Objective To investigate the epidemiological characteristics of acquired immune deficiency syndrome (AIDS) in Shandong Province,and to provide scientific evidence for formulating prevention and control strategy and carrying out effective measures.Methods Epidemiological data of reported human immunodeficiency virus (HIV) infection and AIDS cases (HIV/AIDS) in Shandong Province from 1992 to 2011 were analyzed.Results A total of 4313 cases of HIV/AIDS were confirmed and reported by the end of 2011,with an average incidence of 2.39 parts per million (ppm) annually.An upward trend was showed for annual reported incidence.The top 5 cities of incidence were Ji'nan,Qingdao,Zibo,Weifang and Weihai,which were 5.72 ppm,4.39 ppm,3.29 ppm,3.10 ppm and 3.02 ppm,respectively.The average annual reported incidence was 3.74 ppm for male,which was significantly higher than that for female (1.39 ppm; x2 =743.96,P＜0.05).The reported incidence was highest among 20-29 age group (5.56 ppm),with 57.18％ of homosexual transmission.The proportion of homosexual transmission in annual reported cases increased from 1.82％ in 2004 to 37.49％ in 2011.Conclusions The epidemic situation of AIDS in Shandong Province is severe,with unbalanced geographical distribution.Sexual transmission is the main route of transmission,and cases of homosexual transmission increase sharply.

Objective To detect the serum levels of IL-6 and CRP in patients with acute type A aortic dissection complicated with pulmonary injury and inflammatory response. Methods From January 2007 Month to February 2016,216 patients with acute type A aortic dissection were admitted to our hospital. Among them,there were 120 male and 96 female patients,with a mean age of 52.1 years. All patients underwent cardiac ultrasound and other imaging studies. They were diagnosed and hospitalized immediately after the onset. Treatment lasted for more than 1 week. In a calm state of oxygen ,oxygenation index ≤200 preoperative lung injury is defined as positive. In this study ,according to the definition of the lung injury ,patients were divided into positive and negative lung injury groups. There were 72 positive and 144 negative cases among 216 patients. All patients were hospitalized. Every 4 hours,arterial oxygenation index is calculated. At the same time blood samples were tested for C-reactive protein(CRP)and interleukin-6(IL-6)levels. Data was analyzes by SPSS20.0 statistical software and counted byχ2 test. The results were plotted as the percentage,the measurement data with the t test,with(x ± s) to represent,evaluate serum levels of CRP and IL-6 levels with acute type A aortic dissection complicated by the relationship between lung injury. Results The differences of patients from two lung injury groups in gender,age, smoking,alcohol consumption,and other aspects of common chronic diseases were not significant(P>0.05);the difference between the pre-operative examination of several experimental studies in echocardiography were also no statistically significant(P > 0.05);two groups of patients,serum CRP positive group lung injury peak level and peak IL-6 levels were significantly higher in patients with acute lung injury negative group (P > 0.05). Further study of lung serum CRP in patients with damage to the relationship between IL-6 levels and oxygenation index found after dissection. Patient's oxygenation index decreased ,and serum C-reactive protein and interleukin-6 levels were rising rapidly ,reaching peak levels ,and then ,with the patients with inflammatory response decreased oxygenation index showed an upward trend. Conclusion Inflammatory reaction in acute type A aortic dissection plays a key role in the lung injury. In result ,patients'sicken time is prolonged ,which was closely related to serum C reactive protein(CRP),interleukin 6 levels and hypoxemia. Active anti-inflammation treatment before surgery may improve the patient's oxygenation status.

Objective To evaluate the clinical efficacy of staged treatment of complex tibial plateau fractures with temporary transarticular external fixation and delayed plate fixation.Methods Enrolled in this study were 44 cases of complex tibial plateau fracture who had been treated from January 2011 to January 2014.Temporary transarticular external fixation and delayed plate fixation was adopted in 22 patients (observation group),involving 14 men and 8 women with an average age of 45.5 ± 11.4 years,and 10 left sides and 12 right sides.By the Schatzker classification,13 cases were type Ⅴ and 9 type Ⅵ.Calcaneal traction and plate fixation was adopted in the other 22 patients (control group),involving 13 men and 9 women with an average age of 43.8 ± 10.4 years,and 8 left sides and 14 right sides.By the Schatzker classification,12 cases were type Ⅴ and l0 type Ⅵ.The 2 groups were evaluated by the time from hospitalization to plate fixation,operation time,intra-operative bleeding volume,hospitalization time,healing time,complications and Hospital for Special Surgery (HSS) scoring at the final follow-ups.The 2 groups were compatible with no significant differences regarding the preoperative general data (P ＞ 0.05).Results The 44 patients were followed up for 12 to 30 months (mean,18.6 months).There were significant differences between the 2 groups in the time from hospitalization to plate fixation,operation time,intra-operative bleeding volume and hospitalization time (P ＜ 0.05).There was also a significant difference in the complications rate (4.5％ (1/22) for the observation group versus 27.3％ (6/22) for the control group) (P ＜ 0.05),but there was no significant difference in the good to excellent rate by HSS scoring [86.3％ (19/22) versus 81.8％ (18/22)] (P ＞ 0.05).Conclusions Although both methods can treat complex tibial plateau fractures,temporary transarticular external fixation and delayed plate fixation may be preferable because it can lead to decreased hospitalization time,less intra-operative bleeding volume,fewer surgical complications and good functional recovery of the knee.

Objective To investigate the feasibility and accuracy of a patient-special template for antegrade pubic branch screwing and sacroiliac screwing which is 3D printed and based on the external fixation for treatment of pelvic fractures.Methods From January to April 2017,5 patients with Tile B fracture of the pelvis were treated by external fixation for damage control and closed reduction of the fracture at the first stage.They were 4 males and one female,aged from 42 to 65 years(average,54.8 years).By the Tile classification,there were one case of type B1 and 4 cases of type B2.After the CT scan data following external fixation were reconstructed and the screw trajectories were designed in 3D format,an individual template for the pelvic model was 3D printed.After the feasibility was confirmed by the preoperative operation,the patient-special template was used to insert antegrade pubic branch screws and sacroiliac screws in the surgery.The accuracy and safety of the actual screwing aided by the template were evaluated by comparing postoperative CT scans and preplanned trajectories of the screws.Results The individualized 3D printing templates based on external fixation led to precise screw placements into the superior ramus of the pubis and the sacroiliac joint.All the patient-special templates matched the external fixation well.Screw placement time ranged frown 5.1 to 17.5 min,averaging 10.3 min.The fluoroscopy frequency ranged from 6 to 16 times,averaging 9 times.The wound healed primarily.There was no damnage to the vessels or nerves.Verification of preoperative and postoperative CT scans showed an axial displacement deviation of 1.60 + 0.21 mm and an angle deviation of 2.0° ± 0.3°.The screws were basically in the bone channel without penetrating the cortex of important parts.Conclusion In the treatment of pelvic fractures,a patient-special screw template 3D printed based on external fixation can help accurate and safe insertion of the screws in a minimally invasive manner,significantly reducing the operation time and radiation exposure.

Objective: To explore the correlation between serum vitamin D level and glucose and lipid metabolism among primary and middle school students in Inner Mongolia, so as to providing a scientific basis for guiding rational vitamin D supplementation among primary and middle school students in Inner Mongolia Region. Methods: A total of 2 206 students of primary and middle school students from 8 counties (districts) in Inner Mongolia were enrolled for a questionnaire survey, physical examination, and laboratory test by a multi stage stratified random sampling approach.The levels of fasting blood glucose, blood lipid and other related indexes with different vitamin D levels were analyzed, and their correlation was further discussed. Results: The deficiency and insufficiency rates of vitamin D among primary and middle school students were 33.2% and 42.8%, respectively, and the suitable rate was 24.0%. The body mass index (BMI) and waist height ratio (WHtR) of the vitamin D deficiency group [(22.87±7.41) kg/m 2 , 0.46±0.08)]were higher than the insufficiency [(20.59±8.00)kg/m 2, 0.44±0.09)] and suitable group [(18.01±7.38)kg/m 2, 0.43 ±0.08)] ( P <0.05). Compared with the vitamin D suitable group [(3.87±0.85) mmol/L], the total cholesterol (TC) level in the deficiency group [(3.73±0.67)mmol/L] decreased, with a statistically significant difference ( P <0.05). The levels of high density lipoproteins (HDL) in the vitamin D insufficiency[(1.40±0.33)mmol/L] and deficiency groups [(1.34±0.31)mmol/L] were lower than the suitable group [(1.48±0.34)mmol/L], with a statistically significant difference ( P <0.05). The detection rate of hyperuricemia (HUA) in the vitamin D deficiency group (22.95%) was higher than the suitable group (17.20%), with a statistically significant difference ( P <0.016 7). Pearson correlation analysis showed that vitamin D was negatively correlated with BMI and WHtR ( r =-0.23, -0.11), and positively correlated with TC and HDL level ( r =0.06, 0.16) ( P <0.05). Conclusions The deficiency and insufficiency rates of serum vitamin D among primary and middle school students in Inner Mongolia are high which are associated with several indicators of blood lipids. Therefore, it is recommended to supplement vitamin D preparations in moderation in daily life.

Objective: To understand the survival status of AIDS patients after initiation of antiretroviral treatment (ART) in Shandong province during 2003 to 2017, and to determine the factors associated with survival status. Methods: A retrospective cohort study was conducted among AIDS patients initially received antiretroviral therapy from 2003 to 2017. The epidemiological characteristics of the subjects were described, and life tables were used to estimate the survival rates, the influencing factors were analyzed by Cox regression model. Results: A total of 9 813 cases were enrolled in this study, of the subjects, the median age was 34.9±11.0 years. The median of baseline CD4+ T lymphocyte count was 300.0(P₂₅-P₇₅: 163.0, 428.0)cells/μl, and 83.2% of them were at clinical stage Ⅰ (World Health Organization, WHO). The cumulative survival rates were 97.7%, 96.7%, 95.8% and 93.7%, 1, 3, 5, and 10 years after the initiation of ART respectively. Multivariate Cox regression model analysis showed that the risk of the mortality among those infected through homosexual behavior was 38% lower than that of patients infected via blood or other routes, and HR was 0.62 (95%CI: 0.43-0.89). Higher education level had lower mortality risk(the mortality risk of those with university degree or above was lower, compared to those with primary and lower cultural level, HR=0.41, 95%CI: 0.26-0.65). At baseline, AIDS patients at clinical stage Ⅰ(WHO) had lower mortality risk than those who were at clinical stageⅡ, Ⅲ, and Ⅳ(WHO). Lower baseline CD4+ T lymphocyte count had higher mortality risk. Conclusions Survival rate was higher after initial antiretroviral therapy among AIDS patients in Shandong province. CD4+ T lymphocyte count level, WHO clinical stage, and presence or absence of clinical symptoms at baseline are the main factors influencing the survival time of AIDS patients after ART.

A survey was conducted to analyze the HIV testing status and related influencing factors of male sexually transmitted diseases(STD) patients attending 18 county-level hospitals in Shandong Province from July 2015 to August 2016. The HIV detection rate of 1 570 subjects was 77.58% (1 218/1 570), and the HIV-antibody positive rate was 0.99% (12/1 218). Compared with general hospitals patients, urinary and anorectal patients, non-sexual patients, and patients with negative attitudes toward HIV testing, patients were more likely to be tested for HIV from specialized hospitals (OR=3.74, 95%CI:2.53-5.54), the skin and venereal section (OR=1.92, 95%CI: 1.31-2.79), the STD group (OR=2.02, 95%CI: 1.34-3.03) and patients with positive attitude (OR=15.20, 95%CI:10.74-21.52).

Objective: To analyze the epidemic features of male HIV-infected and AIDS patients by sexual transmission in Shandong Province. Methods: Data on HIV-infected people and AIDS patients (HIV/AIDS) were derived from HIV/AIDS Comprehensive Response Information Management System. To analysis the epidemiological data of male HIV/AIDS by sexual transmission reported in Shandong Province from 1997 to 2016. Results: A total of 8 584 HIV/AIDS were reported by heterosexual transmission or homosexual transmission from 2007 to 2016. 2 421 cases were reported by heterosexual transmission and 6 163 cases were reported by homosexual transmission. Among cases infected by heterosexual transmission. The average age of cases infected by heterosexual transmission was (38.13±12.39) and (31.62±10.22) among cases who infected by homosexual transmission (t=24.95, P<0.001). 84 cases were reported by homosexual transmission and 138 cases by heterosexual transmission from 2007 to 2008, and 6 079 cases were reported by homosexual transmission and 2 283 cases by heterosexual transmission from 2009 to 2016. A total of 770 cases were dead after reported. Among the dead cases, 337 cases were infected by homosexual transmission and 433 cases by heterosexual transmission (χ²=328.21, P<0.001). 61.4% of the dead cases by heterosexual transmission were no longer than 6 months after reported and 54.3% in homosexual transmission (χ²=3.96, P=0.047). Conclusion Homosexual transmission has been the main transmission of HIV/AIDS in Shandong Province. Epidemiological features and social demographic characteristics of each sexual transmission were different. As part of HIV cases developed to death in 6 months.

Objective:To understand the use of drug and its related factors among men who have sex with men, and to provide reference for the development of reasonable intervention measures.Methods:MSM was recruited from Jinan and Qingdao by means of on-site and internet recruiting from March to June in 2016. Anonymous questionnaires were conducted and HIV and syphilis serological tests were performed. The questionnaire included the general situation, sexual behavior, HIV related services and so on. Multi-factor unconditioned logistic regression model was used to explore related factors about rush poppers use.Results:The rush poppers use rate of 901 MSM was 30.1%（271/901）, the age was (29.3±8.1) years, the HIV infection rate was 4.6% (41/901) and the syphilis infection rate was 8.7% (78/901). Multivariate analysis showed that compared with those who were>25 years old, the OR (95% CI) of those who were ≤ 25 years old was 1.571 (1.110-2.224); compared with the number of anal sexual behavior was<2 times in the last week, the OR (95% CI) of those whose number of anal sexual behavior was ≥2 times was 2.991 (1.100-8.132); compared with those who had not received peer education services in the last year, the OR (95% CI) of those who received peer education services was 13.651 (7.239-25.742). Conclusion:Rush poppers are very popular in the MSM crowd, and those who aged less than 25 years old, who had anal sex more than twice in the past week, and who had received peer education services were more likely to use rush poppers. We should carry out targeted interventions according to the characteristics.

Objective:To understand the use of drug and its related factors among men who have sex with men, and to provide reference for the development of reasonable intervention measures.Methods:MSM was recruited from Jinan and Qingdao by means of on-site and internet recruiting from March to June in 2016. Anonymous questionnaires were conducted and HIV and syphilis serological tests were performed. The questionnaire included the general situation, sexual behavior, HIV related services and so on. Multi-factor unconditioned logistic regression model was used to explore related factors about rush poppers use.Results:The rush poppers use rate of 901 MSM was 30.1%（271/901）, the age was (29.3±8.1) years, the HIV infection rate was 4.6% (41/901) and the syphilis infection rate was 8.7% (78/901). Multivariate analysis showed that compared with those who were>25 years old, the OR (95% CI) of those who were ≤ 25 years old was 1.571 (1.110-2.224); compared with the number of anal sexual behavior was<2 times in the last week, the OR (95% CI) of those whose number of anal sexual behavior was ≥2 times was 2.991 (1.100-8.132); compared with those who had not received peer education services in the last year, the OR (95% CI) of those who received peer education services was 13.651 (7.239-25.742). Conclusion:Rush poppers are very popular in the MSM crowd, and those who aged less than 25 years old, who had anal sex more than twice in the past week, and who had received peer education services were more likely to use rush poppers. We should carry out targeted interventions according to the characteristics.