Objective To review the epidemiologic features of norovirus infection outbreaks in Zhejiang province during 2004-2014.Methods Epidemiological data of norovirus infection outbreaks in Zhejiang province from January 2004 to February 2014 were collected from the Emergency Public Reporting System in Zhejiang Provincial CDC.The distribution of time,area,population,route of transmission and genotype of norovirus were analyzed.Results There were 16 outbreaks of norovirus infections with 2 037 cases during 2004-2014 in Zhejiang province.Eleven outbreaks occurred during February and April,and 13 outbreaks occurred in schools.The outbreaks in schools mainly involved students aged 15-20 years,while other outbreaks took place mainly in the young and middle-aged population.The sex ratio of male to female was 1.05 ∶ 1.Among 16 outbreaks,10 were induced by norovirus G Ⅱ infections,3 were induced by norovirus G Ⅰ infections and 3 were induced by norovirus G Ⅰ and G Ⅱ infections.Fourteen outbreaks were caused by water pollution.Conclusion Outbreak of norovirus infection usually occurs in schools during winter and spring in Zhejiang province,and the epidemic of disease is mainly associated with polluted water.

Objective: To explore the effect of exercise preconditioning (EP) on pathological cardiac hypertrophy and heart failure (HF) in pressure over-loaded experimental rats.
Methods:A total of 60 SD rats at the age of 6 weeks were randomly divided into 3 groups, n=20 in each group. Sham-operation group, Transverse aortic constriction (TAC) group and EP + TAC group. The cardiac function and structure were evaluated by echocardiography, patholgical changes and HF biomarkers were examined for EP effect at 4 and 8 weeks after TAC.
Results:Compared with Sham-operation group, the cardiac function and structure had obvious changes in the other 2 groups. Compared with TAC group, the ejection fraction in EP+ TAC group increased 15%, the heart weight index and left ventricular weight index decrease 15.7%and 20%respectively at 8 weeks after TAC, all P<0.05. Compared with Sham-operation group, the mRNA and protein expressions of ANP and BNP increased in TAC group at 4 and 8 weeks after TAC, increased in EP+TAC group at 8 week after TAC. Compared with TAC group, the mRNA expressions of ANP and BNP in EP+TAC group decreased 47%and 62%at 4 weeks after TAC, decreased 44%and 28.1%at 8 weeks after TAC, all P<0.05;the protein expression of ANP and BNP in EP+TAC group decreased 22.3%and 48%at 4 weeks after TAC, decreased 21.5%and 38.3%at 8 weeks after TAC, all P<0.01.
Conclusion: EP may improve cardiac pathological hypertrophy in pressure over-loaded rats at the early stage, and delay the heart failure process.

Objective To investigate the epidemiological characteristics of gonorrhea,and to analyze its temporal-spatial clustering in Zhejiang province.Methods Data on the incidence and demographic characteristics of gonorrhea in Zhejiang province from January 2004 to December 2012 were obtained from the China Information System for Disease Control and Prevention.The population,time and space distributions of gonorrhea were described.Epidemic curve and incidence maps were drawn.A space-time permutation scan statistic was used to detect space-time clusters,and spatial autocorrelation analysis was performed to calculate the Moran's I value and draw Local Indicators of Spatial Association (LISA) cluster maps.Results In Zhejiang province,a total of 199 956 cases of gonorrhea were reported with a decreasing trend in incidence rate from 2004 to 2012.The male to female ratio was 3.51:1 (155 634/44 331).People aged between 25 and 60 years accounted for 75.21％ of these patients,whereas the constituent ratio of people aged 0-1 years and ＞ 60 years increased with time.The incidence rate of gonorrhea was significantly higher in middle and north parts than in the south part of Zhejiang province,and higher in summer than in winter and spring with the peak incidence observed in August.Thirteen temporal-spatial clusters were detected,with the large clusters in Hangzhou,Huzhou,Ningbo,Shaoxing and their neighbor counties/cities/ districts,as well as some counties/cities/districts in Jinhua.All of the above clusters lasted 4.5 years.LISA maps showed an increasing trend in high-high aggregation counties/cities/districts which spread from the north to south part of Zhejiang province.Conclusion There is a temporal-spatial aggregation of gonorrhea in Zhejiang province with young and middle-aged men as the main affected population.

Small cell carcinoma of cervix (SCCC) is a rare disease with highly aggressive behaviour and is pathologically hard to diagnose. In this study, the clinicopathological features, diagnosis, treatment and prognosis of the condition were examined. Clinical records and follow-up data of 7 cases of SCCC were retrospectively studied. Our results showed that five non-recurrent cases initially presented irregular vaginal bleeding or increased apocenosis of varying degrees. Pathological examination revealed that the stroma was diffusely infiltrated with small monomorphous cells ranging from round to oval shape. Three cases were immunohistochemically confirmed. One case was accompanied with squamous cell cancer. Of the 7 cases, one case was classified as stage I b1, two stage I b2, one stage IIa, one stage IIb, and one stage IIIb. On the basis of their stages of condition, one subject with stage III b underwent chemotherapy, and one with stage Ib2 received extensive hysterectomy plus pelvic lymphadenectomy, while the other 5 cases were treated by extensive hysterectomy and pelvic lymphadenectomy in combination with pre- and/or post-operative adjuvant chemotherapy and radiotherapy. Of the 7 patients, 4 had relapse-free survival of 14, 14, 16 and 28 months respectively. It is concluded that SCCC is an aggressive tumor with propensity for early pelvis lymph node metastases. Early-stage patients should be treated by extensive hysterectomy and pelvic lymphadenectomy in combination with pre- and/or post-operative adjuvant chemotherapy and radiotherapy.

OBJECTIVETo understand the temporal-spatial distribution of hand-foot-mouth disease in Zhejiang province, from May 2008 to June 2013.

METHODSThe cases number and incidence data of hand-foot-mouth disease from May 2008 to June 2013 for all the counties(cities, districts) in Zhejiang province were collected from China Information System for Disease Control and Prevention, total 511 643 cases. Temporal distribution of hand-foot-mouth disease was described, the incidence maps were drawn using Epimap software. Temporal-spatial clustering was analyzed by Satscan 9.0.1 software.Log likelihood ratio(LLR) was used to assess the clustering. The year-county (city, district)-specific relative risk(RR) of hand-foot-mouth disease were calculated. RR contour maps were drawn with Arcview GIS 3.3.

RESULTSIn Zhejiang province, from May 2008 to June 2013, the highest incidence rate was 270.81/100 000 (147 943/54 629 996) (2012 year) and the lowest incidence rate was 135.32/100 000 (69 285/51 199 987) (2009 year). The incidence in the eastern coastal areas (217.77/100 000(286 300/131 468 746)) including Ningbo, Taizhou, Wenzhou, was higher than the western mountain areas(168.11/100 000(98 016/58 304 266)) including Quzhou, Lishui, Jinhua. The epidemic curve showed two peaks, during April to July (101.15/100 000(320 144/316 497 516)) , and during October to November (23.30/100 000 (61 088/262 148 114)) .

RESULTSof temporal-spatial scan showed 10 temporal spatial aggregation areas, the strongest one was in Wenzhou city, south-east Zhejiang province, from July 2009 to June 2011(RR = 2.38, LLR = 10 650.75, P < 0.01). The relative risk maps from 2009 to 2012 were similar, the highest density areas were located in the eastern coastal Zhejiang: Longwan district, Wenzhou city (RR = 4.42 and 3.30) in 2009 and 2010 year, Pingyang county, Wenzhou city(RR = 3.04) in 2011 year, and Ninghai county, Ningbo city(RR = 2.97) in 2012.

CONCLUSIONThe eastern coastal area had a high incidence level of hand-foot-mouth disease in Zhejiang province, 2008-2013, with the peak during April to July. Temporal-spatial clustering were observed, the disease showed a distinct regional distribution feature, eastern coastal cluster areas and mid-west cluster areas were found.

Small cell carcinoma of cervix (SCCC) is a rare disease with highly aggressive behaviour and is pathologically hard to diagnose. In this study, the clinicopathological features, diagnosis,treatment and prognosis of the condition were examined. Clinical records and follow-up data of 7 cases of SCCC were retrospectively studied. Our results showed that five non-recurrent cases initially presented irregular vaginal bleeding or increased apocenosis of varying degrees. Pathological examination revealed that the stroma was diffusely infiltrated with small monomorphous cells ranging from round to oval shape. Three cases were immunohistochemically confirmed. One case was accompanied with squamous cell cancer. Of the 7 cases, one case was classified as stage Ⅰ bl, two stage Ⅰ b2,one stage Ⅱ a, one stage Ⅱ b, and one stage Ⅲb. On the basis of their stages of condition, one subject with stage Ⅲ b underwent chemotherapy, and one with stage Ib2 received extensive hysterectomy plus pelvic lymphadenectomy, while the other 5 cases were treated by extensive hysterectomy and pelvic lymphadenectomy in combination with pre- and/or post-operative adjuvant chemotherapy and radiotherapy. Of the 7 patients, 4 had relapse-free survival of 14, 14, 16 and 28 months respectively.It is concluded that SCCC is an aggressive tumor with propensity for early pelvis lymph node metastases. Early-stage patients should be treated by extensive hysterectomy and pelvic lymphadenectomy in combination with pre- and/or post-operative adjuvant chemotherapy and radiotherapy.

Objective    To study the clinical characteristics, therapy strategies and the outcomes of female patients with acute aortic dissection during late pregnancy and puerperal period. Methods    We retrospectively analyzed the clinical data of 7 patients with acute aortic dissection during late pregnancy and puerperal period in Shanghai Changhai Hospital between August 2012 and June 2017. Five of the 7 patients were late stage pregnancy, 2 were puerperal period (1 at the postpartum night, 1 in 18 days after delivery). There were 6 patients of Stanford type A aortic dissection (85.7%), and 1 patient of type B aortic dissection (14.3%). The age of the patients ranged from 26 to 34 (30.8±3.1) years. Cardiac ultrasonography of patients with type A showed that the maximum diameter of the ascending aortas was 4.2–5.7 (4.7±0.6) cm, of which 2 patients were aneurysm of aortic sinus, 3 patients were with Marfan syndrome. Bentall procedure was conducted in 1 patient, Bentall+Sun’s surgery in 2 patients, ascending aorta replacement+Sun’s+coronary artery bypass grafting surgery in 1 patient, aortic root remodeling+ascending aorta replacement+Sun’s surgery in 2 patients. One patient with Stanford type B acute aortic dissection was performed with thoracic endovascular aortic repair (TEVAR) after cesarean section. Results     Aortic blocking time ranged from 51 to 129 (85.5±22.9) min.  Cardiopulmonary bypass time was 75–196 (159.0±44.0) min. Moderate hypothermic circulation arrest with selective cerebral perfusion time was 20–30 (23.8±3.5) min. All maternal and fetuses survived. The infant whose mother received aortic repair in early stage and then received cesarean section was diagnosed with cerebral palsy. Maternal and fetuses were followed up for 9 months to 4 years. During the follow up period, all the fetuses grew well except the cerebral palsy one, and all maternal recovered well. The patient who received aortic repair in the early stage, had a sigmoid rupture during cesarean section and was treated with sigmoid colostomy. Another patient with Stanford type A dissection was diagnosed as left renal vein entrapment syndrome after 2 years. Conclusion    Type A aortic dissection is more common in late pregnancy and puerperal patients. And Marfan syndrome is a high-risk factor for acute aortic dissection in pregnancy women. Early and appropriate surgical treatment strategy based on the type of aortic dissection and gestational age are the key points to achieve good outcomes both for maternal and fetus.

We reported a 54-year-old female patient with severe tricuspid regurgitation, who received mechanic valve in the mitral position 15 years ago. The patient’s Society of Thoracic Surgeons score was 8.27%, and was intolerant to open heart surgery, so she was recommended for transcatheter tricuspid valve replacement via right vena jugularis interna. The procedures were guided by echocardiography and X ray fluoroscopy on November 13, 2021, the prosthesis was implanted successfully, and the patient was recoved without any adverse events. After 1 month follow-up, her general condition was apparently improved.