Objective: To investigate the epidemiological characteristics of sexually transmitted diseases (STDs) in Zhejiang Province from 2018 to 2022, so as to provide insights into improving STDs prevention and control strategies. Methods: Data of syphilis, gonorrhea, condyloma acuminatum, genital herpes and genital Chlamydia trachomatis infections reported in Zhejiang Province from 2018 to 2022 were collected from the Infectious Disease Surveillance System of Chinese Disease Prevention and Control Information System. The temporal, spatial and population distribution of STDs were analyzed, and the trends in incidence of STDs were evaluated using annual percent change (APC). Results: A total of 386 770 STDs cases were reported in Zhejiang Province from 2018 to 2022, with mean annual reported incidence of 127.80/105. The mean annual reported incidence from high to low was syphilis (44.11/105), genital Chlamydia trachomatis infections (40.20/105), gonorrhea (24.92/105), condyloma acuminatum (13.32/105), and genital herpes (5.34/105). The incidence of STDs appeared a tendency towards a decline from 2018 to 2022 (APC=-9.332%, P<0.05), with an average annual growth rate of -9.41%. Syphilis (APC=-11.536%, P<0.05), condyloma acuminatum (APC=-7.509%, P<0.05), and genital Chlamydia trachomatis infections (APC=-9.009%, P<0.05) showed a appeared a tendency towards a decline. The top three highest reported incidence were reported in Hangzhou City (185.98/105), Taizhou City (133.85/105) and Lishui City (122.73/105), respectively. The mean annual reported incidence of females was higher than that of males (140.60/105 vs. 117.83/105; P<0.05). Most STDs cases were at ages of 20 to 49 years (265 314 cases, 68.60%). Farmers (118 096 cases, 30.53%), household and unemployed personnel (85 924 cases, 22.22%) were the predominant occupation. Conclusions The incidence of STDs appeared a tendency towards a decline in Zhejiang Province from 2018 to 2022, with regional differences in incidence. People at ages of 20 to 49 years, farmers, household and unemployed personnel are high-risk populations for STDs.

Objective:To investigate epidemiological features and trends of genital herpes in Zhejiang province, and to provide scientific evidence for developing control strategies.Methods:Data on reported cases of genital herpes in Zhejiang province between 2011 and 2020 were collected from national notifiable infectious disease surveillance system in China Disease Control and Prevention Information System, and a descriptive epidemiological study was conducted.Results:The reported incidence rate of genital herpes in Zhejiang province between 2011 and 2020 ranged from 4.92 per 100 000 to 6.19 per 100 000, without a significant upward or downward trend (trend χ2 = 0.03, P = 0.959) ; the reported incidence rate in females showed an increasing trend (from 4.50 per 100 000 to 6.02 per 100 000, trend χ2 = 5.13, P = 0.034) , with an average annual increase rate of 3.27%; among all the age groups, the sexually active population aged 20 - 39 years showed a high reported incidence rate of genital herpes, but the incidence rate increased significantly in the groups aged 15 - 19 years and over 50 years, with the average annual increase rates being 8.10%, 9.24%,7.81% and 4.27% in the groups aged 15 - 19 years, 50 - 54 years, 55 - 59 years and over 60 years respectively. The largest proportion of cases was found in farmers (28.38%, 8 779/30 931) , and high average annual increase rates in proportions were observed in healthcare workers, retirees, students, unemployed population and cadres (13.71%, 13.14%, 10.74%, 9.36% and 7.00%, respectively) . The reported incidence rates were high (over 5 per 100 000) in Eastern coastal areas such as Ningbo, Wenzhou, Taizhou, as well as Jinhua city with relatively developed industrial economies in central Zhejiang; the reported incidence rate markedly increased in Hangzhou city, with an average annual increase rate of 5.39%. Conclusions:There was no obvious downward trend in the prevalence of genital herpes in Zhejiang province from 2011 to 2020. Attention should be paid to the prevention and treatment of genital herpes in females, adolescents and the elderly, and the monitoring of herpes simplex virus infections and investigation of infection routes and exposure history should be strengthened.

Objective:To analyze spatiotemporal distribution characteristics of syphilis in Zhejiang province from 2016 to 2020, to explore cluster areas of syphilis cases, and to provide a theoretical basis for accurate prevention and control of syphilis.Methods:Data on reported syphilis cases in Zhejiang province from 2016 to 2020 were collected from the notifiable infectious disease surveillance system in China Disease Control and Prevention Information System. The ArcGIS10.2 software was used as a data management and presentation platform to establish a database for spatial analysis of syphilis in Zhejiang province from 2016 to 2020, and spatial autocorrelation analysis of reported syphilis incidence was conducted. The SaTScan 9.6 software was used for spatiotemporal scanning analysis.Results:A total of 158 420 cases of syphilis were reported in Zhejiang province from 2016 to 2020, and the average annual reported incidence rate was 49.07 per 100 000 in all counties and districts (range: 20.52 per 100 000-124.29 per 100 000) . The overall spatial distribution pattern of syphilis cases in Zhejiang province was characterized by higher reported syphilis incidence in the West area and lower incidence in the middle area. Global autocorrelation analysis showed that all the global Moran′s I indices from 2016 to 2020 were over 0, Z values were over 1.96, and P values were below 0.001, suggesting the spatial clustering of reported syphilis cases. Local autocorrelation analysis showed that there were 2 high-high clustering areas (Tonglu and Chun′an counties in Hangzhou city, Jingning county in Lishui city) , and 1 low-low clustering area (Jindong district, Dongyang and Yongkang county-level cities in Jinhua city) . Local hot-spot analysis with G statistic showed that there were 6 positive hot-spot areas and 8 negative hot-spot areas of syphilis cases in Zhejiang province. SaTScan spatiotemporal scanning analysis revealed 3 clustering areas, mainly distributed in Taizhou and Zhoushan cities along the eastern coast, and some counties and districts in the southwestern mountainous areas. Conclusions:The reported incidence rate of syphilis in Zhejiang province is characterized by spatial clustering. In the future, prevention and control of syphilis should be strengthened in southwestern mountainous areas, eastern islands, and other remote areas as well as areas with poor transportation.

With the deepening of China′s healthcare reform, cost control of medical consumables has become an important means to alleviate the problem of " high medical cost" . Through analysis of the difficulties of medical consumables cost control and mechanism loopholes in such control, the authors proposed a whole-process control practice, in terms of assessment, procurement, use, supervision, assessment and evaluation, and recommend on formulating whole-process cost control measures at both government and hospital levels.

Objective : To analyze the prevalence and influencing factors of leprosy reactions in Zhejiang Province from 2010 to 2019, so as to provide reference for the control of leprosy. Methods: Through the national leprosy management system, the new leprosy cases in Zhejiang Province from 2010 to 2019 were recruited to analyze the incidence of leprosy reactions in different demographic characteristics and leprosy clinical features. The multivariate logistic regression analysis was conducted to explore the influencing factors for leprosy reactions. Results : Totally 191 leprosy cases were investigated. The incidence rate of leprosy reactions was 29.32%; the the incidence rate of typeⅠand type Ⅱreaction was 16.75% and 9.42%, respectively. There were 33 leprosy reaction cases (58.93%) before multidrug therapy (MDT) , 13 cases (23.21%) during 0-6 months of MDT, 5 cases (8.93%) during 7-12 months of MDT, 3 cases (5.36%) during over 12 months of MDT, and 2 cases (3.57%) after MDT. The results of the multivariate logistic analysis showed that the cases who were 35 years old or below (OR=2.245, 95%CI: 1.006-5.008) , were not floating population (OR=3.442, 95%CI: 1.394-8.494) , were infected outside family (OR=3.878, 95%CI: 1.075-13.993) and were smear positive (>0+,OR=4.514, 95%CI: 1.365-14.926; >3+,OR=4.727, 95%CI: 1.443-15.485) were risk factors for leprosy reactions. Conclusions The prevalence of leprosy reactions is high in Zhejiang Province from 2010 to 2019, and is associated with age, floating population, source of infection and BI.

Objective To assess the myocardial blood flow and reserve function by rest and stress 13 N-NH3 PET myocardial perfusion imaging ( MPI) , and evaluate the diagnostic value of PET and risk fac-tors of non-obstructive coronary microvascular disease ( CMVD) type 1. Methods A total of 56 patients (28 males, 28 females;age:(52.0±7.6) years) with clinical suspected CMVD type 1 from April 2017 to December 2018 were prospectively enrolled. The coronary CT angiography, coronary angiography and other clinical data were recorded. All patients underwent one-day rest and stress 13 N-NH3 PET MPI. Images were analyzed and the absolute myocardial blood flow ( MBF) and coronary flow reserve ( CFR) were obtained. Patients were divided into CMVD type 1 ( CMVD) group and non-CMVD group. The differences between 2 groups were analyzed by two-sample t test and logistic regression. Results Among 56 patients, 20 patients were diagnosed as CMVD type 1, and 36 patients were excluded as non-CMVD group. The proportion of smoking and diabetes in the CMVD group was significantly higher than that in the non-CMVD group (χ2 val-ues:9.433 and 4.114, both P<0.05). The stress MBF ((2.37±0.61) vs (3.83±1.25) ml·min-1·g-1;t=-4.807, P<0.001) and CFR (2.67±0.60 vs 3.81±0.96;t=-4.751, P<0.001) were lower in smokers than those in non-smokers, and the stress MBF was lower in diabetes patients than that in non-diabetes patients ((2.63±0.98) vs (3.62±1.28) ml·min-1·g-1;t=-2.758, P=0.008). Smoking might be the risk factor for lower stress MBF (odd ratio (OR)=0.310, 95％ CI:0.114-0.880) and lower CFR (OR=0.278, 95％ CI:0. 080-0.894), and diabetes might be the risk factor for lower stress MBF (OR=0.254, 95％ CI:0.073-0. 887) . Conclusions PET MPI can be used for the diagnosis of CMVD type 1. Smoking and diabetes are likely to be associated with the onset of CMVD type 1.

Objective: To optimize the construction of combined hypoxia NASH rat model on the basis of preliminary work, and to explore the role of neovascularization in the process of hepatic fibrosis. Methods: 32 rats were divided randomly to four groups that were null control group(A group ), hypoxia group(B group), high fat diet group(C group ) and high fat diet plus hypoxia group (D group ),treated with null , Intraperitoneal injection of NaNO₂, high fat diet and high fat diet plus Intraperitoneal injection of NaNO₂ respectively. Every group was observed for 16 weeks, B and D group was treated with Intraperitoneal injection of NaNO₂ 20 mg/kg.d at the laster 8 weeks. Liver histology NASH activity score(NAS) and Fibro score(FibroS), biochemical index were detected in this combined hypoxia NASH rat model(D group), meanwhile the changes of HIF1α, inflammatory factor and neovascularization were measured by ELISA, realtime PCR and immunohistochemistry. Results: Liver tissue NAS > 4 was seen in C and D group. D group showed NASH characteristics, including significantly steatosis at liver acinar 3 area(mostly a microvesicular type fat droplets mixed with macrovesicular type), hepatocyte balloon degeneration, obvious lobular inflammation, while fibrosis score increased significantly, including visible hepatic sinusoid fibrosis, fibrosis around portal vein, and bridging fibrosis in a considerable portion of the rats. Compared with C group, biochemical indicators of aspartate aminotransferase (AST), HIF1α, neovascularization-related VEGFA, VEGFR2 mRNA level increased obviously and the expression of immunohistochemistry VEGFR2, CD34 enhanced markedly in D group(p < 0.05). Conclusion A combined hypoxia NASH rat model can be established throught feeding 16 weeks’ high-fat diet then intraperitoneal injection of NaNO₂ 20 mg / kg.d at the laster 8 weeks, meanwhile chronic hypoxia can accelerate this combined hypoxia NASH model liver fibrosis process. In this process neovascularization promoted the formation of hepatic fibrosis in this model.

Objective To observe the relationship between Toll-like receptor 4 (TLR4) and the sensitivity of PANC1 cells to gemcitabine (GEM),and to analyze the potential mechanism.Methods PANC1 cells were divided into GEM group,lipopolysaccharide (LPS) + GEM group and TLR4-siRNA + GEM group.GEM group was treated by GEM alone.LPS + GEM group was pretreated with 1 mg/L LPS for 4 h and then treated by GEM.TLR4-siRNA + GEM group was transfected with 100 pmol/mL TLR4-siRNA for 4 h and then treated by GEM.The untreated cells were used as the control group.MTT method was used to detect the cell proliferation.Morphological changes and apoptosis rate of the cells were examined by Hoechst33258 staining and flow cytometry,respectively.The protein expression of TLR4,phosphorylated AKT (p-AKT) and activated Caspase-3 were detected by Western blot.Results The median inhibition concentration (ICs0) of GEM in the GEM group,LPS + GEM group and TLR4-siRNA + GEM group was (8.9 ± 0.32),(14.21 ±0.95),(3.96 ± 0.27) mg/L,respectively.The IC50 in LPS + GEM group was significantly higher than that in GEM group (P ＜ 0.01),and the IC50 of GEM in TLR4-siRNA + GEM group was significantly lower than that in GEM group (P ＜0.01).Compared with that in GEM group,the cells with typical apoptotic morphological changes were decreased in LPS + GEM group,which was increased in TLR4-siRNA + GEM group.The apoptotic rate in control group,GEM group,LPS + GEM group,TLR4-siRNA + GEM group was (2.1 ± 0.3) ％,(15.1 ± 2.3) ％,(9.8 ± 1.5) ％,(22.9 ± 3.1) ％,respectively.Compared with that in GEM group,the cells apoptotic rate was significantly reduced in LPS + GEM group (P ＜0.01),which was significantly increased in TLR4-siRNA + GEM group (P ＜0.01).TLR4 protein level in the 4 groups was 0.83 ±0.08,0.81 ±0.07,0.85 ±0.07 and 0.16 ±0.03;p-AKT protein level 0.61 ±0.05,0.36 ±0.03,0.73 ± 0.07 and 0.21 ± 0.02;activated Caspase-3 protein level was 0.66 ± 0.05,0.73 ± 0.07,0.45 ± 0.04 and 0.91 ± 0.07,respectively.The expression of TLR4 and p-AKT in TLR4-siRNA + GEM group was significantly lower than that in GEM group (P ＜0.01),while the expression of activated Caspase-3 protein was increased significantly (P ＜ 0.05).Compared with the GEM group,the expression of p-AKT protein in LPS + GEM group was significantly increased (P＜0.01),and the expression of activated Caspase-3 protein was significantly decreased (P＜0.01).Conclusions TLR4 can inhibit the sensitivity of pancreatic cancer PNAC1 cells to GEM,and the mechanism is related to the activation of PI3K/AKT pathway and downregulation of activated Caspase-3.

Objective To prepare a recombinant pneumococcal surface protein A clade 4 ( PspA4) and to analyze its immunogenicity.Methods The gene encoding PspA4 protein was synthesized and inserted into pET-20b to construct the recombinant expression plasmid.The transformed E.coli strains carrying expression plasmid were induced to express PspA4 protein.ELISA was performed to analyze the ti-ters of PspA4-specific IgG in a mouse model.Results The recombinant PspA4 protein of high purity ( 90%) was successfully prepared.The titers of PspA4-specific antibody in mice received PspA4 immuniza-tion were 106 times higher than those of the blank control group, suggesting that the expressed PspA4 protein had the advantage of high immunogenicity.Conclusion This study suggested that the PspA4 protein might be used as one of the candidate protein for the development of pneumovax and laid a foundation for further in-vestigation on pneumococcal protein based vaccine.