Objective To study the short-term clinical efficacy and its possible mechanism of refractory hypertension(RH) treated by continuous veno-venous hemofiltration (CVVH) in maintenance hemodialysis (MHD) patients. Methods Thirty-four MHD patients with RH treated with CVVH enrolled in the treatment group,all these patients were treatment of 2 -3 times,each time 8 - 10 hours. Thirty MHD patients with wellcontroled blood pressure were recruited as control. Changes of blood pressure, dry weight, plasma levels of parathyroid hormone (PTH), renin ( RA), angiotensin Ⅰ , Ⅱ ( AT Ⅰ , AT Ⅱ ), aldosterone ( Ald ) were observed before and after hemodialysis. Results In the treatment group,compared with pre-treatment, the blood pressure decreased significantly with an effective rate of 64.7% and efficient rate of 100. 0%. Before treatment, plasma RA was ([1.10 ±0.25] μg/(L · h)and [0:78 ±0.26] μg/(L · h),AT Ⅰ was [0.89 ±0.21] μg/L and [ 0. 52 ± 0. 14 ] μg/L, AT Ⅱ was [ 177.68 ± 89.46 ] ng/L and [ 89. 25 ± 12. 84 ] ng/L, Ald was [72. 06 ± 11.47 ]ng/L and [ 48.92 ± 8. 65 ] ng/L, PTH was [ 306. 81 ± 69. 37 ] ng/L and [ 248.76 ± 134. 62 ] ng/L in the treatment and control group respectively. All the measurements in the treatment group were significantly higher than those in the control group (P ＜ 0. 05 ). In the treatment group, compared to pre-treatment, plasma RA significantly decreased ( [ 1.10 ± 0. 25 ]μg/ ( L · h) vs [ 0. 76 ± 0. 17 ] μg/( L · h ), as well as AT Ⅰ ( [ 0. 89 ±0.21]μg/L vs [0.50 ±0.12] μg/L),ATⅡ([177.68±89.46]ng/L vs [ 87.13±14.22] ng/L),Ald ([72.06±11.47]ng/Lvs [ 46. 01± 9. 86 ] ng/L ) and PTH ( [ 306. 81 ±69.37]ng/L vs [ 186.53 ±32.93 ] ng/L) ( P ＜ 0. 05 ). However, there was no significant changes in the above mentioned measurements between before and after hemodialysis in the control group (P ＞ 0. 05). Conclusion CVVH may be an effective methods in the treatment of MHD patients with RH, and its antihypertensive mechanisms may be that CVVH can effectively remove the excess water in the body, and reduce plasma RA, AT Ⅰ , AT Ⅱ ,Ald and PTH levels.

Objective To investigate disorders in calcium and phosphorus metabolism and abnormity in parathyroid function and their related factors in maintenance hemodialysis(MHD)patients.Methods We collected serum Hb,SCr,BUN,calcium,phosphorus,iPTH,high sensitivity C-reactive protein(hs-CRP),albumin and calculated albumin-corrected Ca and Kt/V from 198 patients with MHD in Jing'an District Central Hospital,Shanghai from Jan.2009 to Dec.2010.The calcium and phosphorus metabolism and parathyroid function were evaluated according to the guidelines of bone metabolism and controlling of bone disease in Kidney Disease Outcome Quality Initiative(KDOQI)recommended by National Kidney Foundation of the United States.198 patients were classified into the standard group(150-300 ng/L),lower than the standard group(＜150 ng/L)and higher than the standard group(＞ 300 ng/L)according to serum iPTH levels.Results In the 198 cases,110 cases were normal in serum Ac-Ca(55.6％); 118 cases were normal in serum phosphorus (59.6％); 143 cases were normal in Ca × P(72.3％); 39 cases were normal in iPTH(19.7％).All four items up to the standard were 28 cases(14.1％)among 198 cases.However,132(66.7％)patients showed lower than 150 ng/L in serum iPTH.The average serum iPTH gradually decreased with age.The senior patients demonstrated the highest average serum Hs-CRP,the lowest average serum phosphorus and the lowest albumin.There were no statistical significance in sex,hemodialysis duration,diabetes,blood pressure,Hb,Bun,SCr,Ac-Ca and Kt/V among three groups.Conclusion The disorders in calcium and phosphorus metabolism and abnormity in parathyroid function is common in the MHD patients.We should pay attention to hypofunction of parathyroid gland in the patients with MHD,which may be related to aging,malnutrition and potential infection.These findings need further investigation.

Objective To investigate the efficacy and safety of ultra-mini percutaneous nephrolithotomy for the treatment of renal or upper ureteral stones.Methods The data of 32 patients diagnosed as renal or upper ureteral stones were retrospectively reviewed,who underwent ultra-mini percutaneous nephrolithotomy from June to October,2015,including 29 kidney stones,3 upper ureteral stones,of which 21 single stone,7 multiple stones,and 4 staghorn stones.There were 8 cases with inferior calyx stones,10 with renal pelvis stones,3 with upper ureteral stones,10 with renal pelvis stones plus inferior calyx stones and 1 with renal pelvis stones plus upper calyx stones.The mean stone size was (20.1 ±7.6) mm (ranging from 10 to 41mm).The mean Hounsfield unit (HU) was (1 125.9 ±225.9) Hu (ranging from 520 to 1 550Hu).In this cohort,13 cases had mild hydronephrosis,2 moderate hydronephrosis,1 severe hydronephrosis while no hydronephrosis identified in the other 16 patients.One case had concomitant kidney and ureter duplication malformation,and 1 case had residual stones after laparoscopic nephrolithotomy.Results All of the patients were treated by single tract UMP.Among them,middle calyceal puncture was performed in 9 cases,and the other 23 cases underwent lower calyceal puncture,including 4 cases of intercostal puncture,and 28 subcostal puncture.The mean operating time was (30.3 ± 15.0) min (ranging from 10 to 90 min).The mean postoperative hospital stay was (1.9 ± 1.0)days (ranging from 1 to 5 days).The mean hemoglobin decrease was(14.6 ±8.4)g/L (ranging from 1 to 46 g/L).No analgesics were used.Peri-operative complication rate was 3.13％ (1/32) with 1 case of collection system perforation.There was no fever,severe bleeding,urinary extravasation,pleural injury,or blood transfusion.The SFR was 93.75％ (30/32) and 96.88％ (31/32) on the first day and the first month after the operation,respectively.Conclusions UMP could be a safe and effective method for the treatment of renal or upper ureteral stones,especially for inferior calyceal stones less than 2cm.It offers high stone clearance rate,minimally invasiveness,quick recovery,short length of hospital stay and improved quality of life.

Objective : To identify spatio-temporal distribution patterns of mumps in Zhejiang Province from 2008 to 2019, so as to provide insights into precise control of mumps. Methods : The epidemiological data pertaining to mumps in Zhejiang Province from 2008 to 2019 were collected from the China Information System for Disease Control and Prevention. The time- and region-specific incidence of mumps was descriptively analyzed, and the spatio-temporal clustering characteristics of mumps incidence were identified using global and local spatial autocorrelation analyses and spatio-temporal scan analysis. Results : A total of 167 196 cases of mumps were reported in Zhejiang Province from 2008 to 2019, and the incidence of mumps reduced from 56.08/105 in 2008 to 11.35/105 in 2019, with a reduction of 79.76%. There was no remarkable mumps seasonality since 2017; however, spatial autocorrelation was seen in mumps incidence in 2008, 2011 and 2012, respectively ( Moran's I coefficient=0.16, 0.18, 0.16; all P<0.05 ). Spatio-temporal scan analysis identified five spatio-temporal clusters of mumps incidence in 2008, 2011 and 2012, and the most likely spatio-temporal cluster was mainly concentrated in Cangnan County of Wenzhou City, covering 17 counties clustered in the time frame from 15 January 2008 to 28 February 2009, while the other four clusters were concentrated in Pinghu City of Jiaxing City, Kaihua County of Quzhou City, Fuyang District of Hangzhou City and Zhuji City of Shaoxing City, clustered in the time frame from 15 January 2008 to 30 June 2012. Conclusion The incidence of mumps appeared a tendency towards a reduction in Zhejiang Province from 2008 to 2019, and rebounded in some regions. No remarkable mumps seasonality was seen since 2017. The spatio-temporal clusters of mumps incidence were concentrated in Wenzhou and Jiaxing cities of Zhejiang Province in 2008, 2011 and 2012; however, no spatial cluster was identified since 2012.

Objective: To establish an optimized path for health management of HBV infections among pregnant and lying-in women based on a Delphi method, so as to provide the evidence for intensifying the interruption of the mother-to-child transmission of HBV. Methods: Based on literature review and previous studies, the preliminary framework and contents of the optimized path for health management of HBV infections were constructed. Experts from epidemiology, clinical medicine and maternal and children healthcare were invited to participate in two-round Delphi consultations, and the preliminarily designed indicators were screened and revised. The score for feasibility of each indicator was calculated, and the weight of each indicator was estimated using a proportional distribution method. Results: Sixteen experts participated in the consultation, including 13 women. The participants had a mean age of (45.69±5.71) years, and a mean employment duration of (23.06±7.05) years. All participants had a degree of bachelor and above, and there were 14 experts with vice senior professional titles. The mean positive coefficient was 96.88% and the mean authority coefficient was 0.790 during the two-round expert consultations. There were significant differences in the coordination coefficient of importance, necessity and feasibility of indicators at all levels (P<0.05), and the coefficient of variation of the feasibility was all less than 0.250. The final optimized path for health management of HBV infections among pregnant and lying-in women included 6 primary indicators, 17 secondary indictors and 73 tertiary indicators. Among the primary indicators, delivery management (0.173 4), screening and evaluation (0.172 8) and pregnancy management (0.172 7) had a high weight. Conclusion A scientific and reliable optimized path is created for health management of HBV infections among pregnant and lying-in women, which has a potential value for improving the interruption of mother-to-child transmission of HBV.

Objective: To investigate the serum levels of anti-measles antibody among residents in Zhejiang Province in 2018, so as to provide insights into measles control. Methods: Permanent residents aged 0 to 59 years were recruited using the stratified multistage random sampling method in Zhejiang Province in 2018, and subjects' demographic features, medical history of measles and history of immunization with measles-containing vaccine (MCV) were collected using a questionnaire survey. The serum level of anti-measles IgG antibody was detected, and the geometric mean concentration (GMC) of anti-measles IgG antibody was estimated. The seroprevalence, protective rate and GMC of anti-measles IgG antibody were compared among residents at different age groups and regions. Results: A total of 4 189 residents were enrolled, including 1 939 males and 2 250 females, with a male to female ratio of 1∶1.16. There were 3 858 residents positive for anti-measles IgG antibody, with seroprevalence of 92.10%, and there were 2 072 residents with protective antibodies against measles, with a protective rate of 49.46%. The median GMC of anti-measles IgG antibody was 798.33 (interquartile range, 1 024.06) mIU/mL, and the protective rate of anti-measles IgG antibody appeared a tendency towards a decline with age ( χ2trend=18.067, P<0.001 ). There were significant differences in the seroprevalence ( χ2=45.090, P<0.001 ), protective rate ( χ2=57.432, P<0.001 ) and GMC of anti-measles IgG antibody (χ2=88.624, P<0.001 ) among residents at different regions, with the lowest seroprevalence of anti-measles IgG antibody in Ningbo City ( 85.19% ), the lowest antibody-protective rate (38.98%) and the lowest GMC [632.89 ( 909.04 ) mIU/mL] in Zhoushan City, the highest seroprevalence ( 95.16% ), antibody-protective rate (58.48%) and GMC [1 035.84 ( 1 301.77 ) mIU/mL] in Huzhou City. Conclusions The protective rate of anti-measles antibody was low and appeared a tendency towards a decline among residents in Zhejiang Province in 2018. There was a region-specific serum level of anti-measles antibody in Zhejiang Province in 2018.

Abstract Vaccine-hypervariable poliovirus type Ⅲ was detected in an acute flaccid paralysis infant at age of 6 months in Zhejiang Province in June, 2021, and the isolated and incubated virus had six nucleotide variations in the VP1 region as compared to the poliovirus Sabin vaccine strain. The infant had a history of three-dose poliovirus vaccination, and grade 2 muscle strength of the left upper limb upon onset. He was clinically diagnosed with cellulitis of the left shoulder, and recovered to normal following treatment. No abnormality was detected in the nervous system, and the infant was cured and discharged from hospital. No vaccine-hypervariable poliovirus was detected in subsequent infant' clinical samples or in close contacts, and no similar cases were identified during the active case detection by county/district medical institutions and among community populations. Since the infant did not present poliomyelitis-related clinical symptoms caused by vaccine-hypervariable poliovirus, poliomyelitis was excluded. The vaccine-hypervariable poliovirus was not spread because of timely identification and effective responses, suggesting the urgent need to maintain the sensitivity of the acute flaccid paralysis surveillance system and improve the coverage of poliovirus vaccination, so as to inhibit the transmission of poliovirus.

Objective To assess the prognosis of patients with bladder neck (BN) involvement in radical prostatectomy specimens and compare it with patients with seminal vesicle invasion (SVI).Methods From January 2002 to December 2008,42 patients with prostate carcinoma who underwent radical prostatectomy were analyzed retrospectively.The mean age was 70.3 years (range 59-78 years).The patients were divided into two groups according to 2002 TNM system:pT4a group (bladder neck invasion) with 17 cases and pT3b group (unilateral or bilateral seminal vesicle invasion)with 25 cases.Postoperative outpatients were followed-up on a regular basis,two consecutive postoperative serums PSA greater than 0.2 μg/L defined as a biochemical recurrence.The postoperative follow-up to the time of biochemical recurrence or follow up to the deadline without biochemical recurrence were defined as biochemical recurrence free survival time.Results All patients were followed up for 50-122 months.The patients with BN involvement 17.6％ (3/17) had biochemical recurrence,whereas seminal vesicle invasion 24.0％ (6/25),there was no statistical significance between the two groups (P＞0.05).Conclusions Postoperative adjuvant therapies can improve the biochemical recurrence free survival.In this study,the prognosis of pT4a and pT3b group is similar.A conceivable down-staging of BN involvement in the TNM staging system should be considered.

ObjectiveTo observe the clinical characteristic and treatment response of the Gleason 5 + 5 prostate cancer and to summarize the prognostic factor of such patients. MethodsFrom January 2005 to May 2010,21 cases of Gleason 5 + 5 prostate cancer were enrolled in this study.The average age was 73 years and the pre-treatment PSA was 60.8 ng/ml.Six of the 21 cases had a PSA level ≤20 ng/ml.The maximal androgen deprivation therapy (ADT) in the form of castration and Casodex or fluctamide was carried out once the diagnosis was made.Bone metastasis was revealed in 16 cases.PSA levels were tested at the 4th month and then every 3 months after the castration.The observation endpoint was 6 months.Extracorporeal beam irradiation or the systemic chemotherapy was carried out if the PSA did not drop to a normal range after 6 months. ResultsIn the study group with initial PSA ＞ 20 ng/ml,the PSA did not drop to normal range in 5 cases; of which 4 had bone metastasis.With systemic chemotherapy,3 cases died within 1 year.Another case,with localized disease,received an extracorporeal beam irradiation and died within 1 year due to progression of the tumor.Among the remaining 10 cases sensitive to total androgen blockage,7 survived through the end of the study period.One case had PSA recurrence in month seven after the initial therapy and died at month 19.One case had PSA recurrence at month 22 and died at month 36.The patient had his PSA augmented at month 24 after total androgen blockage and the patient passed away 4 months later.Of the 6 cases who had an initial PSA ≤20 ng/ml 4 died within one year. ConclusionsGleason 5 +5 prostate cancer is relatively resistant to ADT with a worse prognosis,especially for the cases with a nadir PSA ＞4 ng/ml after 6 months’ ADT.The patients who had an initial PSA ≤20 ng/ml might have an unsatisfactory clinical outcome.

Objective To discuss the management of renal cell carcinoma(RCC) associated with von Hippel-Lindau(VHL) disease. Methods Clinical data were analyzed retrospectively from 28 ca-ses ( 16 males and 12 females, with a mean age of 45 years), of whom 15 had bilateral RCC and 13 had unilateral RCC. VHL germline mutation was analyzed in 25 cases. Nephron sparing surgery (NSS) or radical nephrectomy was performed in 24 cases. Results VHL germline mutations were detected in 25 cases including 14 asymptomatic patients. Among 29 solid renal tumors in 9 cases observed for a mean time of 44 months (range 12 to 86), the mean increase in tumor size was 0. 531 cm/year. There were 19(65.5%) tumors>3 cm at the end of follow-up but only 1 developed retroperitoneum lymph nodes metastasis. A total of 87 solid tumors were removed and 62 (71.3%) solid tumors were man-aged by NSS. Pathological results showed 86 clear cell carcinomas (73 Fuhrman Ⅰ and 12 Fuhrman Ⅱ ) and 1 calcified lesion. During mean follow-up of 50(5-237) months, local recurrence occurred in 4 cases treated with NSS; 26 patients were alive at the end of follow-up. Conclusions DNA testing might be helpful in the earlier detection of asymptomatic VHL patients. Most solid renal tumors in VHL disease grow slowly. The majority of the tumors >3 cm may still be indolent and do not metas-tasize during longer follow-up and can be observed. NSS is effective and safe for RCC in VHL disease.