Objective To investigate the effects on the improvement of the function of islet β cell by three intensive insulin treatments on newly diagnosed type 2 diabetes(T2D) in different insulin resistant status.Methods Ninety-eight patients of newly diagnosed T2D were divided into two groups:group with overt insulin resistant status ( IR group) ( HOMA-IR ≥ 5 ); group without overt insulin resistant status ( Non-IR group) ( HOMA-IR ＜ 5).According to the condition of patient,there were six subgroups:IR-CSⅡ group ( n = 20 ); IR-glar group ( n = 22 );IR-aspart 30 group (n=23); Non-IR-CSⅡ group (n= 10); Non-IR-glar group (n=12); Non-IR-aspart 30 group (n = 11 ).Subgroups were treated with continuous subcutaneous insulin injection (CSⅡ group),insulin aspart plus insulin glargine ( glar group),and insulin aspart 30 injection ( aspart 30 group) for two weeks,respectively.The levels of fasting plasma glucose (FPG) ,fasting C-peptide(C-P) ,2 h plasma glucose (2 hPG) were measured and homeostasis model assessments of beta cell (HOMA-β) and homeostasis model assessments of insulin resistance ( HOMA-IR) were calculated using fasting C-P.Results The time of blood glucose recover,insulin dosage and the incidence of hypoglycemia of CSⅡ group were lower than those of the glar group and aspart 30 group( P ＜ 0.05 and P ＜0.01 ,respectively).However,there were no significant difference between the glar-group and aspart 30 group ( P ＞ 0.05 ).The insulin dosage of Non-IR-subgroups was significantly lower than the IR-subgroups ( P ＜ 0.01 ).The △HOMA-IR(C-P) of Non-IR-subgroups was lower than the IR-subgroups ( P ＜ 0.05 ).The △HOMA-islet(C-P) of the Non-IR-subgroups was higher than the IR-subgroups ( P ＜ 0.05 ).The △HOMA-IR(C-P) ( 1.79 ± 0.15 and 1.51 ±0.09 in IR and non-IR group,respectively) and △HOMA-islet(C-P) (4.01 ±0.21 and 4.35 ±0.23 in IR and Non-IR group,respectively) of the CSⅡ group were higher than those of the glar group (1.63 ± 0.21 and 1.40 ±0.19 of △HOMA-IR (C-P) and 3.86 ± 0.12 and 4.03 ± 0.18 of △HOMA-islet(C-P) in IR and Non-IR group,respectively) and aspart 30 group ( 1.61 ± 0.13 and 1.42 ± 0.1 1 ) △HOMA-islet (C-P) and 3.88 ± 0.32 and 4.01 ±0.14of△HOMA-islet(C-P)inIRandNon-IRgroup,respeetively)(P＜0.05).Conclusions Thethree intensive insulin treatments for newly diagnosed T2D accompanied with high blood glucose may improve the function of β cell and alleviate insulin resistance,especially the CSⅡ.However,the efficacy on T2D with overt insulin resistant status is limited.

OBJECTIVETo investigate the predominance ticks and the infectious status of severe fever with thrombocytopenia (SFTSV) in Penglai and Laizhou counties, Shandong province.

METHODSTwo towns with high incidence rate were selected in Penglai and Laizhou, respectively, then three villages were selected in each towns. Parasitic ticks were collected from the host skin by hand manually and free ticks manually with white cloth from the grassland, monthly, during April to December in 2011. Samples were classified by original, varieties, developmental stages, then extracted RNA, using Realtime RT-PCR to test severe fever thrombocytopenia syndrome virus, S fragments were amplified with nested PCR, then isolated virus. By neighbor joining method in the phylogenetic tree, the minimum infection rate (MIR) was used to represent the infection status of ticks in novel bunyavirus.

RESULTSA total of 3 145 ticks were collected totally from 5 categories, there were 3 048(96.92%) of Haemaphysalis longicornis, 73(2.32%) of Rhinpicephalus sanguineus, 10(0.32%) of microplus Boophilus, 9(0.29%) of Haemaphysalis campanulata, 5(0.16%) of Dermacentor sinicus, respectively. The positive rate of nucleic acid of 2 044 samples was 6.16% (126/2 044), minimum infection rate (MIR) was 4.01%, there were 122(96.83%) of Haemaphysalis longicornis, 3(2.38%) of Rhinpicephalus sanguineus, and 1(0.79%) of microplus Boophilus, MIR was 4.00%, 4.11%, and 10.00%, respectively. There were no nucleic acid positive samples in Haemaphysalis campanulata and Dermacentor sinicus. The 11 S segments were amplified in 126 positive samples, the homology of S fragment was 95.6%-99.9% with 11 strains isolated from the identified SFTS cases in local area, 3 strains isolated from animals, and 11 strains isolated from other areas. There was no significant difference among original, varieties and developmental stages.

CONCLUSIONHaemaphysalis longicornis was the predominant species in Penglai and Laizhou counties, it could be propagation medium with Rhipicephalus sanguineus and microplus Boophilus, S sequence in ticks was higher homology with virus isolated from local SFTS cases.

Objective To investigate the application of venous superdrainage technique based anterolateral thigh flap based on oblique branch for the soft tissue defect of proximal shank.Methods Between October,2012 and March,2017,11 cases of the soft tissue defect in proximal shank were treated.There were 8 males and 3 females with a mean age of 43 (range,26-59) years.Causes of injury:7 cases of traffic injury,3 cases of bruise,1 case of machine wound;The defect sizes ranged from 10 cm×5 cm to 13 cm×10 cm,with fracture or plate exposure.Accord ing to the size of the defect,the distally based anterolateral thigh flap was designed to repair the defect.The flap sizes ranged from 14 cm×6 cm to 16 cm×8 cm.The oblique branch and their accompanying vein with great saphenous vein was anastomosed to construct the venous superdrainage,and the donor site suture directly.Three cases followed-up by WeChat,and 8 cases by return visit.Results Distally based anterolateral thigh flaps were derived from oblique branches,and no arteriovenous crisis occurred postoperatively.Eleven flaps healed well after operation.There were no distal end blood supply disorder.Followed-up for 6-12 months,the flaps survived well.The texture was closed to the surrounding skin,and no ulcer exposed.There were no serious complications in donor site.And the thighs were linear scars.Conclusion The distally based anterolateral thigh flap based on oblique branch have a long vascular pedicle.The venous superdrainage technique can effectively avoid venous crisis,and improve the survival quality of the flap and the survival rate.

Objective:To evaluate of the general practice residency training bases in Hebei Province.Methods:Based on the 2020 Standardized Residency Training Base Evaluation Index-General Practitioners of Chinese Medical Doctor Association,24 training bases in Hebei Province were assessed;and the satisfaction questionnaire survey and in-depth interview were conducted among 124 general practice trainees who were randomly selected in November 2020. Results:All 24 bases set the general practice department in the hospitals as required. However, the annual outpatient visits in department of general practice were less than 20000 in 45.83% (11/24) bases, only 41.67% (10/24) bases met the teaching requirements of general practice, and 33.33% (8/24) bases fulfilled the provincial target for general practice residency training enrollment; only 3 bases (13.64%) had the pass rate≥85% in medical licensing examination in the previous year. For the training satisfaction, 66.94% (83/124) trainees were satisfied with residency training, and 33.06% (41/124) were moderately satisfied. There was significantly difference in the satisfaction degrees among trainees with different expectations of career prospects (χ 2=24.436, P<0.05). Conclusions:Basically, the management system of general practice residency training bases has been completed and the construction of teaching teams has been standardized in Hebei Province. But the job attraction of general practitioner is inadequate, the training bases need to be strengthened, and the training quality needs to be improved.

Objective To learn the prevalence of infection of human and animals severe fever with thrombocytopenia syndrome bunyavirus(SFTSV)in Yantai,Shandong province,and to analyze the pathogenic features of SFTSV as well as its relationship between human and animal hosts. Methods From April to November in 2011,3 576 serum samples were collected from domesticated animals,including sheep,cattle,pigs,dogs,chickens,in Laizhou and Penglai areas where fever with thrombocytopenia syndrome frequently occured among local residents. Total SFTSV antibodies and virus-specific nucleic acids of the serum were tested by ELISA and Real time RT-PCR,respectively. SFTSV infection on each animal was observed in different months. 2 590 human serum samples were also collected in Laizhou and Penglai areas,with IgG antibodies tested by ELISA. Virus was isolated with Vero cells from the serum which SFTSV viral nucleic acids were positive. S fragments were amplified by RT-PCR and sequenced,with homology analysis conducted on these sequences. Results The overall positive rate of serum samples from animals on the total SFTSV antibodies was 40.24%(1 439/3 576)while the positive rate for specific nucleic acids was 4.56%(163/3 576). The positive rates for SFTSV antibodies were 62.78%,52.97%,45.56%,28.73%,1.45%and the positive rates for specific nucleic acids were 5.72%,4.63%,3.02%,5.25%and 3.73%,in sheep,cattle,chickens,dogs, pigs,respectively. The antigens/antibodies for SFTSV in animals changed seasonally. The overall positive rate for SFTSV IgG antibody from 2 590 human samples was 5.41%. Thirteen virus strains were isolated from these serum samples(10 strains from human and 3 strains from animals). The nucleotide homology of 13S fragments’sequences ranged from 95.23%to 100.00%and the nucleotide homology with the isolates from other provinces were between 94.72%and 99.13%. The homology was considered to be high. Conclusion High prevalence of SFTSV infections occured both in human and domestic animals in Yantai city. The nucleotide sequences of SFTSV were highly homologous among human and domestic animals. The findings suggested that domesticated animals might serve as SFTSV proliferation and the hosts for transmission thus should be attached great importance.

Objective:To analyze the current status of faculty development in general practice residency training bases in Hebei Province.Methods:A questionnaire survey with deep interview was conducted among 79 faculty from 24 general practice residency training bases in Hebei Province during November to December 2020.Results:Among 79 participants, 21 were males (26.58%) and 58 were females (73.42%), 41 (51.90%) of whom were aged 31-40 years; 44 (55.70%) were general practitioners, and 35 (44.30%) were specialists. There were no significant differences in sex, age, education background, professional title, between faculty with general practice background and specialist background (all P>0.05); while there were significant differences in job-transfer training, teaching training for general practice, the training form, teaching method grasped, understanding the work contents of general practice, the view and prospect for general practice between general practitioner faculty and specialist faculty (all P<0.05). The score of ward round teaching of general practice faculty was significantly higher than that of specialist faculty ( P<0.05) The interview showed that all faculty members were willing to teach, most of them had increased work pressure after engagement in teaching, and there was lack of incentive policies for teaching in some bases. Conclusions:The current status of faculty development in the general practice residency training base in Hebei Province is basically satisfactory, but there is lack of general practice training for faculty with specialist background; the professional identity of general practitioner need to be enhanced, and their status and treatment need to be improved.

Objective To investigate the predominance ticks and the infectious status of severe fever with thrombocytopenia (SFTSV) in Penglai and Laizhou counties, Shandong province.Methods Two towns with high incidence rate were selected in Penglai and Laizhou, respectively, then three villages were selected in each towns.Parasitic ticks were collected from the host skin by hand manually and free ticks manually with white cloth from the grassland, monthly, during April to December in 2011.Samples were classified by original, varieties, developmental stages, then extracted RNA, using Realtime RT-PCR to test severe fever thrombocytopenia syndrome virus, S fragments were amplified with nested PCR, then isolated virus.By neighbor joining method in the phylogenetic tree, the minimum infection rate (MIR) was used to represent the infection status of ticks in novel bunyavirus.Results A total of 3 145 ticks were collected totally from 5 categories, there were 3 048(96.92％) of Haemaphysalis longicornis, 73(2.32％) of Rhinpicephalus sanguineus, 10(0.32％) of microplus Boophilus, 9(0.29％) of Haemaphysalis campanulata, 5 (0.16％) of Dermacentor sinicus, respectively.The positive rate of nucleic acid of 2 044 samples was 6.16％ (126/2 044), minimum infection rate (MIR) was 4.01％, there were 122(96.83％) of Haemaphysalis longicornis, 3(2.38％) of Rhinpicephalus sanguineus, and 1 (0.79％) of microplus Boophilus, MIR was 4.00％, 4.11％, and 10.00％, respectively.There were no nucleic acid positive samples in Haemaphysalis campanulata and Dermacentor sinicus.The 11 S segments were amplified in 126 positive samples, the homology of S fragment was 95.6％-99.9％ with 11 strains isolated from the identified SFTS cases in local area, 3 strains isolated from animals, and 11 strains isolated from other areas.There was no significant difference among original, varieties and developmental stages.Conclusion Haemaphysalis longicornis was the predominant species in Penglai and Laizhou counties, it could be propagation medium with Rhipicephalus sanguineus and microplus Boophilus, S sequence in ticks was higher homology with virus isolated from local SFTS cases.

Objective To investigate the predominance ticks and the infectious status of severe fever with thrombocytopenia (SFTSV) in Penglai and Laizhou counties, Shandong province.Methods Two towns with high incidence rate were selected in Penglai and Laizhou, respectively, then three villages were selected in each towns.Parasitic ticks were collected from the host skin by hand manually and free ticks manually with white cloth from the grassland, monthly, during April to December in 2011.Samples were classified by original, varieties, developmental stages, then extracted RNA, using Realtime RT-PCR to test severe fever thrombocytopenia syndrome virus, S fragments were amplified with nested PCR, then isolated virus.By neighbor joining method in the phylogenetic tree, the minimum infection rate (MIR) was used to represent the infection status of ticks in novel bunyavirus.Results A total of 3 145 ticks were collected totally from 5 categories, there were 3 048(96.92％) of Haemaphysalis longicornis, 73(2.32％) of Rhinpicephalus sanguineus, 10(0.32％) of microplus Boophilus, 9(0.29％) of Haemaphysalis campanulata, 5 (0.16％) of Dermacentor sinicus, respectively.The positive rate of nucleic acid of 2 044 samples was 6.16％ (126/2 044), minimum infection rate (MIR) was 4.01％, there were 122(96.83％) of Haemaphysalis longicornis, 3(2.38％) of Rhinpicephalus sanguineus, and 1 (0.79％) of microplus Boophilus, MIR was 4.00％, 4.11％, and 10.00％, respectively.There were no nucleic acid positive samples in Haemaphysalis campanulata and Dermacentor sinicus.The 11 S segments were amplified in 126 positive samples, the homology of S fragment was 95.6％-99.9％ with 11 strains isolated from the identified SFTS cases in local area, 3 strains isolated from animals, and 11 strains isolated from other areas.There was no significant difference among original, varieties and developmental stages.Conclusion Haemaphysalis longicornis was the predominant species in Penglai and Laizhou counties, it could be propagation medium with Rhipicephalus sanguineus and microplus Boophilus, S sequence in ticks was higher homology with virus isolated from local SFTS cases.

Objective:To study the epidemiological characteristics and spatio-temporal aggregation of hemorrhagic fever with renal syndrome (HFRS) in Shandong Province, and to provide reference for formulating reasonable prevention and control strategies.Methods:Retrospective analysis was used to collect HFRS surveillance data and confirmed case data in Shandong Province from 2017 to 2020 in the "China Disease Prevention and Control Information System Infectious Disease Surveillance System". Geoda 1.18 software was used for global and local spatial autocorrelation analysis, SaTScan 9.6 software was used for spatio-temporal scanning analysis, and ArcGis 10.7 software was used for map drawing and visual display.Results:A total of 3 753 cases of HFRS were reported in Shandong Province from 2017 to 2020, including 56 deaths. The annual incidence rate was 1.26/100 000, 1.22/100 000, 0.75/100 000 and 0.53/100 000, respectively, with an average annual incidence rate of 0.94/100 000. The incidence of HFRS was obviously seasonal, mainly concentrated in autumn and winter from October to December, accounting for 50.41% (1 892/3 753). The age of onset was mainly 30-59 years old, accounting for 61.68% (2 315/3 753). The male to female ratio was 2.76 ∶ 1.00 (2 756 ∶ 997). The occupation distribution was mainly farmers, accounting for 81.99% (3 077/3 753). The global spatial autocorrelation analysis showed that HFRS showed spatial aggregation areas in each year from 2017 to 2020 (Moran' I = 0.38, 0.33, 0.59, 0.46, Z = 7.47, 7.23, 10.69, 8.66, P < 0.001). The local spatial autocorrelation analysis showed that "high-high" aggregation areas were mainly concentrated in central and southeast of Shandong Province, while "low-low" aggregation areas were mainly concentrated in northwest of Shandong Province. Spatio-temporal scanning analysis revealed 1 type Ⅰ agglomerations and 2 type Ⅱ aggregation areas. The type Ⅰ aggregation areas occurred from October to November 2018, covering 22 counties (districts) of 5 cities in Qingdao, Yantai, Weifang, Weihai and Rizhao. The first type Ⅱ aggregation area occurred from October to November 2017, involving 23 counties (districts) of 8 cities in Jinan, Zibo, Zaozhuang, Weifang, Jining, Tai 'an, Rizhao and Linyi. The second type Ⅱ aggregation area occurred in Jinxiang County, Jining City from February to March 2017. Conclusion:The incidence of HFRS in Shandong Province from 2017 to 2020 has obvious spatio-temporal aggregation, and the hot spots are concentrated in central and southeast of Shandong Province, which should be regarded as a key area for prevention and control of HFRS.

Objective:To deeply explore the decision-making experience of patients participating in clinical trials of neoadjuvant immunotherapy for lung cancer.Methods:Using the descriptive and qualitative research, 15 lung cancer patients who participated in clinical trials of neoadjuvant immunotherapy at the Cancer Hospital of the Chinese Academy of Medical Sciences were selected by purposive sampling from April 2021 to August 2022 for semi-structured in-depth interviews. Content analysis method was used for data analysis, summarization, and induction.Results:Three themes were extracted, namely decision-making information dilemma (insufficient or overloaded information, difficulty in understanding professional information, urgent need for decision-making information assistance), complex emotional experience (negative emotional experience, positive emotional experience), and hope for multi-party support (expecting psychological communication, hoping for family understanding, and longing for social recognition) .Conclusions:The decision-making experience of patients in clinical trials of neoadjuvant immunotherapy for lung cancer were summarized and described, which can help strengthen the understanding of the research team and medical and nursing staff on the live experience of such patients when making decisions, provide targeted decision support strategies, and promote good informed consent of patients.