Objective To investigate the influence of host animals on epidemics of hemorrhagic fever with renal syndrome (HFRS) so as to provide a basis for effective control of HFRS.Methods From the national infectious disease network direct reporting system,the incidence of HFRS cases diagnosed by direct diagnosis of medical institutions in Qingdao was collected from 2011-2015.We captured rats indoor and outdoor by night trapping method quarterly and calculated the capture rates from 2011-2015 in Qingdao areas.The incidence of HFRS in different regions and the change of seasonal growth,the distribution of host animals,the characteristics and distribution of animals,and the seasonal variation of dominant species were analyzed and a database was set up and statistic analysis was conducted by SPSS 13.0.Results The peak incidence rate of HFRS in Qingdao areas occurred in 2012 (3.54/100 000) and presented a decrease trend year by year (x2 =64.15,P ＜ 0.05),but there were different characteristics among the epidemic areas,and lowest in 2015 (1.68/100 000).And the peak presented a two-peak pattern which was mainly an autumn peak and a gentle peak in late spring and early summer.The epidemics were gradually decreased from the rural areas to the urban fringes and then the urban areas.The seasonal variation was disappeared gradually.There was a heavy epidemic intensity in areas with a high capture rate and a complex type of host animals.The epidemic peak was in consistence with the distribution of rats.Capture rates were different among the epidemic areas.The capture rate in Jiaonan was the highest [5.32％(2 886/54 287)] and lowest in Pingdu [1.77％ (258/14 584)].The mean (x2 =820.39,P ＜ 0.05) and annual capture rates (x22011-2015 =32.61,356.24,233.07,129.33,33.42,all P ＜ 0.05) among epidemic areas were different.In the third quarter the accumulated capture rate was the highest [4.69％ (1 187/25 301)].In total 8 kinds of host animals were captured and the dominant species were brown rat [30.27％ (1 235/4 080)],house mouse[29.75％ (1 214/4 080)] and striped field mouse [16.25％ (663/4 080)].Conclusions The epidemic intensity of HFRS is related to the densities and the types of host animals.The gradually decreased epidemic pattern from the rural areas to the urban fringes and then the urban areas may be related to urbanization and improved health behaviors.

Objective To understand the ecological developmental characteristics of rats in the epidemic areas of hemorrhagic fever with renal syndrome (HFRS) so as to provide a basis for effective control of HFRS.Methods Based on the China National Disease Surveillance Reporting and Management System,data of HFRS cases from 2010 to 2014 were collected and analyzed by retrospective analysis.Meanwhile surveillance data of rats were collected and the capture rates in different seasons,genders and districts were also analyzed.Results Totally 51,92,129,85 and 71 cases of HFRS were reported from 2010 to 2014.Most HFRS cases occurred from October to November which were 43,59,78,37 and 37,respectively.Totally 2902 rats were captured from 2010 to 2014.The five-year average capture rate was 4.87％ (2902/59610).The highest capture rate was 6.94％ (910/13107) in the third quarter and the outdoor capture rate (5.80％,1681/28987) was higher than that of indoor(3.99％,1221/30623,x2 =324.35,P ＜ 0.05).More male rats were captured than female rats and the overall proportion was 62.82％ (348/554) and 37.18％ (206/554),respectively.The outdoor rats were mainly Apodemus agrarius (556),Cricetulus triton (432),Rattus noruegicus (217),Mus musculus (211) and Sorex araneus (139),and the indoor rats were mainly Mus musculus (514),Rattus noruegicus (469) and Sorex araneus (181).The black rat disappeared and White-bellied rat appeared.Conclusions The rat density keeps higher all year round and the type of rats has become increasingly complex.Mixed living of indoor and outdoor rats increased the infection probability of different types of Hantavirus,which has an immediate impact on the spreading pattern of HFRS.

Teaching of Critical Care Medicine faces several challenging issues includingcomprehensive intensive or specialist intensive, approach of curriculum, tralning of team working ability, building of teaching platform and teaching staff. Critical care medical education requires the concept of viewing the discipline as a whole. Under its guidance and with the opportunity of critical care medical subspecialties building, critical care medical education should focus on bothcompre-hensive critical care and specialist critical care, and have rational planning of Critical Care Medicine course. Through the construction and integration of ICU, we should create a comprehen-sive clinical practice platform of critical care medicine to carry out clinical practice and team work tralning. Meanwhile, construction of quality critical care medicine faculty should be based on its pro-fessional features.

Objective:To analyze the epidemiological characteristics and genotypes of human rhinovirus (HRV) in patients with upper respiratory tract infection in Qingdao in the winter of 2020.Methods:Throat swab samples were collected from 101 patients with upper respiratory tract infection in Qingdao from November 2020 to January 2021. Quantitative PCR was used to detect 15 common respiratory viruses in the samples. HRV-positive samples were further analyzed with RT-PCR to amplify and sequence HRV VP4/VP2 gene. A phylogenetic tree was constructed based on the sequencing results and homology analysis was conducted.Results:Six common respiratory viruses were detected in the 101 patients. Thirty-four cases (34/101, 33.66%) were single pathogen infection and two cases were multiple infection (2/101, 1.98%). The positive rate of HRV was the highest (21.78%, 22/101). Twenty HRV VP4/VP2 sequences were successfully amplified. Phylogenetic analysis showed that there were 16 strains of HRV-A subtype and four strains of HRV-C subtype and 14 serotypes were involved.Conclusions:HRV was one of the leading viral pathogens causing upper respiratory tract infection in Qingdao in the winter of 2020 and the predominant subtype was HRV-A.

Objective To investigate the influence of the variations of an epidemic focus on hemorrhagic fever with renal syndrome (HFRS) so as to provide a basis for effective control of HFRS.Methods HFRS epidemic data from the rapid development of urbanization of Huangdao District and the general development of Jiaonan City were collected and analyzed retrospectively from 1979 to 2014.And the HFRS cases,incidences,host animals and Hantavirus surveillances were compared.Results The three epidemic peaks occurred from 1979 to 2014 in Huangdao District and Jiaonan City,they were in the mid-1980s (1983-1987),the late 1990s (1995-1999) and around 2012 (2010-2014),and 954,80,37 and 2 506,614,432 cases were reported,respectively,in Huangdao District and Jiaonan City.The three peak years were 1986,1999 and 2012.And the annual incidences of Huangdao District were 385.73/100 000,15.64/100 000 and 2.51/100 000,respectively.The annual incidences of Jiaonan City were 67.07/100 000,28.68/100 000 and 14.68/100 000,respectively.The three peaks obviously appeared double peaks [the autumn and winter (from Oct.to Dec.) and the spring (from Jan.to Feb.)] in Jiaonan City.And the first peaks in Huangdao District was in the autumn and winter (from Oct.to Dec.) and the spring (from Jan.to Feb.),the second and the third were only in the autumn and winter (from Oct.to Dec.).Eight kinds of host animals were detected in Jiaonan City from 2005 to 2014.They were house mouse [27.53％ (1 108/4 024)],brown rat [25.50％ (1 026/ 4 024)],striped field mouse [14.84％ (597/4 024)],black rat [10.74％ (432/4 024)],hamsters [11.01％ (443/4 024)],shrew [8.72％ (351/4 024)],back grain hamster [1.02％ (41/4 024)] and club rat [0.65％ (26/4 024)].Two kinds of host animals were detected in Huangdao District.They were house mouse [57.14％ (16/28)] and brown rat [42.86％ (12/28)].The capture rates in Jiaonan City were higher than those of Huangdao District.The capture rate in 2012 was 8.04％ (855/10 638) and the capture rates in Huangdao District were all lower than 0.84％.The total detection rate in Jiaonan City was 2.81％ (113/4 024).And there was no positive detection for ten years in Huangdao District.Conclusions HFRS epidemic intensities have receded gradually in Huangdao District and Jiaonan City.The epidemic in Huangdao District obviously presents a low epidemic condition after the first peak.The few kinds and low densities of host animals are resulting in the sustainable condition.The evolution of epidemic patterns of HFRS is related to the change of epidemic sources by the differences in urbanization between the two places.

Objective To explore the influence of agricultural mechanization progress on epidemic intensity of hemorrhagic fever with renal syndrome (HFRS) so as to provide reference for prevention and control of HFRS in rural areas.Methods Data of HFRS epidemics and agricultural mechanization progress of Qingdao City and five main epidemic areas of HFRS were collected by retrospective analysis methods.Agricultural mechanization progress,time distribution,incidence rate of HFRS and capture rate of rats were compared,respectively.Risk factors were analyzed by case-control study using simple random sampling method.Cases of case group were selected from HFRS cases of Jiaonan County recovered between 2012 and 2013.The control group was healthy residents with a equal number of the case group.Residential locations,work ways,rodent infestation at work locations and in residential areas and skin injury conditions were surveyed by a household questionnaire survey.Results Agricultural machinery gross power of Qingdao City was developed from 174.76 megawatts of electricity (mwe) in 1985 to 854.00 mwe in 2015.The comprehensive mechanization degree marched from 60.0％ in 1994 to 90.2％ in 2015.HFRS incidence in Qingdao City declined from the first epidemic peak (1986) of 32.97/100 000 to the third peak (2012) of 3.54/100 000.HFRS incidence in Jiaonan,Jiaozhou,Pingdu,Laixi,Jimo cities reduced from the first epidemic peak (1985 or 1986) of 101.25/100 000,86.37/100 000,35.80/100 000,11.55/100 000,8.13/100 000 to the third peak(2012) of 14.68/100 000,4.43/100 000,2.33/100 000,6.02/100 000,3.26/100 000.The platform stage of epidemic peak in autumn and winter shortened from 4 or 5 months to 2 months.The capture rate of rats fluctuated around 2％.The infection risk of small farm implements or handwork was greater than huge mechanization (OR =0.01,P ＜ 0.01).Conclusions Agricultural mechanization changes the agricultural activity patterns to a large extent and lowers the HFRS epidemic by minimizing the risk of infection and shortening the platform stage of epidemic peak.The higher the degree of mechanization,the lower the epidemic intensity.

Objective:To investigate the different outcomes of two types of acute kidney injury (AKI) according to standard of Kidney Disease: Improving Global Outcomes-AKI (KDIGO-AKI), and to analyze the risk factors that affect the prognosis of intensive care unit (ICU) patients in China.Methods:A secondary analysis was performed on the database of a previous study conducted by China Critical Care Clinical Trial Group (CCCCTG), which was a multicenter prospective study involving 3 063 patients in 22 tertiary ICUs in 19 provinces and autonomous regions of China. The demographic data, scores reflecting severity of illness, laboratory findings, intervention during ICU stay were extracted. All patients were divided into pure AKI (PAKI) and acute on chronic kidney disease (AoCKD). PAKI was defined as meeting the serum creatinine (SCr) standard of KDIGO-AKI (KDIGO-AKI SCr) and the estimated glomerular filtration rate (eGFR) at baseline was ≥ 60 mL·min -1·1.73 m -2, and AoCKD was defined as meeting the KDIGO-AKI SCr standard and baseline eGFR was 15-59 mL·min -1·1.73 m -2. All-cause mortality in ICU within 28 days was the primary outcome, while the length of ICU stay and renal replacement therapy (RRT) were the secondary outcome. The differences in baseline data and outcomes between the two groups were compared. The cumulative survival rate of ICU within 28 days was analyzed by Kaplan-Meier survival curve, and the risk factors of ICU death within 28 days were screened by Cox multivariate analysis. Results:Of the 3 063 patients, 1 042 were enrolled, 345 with AKI, 697 without AKI. The AKI incidence was 33.11%, while ICU mortality within 28 days of AKI patients was 13.91% (48/345). Compared with PAKI patients ( n = 322), AoCKD patients ( n = 23) were older [years old: 74 (59, 77) vs. 58 (41, 72)] and more critical when entering ICU [acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score: 23 (19, 27) vs. 15 (11, 22)], had worse basic renal function [eGFR (mL·min -1·1.73 m -2): 49 (38, 54) vs. 115 (94, 136)], more basic complications [Charlson comorbidity index (CCI): 3 (2, 4) vs. 0 (0, 1)] and higher SCr during ICU stay [peak SCr for diagnosis of AKI (μmol/L): 412 (280, 515) vs. 176 (124, 340), all P < 0.01]. The mortality and RRT incidence within 28 days in ICU of AoCKD patients were significantly higher than those of PAKI patients [39.13% (9/23) vs. 12.11% (39/322), 26.09% (6/23) vs. 4.04% (13/322), both P < 0.01], while no significant difference was found in the length of ICU stay. Kaplan-Meier survival curve analysis showed that the 28-day cumulative survival rate in ICU in AoCKD patients was significantly lower than PAKI patients (Log-Rank: χ2 = 5.939, P = 0.015). Multivariate Cox regression analysis showed that admission to ICU due to respiratory failure [hazard ratio ( HR) = 4.458, 95% confidence interval (95% CI) was 1.141-17.413, P = 0.032], vasoactive agents treatment in ICU ( HR = 5.181, 95% CI was 2.033-13.199, P = 0.001), and AoCKD ( HR = 5.377, 95% CI was 1.303-22.186, P = 0.020) were independent risk factors for ICU death within 28 days. Conclusion:Further detailed classification (PAKI, AoCKD) based on KDIGO-AKI SCr standard combined with eGFR is related to ICU mortality in critical patients within 28 days.