type and duration of immunosuppressive therapy (Table 3). It is suggested that antiviral prevention should be used for patients with HBV reactivation or high risk of disease, or early preemptive treatment should be used for patients with low risk. Only in the presence of clinically relevant diseases (such as cytopenia and cytomegalovirus diseases) can cytomegalovirus disease be treated.

　 　 　 　The effect of chronic HCV on the course of multiple myeloma is not very clear, but it is known that it will be reactivated after chemotherapy, and it may be necessary to reduce or stop taking drugs, but acute liver failure or death is not the outcome of chronic HCV infection. It is suggested that HCV serum status should be evaluated when multiple myeloma is diagnosed, and interferon α-free treatment schemes, such as direct antiviral drugs (such as sofebuvir, cimetivir and redipavir), should be used during the whole treatment period, and serum alanine aminotransferase and HCV viral load should be closely monitored.

Before stem cell mobilization, it is very important to monitor HCV viral load and treat infection. Chronic HCV infection may cause three-line hemocytopenia and lead to poor mobilization. Cancer patients may rarely lose HCV seropositivity, so it is suggested to measure HCV viral load when the patient’s serum status is unknown. It is recommended to seek help from infectious disease experts in complex situations.

vaccine

General principle of multiple myeloma vaccine

　 　 　 　Although the response to vaccination is usually very small, partial protection may still reduce the infection rate and hospitalization rate, but it should also be noted that the duration of benefit is unknown and may vary with vaccination time. Although the safety of most vaccines has not been tested in patients with multiple myeloma, inactivated vaccines such as influenza and pneumococcal vaccines are safe. Patients with multiple myeloma strongly recommend vaccination against Streptococcus pneumoniae and seasonal influenza virus, as well as vaccines necessary for local epidemiology (such as HBV). Splenectomy patients are also vaccinated against Haemophilus influenzae.

　 　 　 　It is suggested that patients with multiple myeloma should be vaccinated with pneumococcal vaccine, including one dose of pneumococcal conjugate vaccine (PCV13) and another dose of polysaccharide vaccine (PPS V23) at least 8 weeks later. If the patient has been vaccinated with PPSV23 before, it is recommended to be vaccinated with PCV13(NCCN 2A grade; Table 2). The protective titer of pneumococcus is unknown, which may vary according to serotype. If a breakthrough pneumococcal infection occurs after vaccination, it is suggested to try to identify the serotype of the strain to report the non-response to the vaccine (if possible). The purpose of serotype identification is to determine whether this serotype is included in the PCV13 vaccine-for example, patients vaccinated with PCV7 or PCV10. In this case, consider vaccination with PCV13 vaccine.

　 　 　 　Because the antibody response of pneumococcal vaccine may not be ideal, it may be useful to prolong antibiotic prevention in patients with recurrent pneumococcal infection and patients with invasive pneumococcal disease. Although penicillin G is the standard treatment, antibiotics based on strain sensitivity and local drug resistance patterns that have caused invasive pneumococcal diseases in the past can be used. Fluoroquinolones (such as levofloxacin), azithromycin or second-generation penicillin or cephalosporin are reasonable substitutes (NCCN 2B grade). (panel 1)。

　 　 　 　Vaccination against seasonal influenza virus is necessary because cancer patients are at increased risk of infection and death. It is suggested that patients with multiple myeloma be vaccinated with two doses of inactivated tetravalent influenza vaccine instead of standard vaccine, regardless of age (NCCN 2A level). The initial dose should be given as early as possible in the flu season, and the second high-dose booster vaccination should be carried out one month later. For patients with inactivated influenza vaccine in serious adverse events, two doses of recombination vaccines can be considered.

　 　 　 　It is generally recommended to vaccinate against HBV, especially for patients with high risk of virus infection (NCCN 2A level). Other potentially useful vaccines for patients with multiple myeloma include vaccines against Neisseria meningitidis, tetanus, diphtheria and pertussis, and inactivated poliovirus vaccines.

　 　 　 　Because of the increased risk of reactivation of varicella-zoster virus during the treatment of multiple myeloma, vaccination should be considered to reduce the risk of infection and post-herpetic neuralgia. It is suggested that patients with multiple myeloma should be vaccinated with recombinant herpes zoster vaccine instead of live herpes zoster vaccine, because it is safe (that is, non-live vaccine) and can provide higher and longer-lasting prevention of herpes zoster, thus preventing post-herpetic neuralgia (NCCN grade 1). However, even after vaccination, patients treated with proteasome inhibitors or CD38-targeted monoclonal antibodies should continue to receive acyclovir preventive treatment, because the degree of protection provided by vaccination is difficult to assess (NCCN 2A level). Specifically, patients with multiple myeloma have different immune responses and are highly dependent on their immune status, so they cannot be prevented by vaccination alone. For patients who have been vaccinated with live herpes zoster vaccine in the past, it is recommended to vaccinate with 2 doses of recombinant herpes zoster vaccine at least 8 weeks after vaccination.

　 　 　 　Generally speaking, due to the lack of safety or efficacy data, live vaccines are not recommended for patients with multiple myeloma. For patients with MGUS and SMM, considering their relatively healthy immune system, we can consider vaccination with live vaccine. Measles, mumps and rubella vaccines and live herpes zoster vaccine have been used after HSCT. If patients are in remission, they can be considered for use under certain circumstances.

Vaccination of non-immune close contacts

　 　 　 　Patients with multiple myeloma, especially those receiving treatment, may not be able to produce immune response to pathogens, and close contacts vaccinated with inactivated vaccine may also provide group immunity for patients. Therefore, according to vaccination history, age and exposure history, it is suggested that non-immune close contacts should be vaccinated with vaccines that are usually suitable for individuals with normal immune function, and it should be emphasized that inactivated vaccines (NCCN 2A level) should be used. Encourage the medical care and family members of patients with multiple myeloma to receive all designated immunization, especially seasonal influenza virus immunization.

Immunoglobulin substitution

　 　 　 　Immunoglobulin replacement can be administered intravenously, subcutaneously or intramuscularly. Intravenous immunoglobulin is recommended for patients with plateau multiple myeloma who have hypogammaglobulinemia and recurrent bacterial infection and have no response to pneumococcal immunization. However, immunoglobulin substitution supports the scarcity of contemporary data, high cost, limited availability and the possibility of complications (including acute renal failure and cardiovascular events). It is suggested that replacement therapy should be limited to patients with serum IgG concentration below 400 mg/dL and severe and recurrent infection caused by capsular bacteria (or other pathogens reasonably thought to be caused by hypogammaglobulinemia), even with antibacterial prevention and immunization (NCCN 2A level).

　 　 　 　Another potential consideration includes patients with insufficient antibody production, especially pneumococcal vaccine. Using immunoglobulin replacement therapy can only benefit patients infected with pathogens, which may respond according to the specific antibody titer against the target pathogen in intravenous immunoglobulin preparation; For example, it is used for infection caused by severe parvovirus B19 in patients with multiple myeloma.

　 　 　 　When planning to use intravenous immunoglobulin, it is necessary to evaluate the patient’s immune status and infection history (especially recurrent infection), and carry out laboratory examination of immune parameters (including specific antibody response) to determine the patients who can benefit from early intravenous immunoglobulin intervention.

　 　 　 　Immunoglobulin infusion is usually well tolerated, and most reactions are frequency dependent. But serious complications may also occur, including acute renal failure and rare cardiovascular events (such as myocardial infarction, stroke or venous thromboembolism). It is suggested to give standard preoperative medication to reduce the severity of infusion-related reactions, and to replenish water before infusion, especially in patients with hyperviscosity, risk factors of renal complications and receiving sucrose-containing preparations. It is suggested that intravenous immunoglobulin therapy should be started at a slow rate of 0.01 mL/kg/min and gradually increased to a maximum rate of 0.08 mL/kg/min according to the tolerance. If the serum IgA concentration cannot be detected, it is recommended to use intravenous immunoglobulin to remove IgA.

Post-exposure prevention of immunosuppressed MM patients

　 　 　 　 Immunoglobulin prevention may have protective effect on patients with multiple myeloma who are immunosuppressed after exposure to chickenpox, herpes zoster and hepatitis A (NCCN 2B grade). Serious diseases after exposure to herpes zoster, especially chickenpox, are very high, so it is very important to determine the risk level. The infectious stage begins 1-2 days before the rash occurs, so patients can appear several days after exposure. Except the recipients of autologous HSCT, all immunocompromised patients with a history of chickenpox infection can be considered immune. For patients with no history of varicella infection, risk assessment includes determining the susceptibility and exposure duration of patients. Risk factors include recent use of proteasome inhibitors, previous vaccination against varicella, severe immunosuppression, and close face-to-face or indoor contact for more than 1 hour. Post-exposure prevention depends on varicella-zoster immunoglobulin, ideally within 96 hours after exposure, but the benefit can be extended to 10 days. If immunoglobulin of varicella-zoster is not easily available, it is recommended to use acyclovir after exposure. The typical incubation period of chickenpox is 14-16 days. However, since the immunoglobulin of varicella zoster may prolong the incubation period, it is recommended to monitor the evidence of varicella for up to 28 days after exposure in the recipients of this therapy.

　 　 　 　For patients with multiple myeloma who travel to areas where hepatitis A virus is prevalent, it is recommended to give 0.02 mL/kg of hepatitis A immunoglobulin within 2 weeks of travel, and give the initial dose of hepatitis A vaccine. It is recommended to give a dose of hepatitis A immunoglobulin to patients with known exposure.

　 　 　 　For patients who have not been vaccinated against HBV or whose anti-HBV titer is less than 10 IU/L after vaccination, it is suggested to use tenofovir or entecavir for prevention to avoid the need for HBV immunoglobulin.

　 　 　 　Patients may occasionally need tetanus immunoglobulin 138 or human rabies immunoglobulin 139 after specific high-risk exposure. For patients at risk of respiratory syncytial virus infection in virus season, it is not recommended to use intravenous immunoglobulin or palizumab, that is, humanized monoclonal antibody against respiratory syncytial virus F glycoprotein.

Myeloid growth factor

　 　 　 　Prophylactic granulocyte macrophage colony stimulating factor (granulocyte colony stimulating factor is better) is recommended for patients without fever, and the risk of fever and neutropenia in these patients is at least 20%(NCCN 2A grade). The decision on whether to use granulocyte colony stimulating factor to prevent treatment delay (such as treatment delay related to lenalidomide) should be considered individually. Chronic neutropenia occasionally needs the support of growth factors.

references

1. Jessica Caro, Marc Braunstein, Louis Williams, et al. Inflammation and infection in plasma cell disorders: how pathogens shape the fate of patients. Leukemia . 2022 Feb 2. doi: 10.1038/s41375-021-01506-9.

2. Noopur S Raje, Elias Anaissie,Shaji K Kumar, et al.Consensus guidelines and recommendations for infection prevention in multiple myeloma: a report from the International Myeloma Working Group. Lancet Haematol . 2022 Feb; 9(2):e143-e161. doi: 10.1016/S2352-3026(21)00283-0

　　Incoming call information is kept strictly confidential, and the progress feedback is timely.

　　12309: Reporting Hotline Smooth Anti-corruption Public Opinion

　　　

　　On behalf of the real-name whistleblower, the lawyer received a bonus of 5,000 yuan from the procuratorate of Xuzhou City, Jiangsu Province.

　　Procuratorate of Xuzhou City, Jiangsu Province: Award bonuses to real-name informants.

　　On June 24th, at the press conference of "Reporting Publicity Week" and "Prosecution Open Month" held by the procuratorate of Xuzhou City, Jiangsu Province, the procuratorate of Xuzhou City awarded a bonus to a real-name whistleblower. The acting master (pseudonym) of the former Xuzhou Refractory Factory received a reward of 5,000 yuan from the procuratorate for reporting Chen Lingxi’s bribery case. In order to protect the whistleblower, his lawyer took the stage to receive the prize.

　　In the afternoon, the bonus was sent to the acting master. He said excitedly: "I was also afraid when I reported it. Jiawang City is small in scale, not a relative or a cousin, and I am afraid of retaliation. Now I think I did the right thing. You checked Chen Lingxi, which is to be the master for our laid-off workers. "

　　On April 13, 2012, Xuzhou City Procuratorate 12309 received a report phone: "I hesitated for a long time before I made up my mind to report it. I am a laid-off worker in a refractory factory. Today, I reported Chen Lingxi with my real name. He is the rear office of our factory. If he doesn’t give money, he won’t retire, and he won’t let go of the disabled. " "Daishifu, we will seriously investigate every real-name report, and we will also do a good job in protecting the whistleblower." The operator responded. Put down the phone, the staff of "12309" immediately sent the report clue to the relevant leaders according to the procedure. Soon, the clues were transferred to the jiawang district Procuratorate.

　　At this time, the jiawang district Procuratorate also received a similar report letter: "Dear Attorney General, I am a laid-off worker from Xuzhou Refractory Factory. When I went through the retirement formalities, Chen Lingxi of the rear office forced me to ask for money. Please ask the Attorney General to make decisions for us."

　　According to the investigation, Xuzhou Refractory Factory is a state-owned enterprise with a long history. Due to poor management, it went bankrupt and liquidated, and nearly a thousand workers were laid off. After bankruptcy, the refractory factory set up a rear office to handle the social security work for employees. Chen Lingxi’s bribery behavior reflected in the report was mainly concentrated from 2007 to 2012, and the bribe recipients were mainly workers. The laid-off workers who had gone through retirement procedures in the factory in the past five years became important witnesses in this case.

　　Prosecutors immediately began the preliminary work. In order not to alarm them, they used their break time to visit important witnesses from house to house. The work of obtaining evidence was very smooth, and many workers volunteered to testify. After initially grasping the fact that Chen Lingxi took bribes of nearly 50,000 yuan, the jiawang district Procuratorate summoned Chen Lingxi according to law.

　　"I have high blood pressure and heart disease. I can’t sit for a long time and stand for a long time. You have to take responsibility for my problems." "They don’t meet the retirement conditions at all. After retirement, they are happy. They took the initiative to give money and invite them to dinner." ….. Chen Lingxi tried his best to evade interrogation and legal sanctions. The prosecutor saw the confession and took Chen Lingxi to the hospital for a comprehensive physical examination, which broke his lies. Finally, in the face of solid evidence, Chen Lingxi’s psychological defense line collapsed and confessed his criminal facts.

　　Investigators verified that from 2007 to 2012, Chen Lingxi took advantage of his position to ask for bribes in cash and shopping cards totaling 47,700 yuan. In March 2013, the jiawang district court sentenced the defendant Chen Lingxi to three years and six months in prison for accepting bribes.

　　(Special correspondent of this newspaper Tang Ying correspondent Guo Wei)

　　Qiongshan district Procuratorate, Haikou City, Hainan Province: The fourth visit finally paid off.　　

　　One morning in January, the telephone of 12309 reporting center of qiongshan district Procuratorate in Haikou City suddenly rang: "Hello, is this qiongshan district Procuratorate?" There is a cadre in our village who takes the land compensation as his own, about 300,000 yuan. I hope the procuratorate can check it. " Before Xiao Ceng, the prosecutor who answered the phone, responded, the phone was hung up. Xiao Ceng checked and the telephone number belongs to Yunlong Town, qiongshan district.

　　The situation was quickly fed back to Chen Zhensheng, the chief procurator of the qiongshan district Procuratorate. Chen Zhensheng immediately found the heads of the anti-corruption bureau, prevention and reporting departments to analyze the clues that were not reported to the "home". Everyone agrees that further investigation should be carried out. Since the phone call is from Yunlong Town, it can basically be concluded that the informant is in the jurisdiction of Yunlong Town. Chen Zhensheng decided to send police officers to visit various villages and households in Yunlong Town on the grounds of popularizing the law, and strive to find out this report clue.

　　The next morning, Xing Fuhe, the chief of the prevention department of the hospital, led the police officer Xiao Ceng to drive to Yunlong Town, where he conducted legal publicity and asked about the distribution of compensation funds for land acquisition. However, the three-day visit yielded nothing. Xing Fu and Xiao Ceng didn’t lose heart. On January 14th, they went into a village in Yunlong Town, where they started a family conversation with the villagers.

　　The fourth visit finally paid off. During the chat, a villager named Lu approached Xing Fuhe and said indignantly: "There is a cadre named Li in the village who has neither engaged in business nor farming, but he can spend hundreds of thousands of dollars to build a new house in a blink of an eye. I heard that a real estate boss gave Li the compensation for land acquisition in the village, with more than 300,000 yuan. "

　　"What’s the name of this real estate boss?" Xing Fuhe asked, Lumou didn’t speak, but wrote a name in Xing Fuhe’s hand, and then said, "What I said just now was to close the door. As soon as you left my house, it means that I didn’t say anything today." "You don’t have to worry. It’s our responsibility to keep secrets for you. You should keep secrets from others for the time being!" Xing Fuhe said.

　　Xing Fuhe transferred the clue to the application control department of the hospital, and Li Yan, the chief of the application control department, and Fan Shurong, the police officer, started the investigation and conducted the initial nuclear test on March 24.

　　After collecting the land use right transfer agreement signed between a farm in Qiongshan and a real estate development company, the qiongshan district court’s civil judgment on the land and other relevant documentary evidence, as well as checking the transfer voucher at the bank, a large amount of evidence shows that Li took advantage of his power to accept the land compensation of 320,000 yuan paid by a real estate boss when dealing with the land left over. Soon, the clues of the case were transferred to the Anti-Corruption Bureau. On June 21, the Anti-Corruption Bureau officially filed a case. On June 24, the hospital applied to Haikou City Procuratorate for approval to arrest Li for allegedly accepting bribes.

　　(Reporter Li Xuanwei correspondent Jelena)

　　Fujian Youxi County Procuratorate: In just 4 days, the reporter received feedback from the case.

　　"Is it illegal for the top leader to borrow money from the unit? Does the procuratorate care about this?" On June 15, a person who claimed to be Huang called the 12309 report number of Youxi County Procuratorate in Fujian Province.

　　"Who is the borrower? What position? Can you provide his real name? Do you know how much money he borrowed? What is the use of this money? " Xiao Zhang, the reporting center, asked Huang about the situation in detail.

　　"He is Zhang, the president of Xibin Health Center, and borrowed 50,000 yuan from finance. I don’t know what to do." Huang said. "If it is used for official business, his behavior does not constitute a crime, but it may involve discipline or violation; If it is for personal use, it depends on how long it takes for its specific use and use time to be qualitative. " Xiao Zhang patiently explained to Huang. Hang up the phone, Xiao Zhang immediately submitted this situation to the report clue evaluation team.

　　"The reporter dialed 12309, which is a trust in us. We must take the time to investigate and feedback the results to the reporter in time." Yang Liangwen, the chief procurator of the hospital, said after listening to the report. Soon, the hospital found out that Zhang of Xibin Health Center in Youxi County used his authority to "borrow and approve" and embezzled 200,000 yuan of public funds for his relatives and friends during his tenure as dean.

　　On June 18, the court filed a case against Zhang for alleged misappropriation of public funds, and informed the reporter Huang of the progress of the investigation.

　　It took only four days from calling 12309 to receiving feedback from the procuratorate, and Huang was very satisfied. He said, "I learned that there was a 12309 report phone number from the procuratorate’s next visit, but I didn’t expect that once it was reported, the procuratorate found it so quickly!" On June 26, Youxi County Procuratorate filed a public prosecution against Zhang for alleged misappropriation of public funds.

　　Youxi County Procuratorate has a perfect working mechanism to guarantee the acceptance, handling and feedback of the 12309 report phone. The "12309 Reporting Telephone Receiving and Handling Work System" formulated by the hospital stipulates that it is necessary to ensure that the reporting telephone is kept open for 24 hours; The receiver should be civilized and enthusiastic when answering the phone; For those under the jurisdiction of our hospital, the diversion should be completed within 3 days, and the results should be fed back to the reporter within one month. "Answering, registering, evaluating, diverting, investigating, and giving feedback are all indispensable." The person in charge of the reporting center of the hospital introduced.

　　(Reporter Zhang Renping correspondent Lai Shijun Zhang Shijia)

　　Yugan county Procuratorate, Jiangxi Province: Follow the trail to find out the case of corruption subsidies.

　　　 "We are villagers in HouHe Cun, Shikou Town. Our food subsidies have been taken by village Committee cadres. What should we do now?" On April 12th, the phone of the report center of yugan county Procuratorate rang, and the villagers’ words were confused and impatient.

　　On the other end of the phone, the Shenke police officers in the hospital enthusiastically and professionally answered the villagers’ questions, carefully recorded the reasons for the villagers’ reports, and quickly reported to the hospital leaders. After evaluating the clues, the hospital believes that many people jointly reported that the village Committee cadres were suspected of corruption, and the clues were highly credible and traceable.

　　"This reported case must be done quickly and well!" Ai Jianliang, the head of the second investigation section of the anti-corruption bureau of the hospital and a post-80 s policeman from rural areas, took the lead in investigating the case. Subsequently, the hospital set up a case-handling team composed of four police officers from the departments of application control, anti-corruption and duty crime prevention. Everyone quickly worked out a preliminary investigation plan and plan, and a legal network was quietly rolled out.

　　The policemen were divided into two groups, one to the county agricultural bureau, responsible for collecting the rice planting verification area and the registration form of growers reported by Houhe Village Committee in Shikou Town over the years, and the other to the county finance bureau, responsible for collecting the rice grain subsidy standards over the years. On the weekend of April 13th, police officers worked overtime to carefully verify the rice planting area and receive subsidies. As soon as the data were summarized, doubts immediately emerged. The police officers found that from 2009 to 2011, several farmers in Houhe Village Committee received a significantly higher amount of food subsidies than other villagers in the same village, and there was suspicion of taking food subsidies.

　　On April 14th, police officers visited the government of Shikou Town for investigation. Upon inquiry, it was learned that the farmers who had doubts were none other than the six village cadres themselves or their relatives, including the secretary, director, deputy director and accountant of Houhe Village Committee. After understanding this situation, the police officers immediately went to Houhe Village Committee to collect accounting accounts and find witnesses. Accounting accounts and witness testimony show that six people, including He Mou, secretary of Houhe Village Committee, falsely reported the rice planting area of more than 270 mu.

　　The police officers brought six people, including He Mou, back to the hospital for questioning. In the face of the evidence, they all truthfully confessed the fact and process of taking food subsidies for private distribution. The amount involved was about 113,000 yuan. Recently, the hospital was suspected of corruption. Six people filed a public prosecution against He Mou.

　　While consolidating the evidence and handling the case, the police officers returned all the recovered money to the Shikou town government, and urged the town government to distribute subsidies to the villagers according to the actual planting area. In view of the hidden dangers and loopholes in the management of the Agricultural Bureau and the town government, the hospital also carried out careful investigation and analysis, and put forward 8 procuratorial suggestions, which were adopted by relevant functional departments. (Reporter Jing Meffert correspondent Wu Bo)

Original Xiao yin yin ke aesthetics

Recently, a lot of negative news has been exposed, and we are all extremely angry at the evil deeds of the criminals. It is time to learn about the law.

Today, Xiaoyin gives you several documentary films about criminal investigation and popularization of law in Amway, to see those incredible cases and superb cracking thinking, and to experience real crimes at close range!

Revealing the secret from the perspective of forensic medicine

NO.1

Forensic Medicine Secret File

Source: CCTV, Beep Beep, Watermelon Video

Bilibili’s entry-level popular science documentary "Forensic Medicine Secret Files" tells people’s moral bottom line and interpersonal boundary with various classic cases as the carrier. For example, a young girl in Sichuan was killed by her brother-in-law and dumped.

My sister helped my brother-in-law hide it, but she couldn’t escape the forensic doctor’s death appraisal. The forensic doctor extracted the girl’s DNA from the scratches on her brother-in-law’s neck, and finally the truth came out.

In addition to the popular science of forensic work, we can also learn to judge the time of death by the length of maggots, corpse spots, corpse wax, etc., to judge the age of the deceased by pubic bone, teeth and skull, and to judge the direction of murder by blood, etc., which is strongly promoted. (Funny)

NO.2

Forensic Song Ci

Source: CCTV. com, BiLi.

Forensic Medicine Song Ci tells the evolution and development of cross-century medicine by comparing Song Ci, a forensic doctor in the Southern Song Dynasty, with modern science and technology medicine.

How to use the length of maggots to solve cases? How to determine the time of death in a dismembered body case? Poisoning cases are compared with snake venom cases, and forged injuries are compared with skin dyeing cases. It is a magical and mysterious documentary that netizens are burning their brains and repeating their words.

This documentary is short and pithy, with an episode of only 20 minutes. However, the purpose of the whole documentary is "forensic doctors speak for the living, for the rights of the dead", and the core is judicial justice, which leads the audience to the truth step by step.

Walk into the life of the market

NO.3

Here’s the thing, judge

Source: Tencent Video

Perhaps many friends have heard of Guarding the Liberation of the West, but they don’t know that there are some after-sales trial contents. In this documentary column, we can directly attack the "human reality" on the execution site.

The victim was killed in a car accident, but only sentenced to six months? What is the difference between drunk driving and drunk driving? What attention should be paid to the judgment of young criminal groups?

Although it is a serious content, it is explained to us in a relaxed and happy way with a variety of editing techniques. If you like the style of emancipating the west, then this judge should not be missed ~

NO.4

Patrol Site Record 2018

Source: Tencent video, 囎 囎 囎

Dragon TV, the first panoramic police documentary film in China, truly records the busy and trivial patrol work of Shanghai grassroots police, showing us the way of urban management and the spirit of the people’s police.

The classic "perfect victim" discussion is very prominent here. A man angrily cut his wife more than twenty times for cheating. Barrage summary: it takes two hands to make a sound. It is suggested that you should keep a good attitude when watching this documentary.

The content of the 12 issues is recorded in thematic diversity, and the length of a single episode is 50 minutes. Although it takes a long time, there are 5-7 short stories about people’s livelihood in each episode, and the narrative will not drag on.

NO.5

No small thing in a big city-a real hero in a city

Source: Li Li Li

This is another police investigation documentary on bilibili after the on-site patrol. However, compared with the previous paragraph, the perspective of this part has shifted from the grassroots police station to the dimension of combating crime, focusing on criminal cases and economic disputes.

It includes anti-fraud, plainclothes police, major crimes and other elements, as well as 24 years’ unsolved cases of unknown female corpses in heavy cases. The audience can feel the whole process of arrest and experience the tense atmosphere through the lens.

"In peacetime, the public security team is a team with the most sacrifices and the greatest dedication, and it is worthy of being a loyal guardian of the party and the people."

They choose to pursue their inner light and become our light.

Heavy taste and different novelty hunting

NO.6

Asian Crime Investigation Archives

Source: Iqiyi Video

Asian crime is a documentary about major criminal cases produced by the mainland. The serial murders in Taipei, Chen Yongzhi, a "hotel killer" in Taiwan Province, Wang Lijuan, a Malaysian Chinese, a masseuse in Thailand and a pickup truck driver in Thailand were described.

The whole documentary has a strong irony, full of carnival meaning of media and bystander society. As the taiwanese drama asked, "The distance between us and evil."

NO.7

Skynet

Source: CCTV

Skynet of CCTV is a talk show, which is heavier than legal report’s, and is called a suspense thriller in the cloak of popularizing law.

Every episode is full of horror movies: a burning wedding car, a cashier at night, and a secret car ride. There is no fancy editing technique, and the atmosphere is mainly set off by the gloomy bgm, which is probably the shadow of many people’s childhood.

There is no forced sensation in the column of popularizing law, the rhythm is compact, the narrative is concise and the process is thrilling.

If you are interested in this one-episode half-hour "next meal drama", you can take a shower.

NO.8

Sword of China

Source: CCTV

This 300-minute documentary, which doesn’t even have serious posters and stills, is the first documentary that comprehensively reflects the anti-drug field in China and the longest documentary that reflects the anti-drug struggle in the world so far.

The content of the record is extremely large, and the whole process of becoming a drug addict is recorded in detail: how to get infected, how to start drug abuse and drug trafficking, how to be rampant …

The most heart-wrenching thing is our law enforcement officer, a man with indomitable spirit. Facing the grief of the death of his life, he pulled every audience’s heart into the abyss of sorrow. This great sorrow is more impressive than the exciting arrest.

NO.9

On-the-spot record of major criminal investigations in western China.

Source: Li Li Li

Explosions, all kinds of robbers, murderers and torturers … All kinds of subjects can be an eye-opener in this documentary.

Bilibili has a series collected and sorted by up Master. Even the body is not coded here, a proper "horror film" that makes people’s adrenal hormones soar.

However, the over-straightforward lens and the incompatible literary narration make many viewers feel heavy and depressed. In all kinds of bizarre cases, we have glimpsed the "humanity" that we dare not touch.

NO.10

On-the-spot record of serious criminal investigation cases in western China

Source: Li Li Li

This is a companion piece to the last documentary, which tells the same horrible and shocking case. Chasing a wife for murder, murder case in 09, killing a family … The primitiveness of human beings is completely exposed.

The whole documentary is 20 episodes long, and a single film has 45 minutes. If you are a fan of horror movies and serious crimes, these two documentaries can satisfy your desire for "horror". The source of the films is a little hard to find, so ask the omnipotent mother.

All the true reappearance, all the endless cruelty, make us wonder how bad people can be.

In the face of bloody reality, we are as powerless to fight back as naked children. As human beings, perhaps the biggest gap between us and animals lies in "altruism".

If everyone can stick to the inner moral bottom line and kindness, the world may become a friendly world.

Topic collection

Leave the topic you want to see most in the comment area. If you like the top three topics, you will have the opportunity to be selected into Xiaoyin topic library. The final selected inker will get an exclusive book gift from this print ~

Author: Sally Mi Lu

Editor: Laishipu

Original title: "10 high-scoring criminal investigation documentaries, hard-core law popularization"

Read the original text