Objective: To analyze the timeliness of antir-etroviral therapy (ART) and its influencing factors among newly reported HIV/AIDS cases in Wenzhou City, Zhejiang Province from 2016 to 2023, so as to provide a reference for improving the ART effect of HIV/AIDS cases. Methods: Newly reported HIV/AIDS cases in Wenzhou City from 2016 to 2023 were selected as the research subjects. Demographic information, the situation of the first CD4+ T lymphocyte (CD4 cell) test, baseline CD4 cell count, and ART situation were collected through the Chinese Disease Prevention and Control Information System. The timely rate of ART was analyzed, and the influencing factors for timely ART among HIV/AIDS cases were analyzed using a multivariable logistic regression model. Results: A total of 4 500 newly reported HIV/AIDS cases in Wenzhou City from 2016 to 2023 were included, among which 3 679 were males, accounting for 81.76%, and 821 were females, accounting for 18.24%. The median age was 46.24 (interquartile range, 26.23) years. Among these cases, 3 606 received timely ART, with a timely rate of 80.13%. The timely rate of ART increased from 57.54% in 2016 to 91.97% in 2023 (P<0.05). Multivariable logistic regression analysis showed that unmarried/divorced/widowed (OR=0.769, 95%CI: 0.641-0.922), detainees (OR=0.492, 95%CI: 0.269-0.900), untimely first CD4 cell test (OR=0.278, 95%CI: 0.234-0.330), baseline CD4 cell count ≥200 cells/µL (OR=0.709, 95%CI: 0.595-0.843) or undetected (OR=0.131, 95%CI: 0.080-0.213) were associated with a lower timeliness for ART among HIV/AIDS cases. Conclusion From 2016 to 2023, the timely rate of ART among newly reported HIV/AIDS cases in Wenzhou City showed an upward trend, which was mainly affected by marital status, case source, timeliness of the first CD4 cell test, and baseline CD4 cell count.

Objective: To analyze the spatio-temporal distribution characteristics of new HIV/AIDS cases at ages of 50 years and older in Wenzhou City from 2006 to 2020, so as to provide insights into precise control of AIDS. Methods : The data of new HIV/AIDS cases aged 50 years and older in Wenzhou City from 2006 to 2020 were collected from the China Information System for Disease Control and Prevention. The temporal and spatial distribution characteristics of new HIV/AIDS cases at ages of 50 years and older were identified using global and local spatial autocorrelation analyses and spatial-temporal scan analysis. Results: Totally 1 917 new HIV/AIDS cases aged 50 years and older were detected in Wenzhou City from 2006 to 2020, and there were 179 new HIV/AIDS cases in 58 townships ( streets ) from 2006 to 2010, 643 cases in 113 townships ( streets ) from 2011 to 2015 and 1 095 cases in 147 townships ( streets ) from 2016 to 2020, respectively. The distribution of new HIV/AIDS cases appeared positive spatial autocorrelations from 2006 to 2010 ( Moran's I value=0.05, Z=1.976, P=0.046 ), from 2011 to 2015 ( Moran's I value=0.08, Z=2.314, P=0.028) and from 2016 to 2020 (Moran's I value=0.18, Z=3.956, P=0.003 ). Spatial-temporal scan analysis identified two clusters. The primary cluster mainly covered 70 towns ( streets ) in Lucheng Distrct, Ouhai District, Longwan District, Economic and Technical Development Region, Rui' an City and Pingyang County of Wenzhou City from January 1, 2014 to December 31, 2020, with a cluster radius of 34.30 km [log likelihood ratio ( LLR )=192.84, RR=2.60, P<0.001], and the secondary cluster was located in Hongqiao Township of Yueqing City from January 1, 2009 to December 31, 2015, with a cluster radius of 0 ( LLR=90.60, RR=7.27, P<0.001 ). Conclusions The number of new HIV/AIDS cases aged 50 years and older appeared a tendency towards a rise in Wenzhou City from 2006 to 2020, with spatial clusters that were predominantly identified in urban areas, Rui' an City and Pingyang County of Wenzhou City.

Objective:To analyze the relationship between homology of Kleber pathogen pneumoniae (KP) in patients with neurocritical infections and the Genomics.Method:Five non-multidrug resistant pathogen KP were identified in 2015 to 2018, including the same cloning strain of P90 and P91, the same popular cloning system of P66,P90 and P91, and there is no homology between P20,P39 and other strains, which makes a second generation full genome sequencing. A variety of bioinformatics software were used for genomic analysis to understand the basic genomic information, chromosomal and plasmid distribution, single nucleotide polymorphism (SNP) differences and gene family clustering characteristics, meanwhile with the National Center for Biotechnology Information (NCBI) website registered 18 KP strains (2013--2016) to analyze the evolutionary affinity between strains.Results:The total genome sizes of P20, P39, P66, P90 and P91 were 5 469 543 bp, 5 480 332 bp, 5 768 352 bp, 5 745 666 bp, 5 722 999 bp. The GC contents were 57.07% (1 559 929+1 561 432)/5 469 543, 57.27% (1 566 970+1 571 424)/5 480 322, 56.96% (1 640 438+1 645 432)/5 768 352, 56.88% (1 634 285+1 634 038)/5 745 666, and 56.95% (1 627 360+1 631 781)/5 722 999, respectively. Compared with P20 reference strains, the total number of SNP in P39, P66, P90 and P91 were 32 682, 34 226, 34 292, 34 375, and the total mutation rates of gene coding region sequences were87.18% (28 491/32 682), 86.71% (29 679/34 226), 85.26% (29 238/34 292), 86.22% (29 638/34 375), respectively. Nonsynonymous mutations accounted for some advantages, and the rates were 44.57% (14 566/32 682), 44.01% (15 063/34 226), 48.01% (16 465/34 292), 48.75% (16 758/34 375), and synonymous mutations were 42.61% (13 925/32 682), 42.70% (14 616/34 226), 37.25% (12 773/34 292), 37.47% (12 880/34 375), respectively. P90 and P91 have 6 specific gene families, and P66 has 4 specific gene families. The same popular clone lines P66, P90 and P99 are on the same evolutionary branch of the phylogenetic tree. The same clone P90 and P99 are on the same subbranch. P20 and P39 without homology are on different evolutionary branches respectively. P20, P39, P66, P90 and P91 on the evolutionary branches of phylogenetic tree are closely related to the evolutionary grade of strain KP52-145 from France and strain ED23 from Taiwan, China submitted on NCBI website.Conclusion:Klebsiella pneumoniae in patients with neurocritical infection has the same clone, and the number of unique gene families among strains is the same. There are small differences in the number of unique gene families and the total number of SNPs among the same epidemic clone lines, and they are characteristic of the same evolutionary branch of the phylogenetic tree. The number of unique gene families and the total number of SNPs of non homologous strains are quite different, and they are in different evolutionary branches of the phylogenetic tree.

Objective:To explore the current status and influencing factors of knowledge, attitude and practice of drug clinical trials among ovarian cancer patients.Methods:We selected 268 ovarian cancer patients from a ClassⅢ Grade A cancer hospital in Zhejiang Province from January to December 2018 by convenience sampling. The mature Knowledge, Attitude and Practice Questionnaire was used to investigate the current status of knowledge, attitude and practice in drug clinical trials. According to the survey results, patients were divided into the high cognition group and the low cognition group. Univariate and multivariate Logistic regression were used to analyze the influencing factors.Results:Among 268 patients, the scores of knowledge, attitude and practice were (31.67±3.59) , (16.35±2.71) and (10.56±1.43) respectively. Univariate analysis showed that there were statistical differences in knowledge, attitude and practice among patients with different education levels, residence places, medical insurance, occupation, fertility, medical attention, medical relatives and friends, and annual income ( P<0.05) . Multivariate analysis indicated that the influencing factors of knowledge, attitude and practice in drug clinical trials of ovarian patients included education levels, medical insurance, medication attention and annual income. Conclusions:Patients with ovarian cancer are not optimistic about the level of knowledge, attitude and practice in drug clinical trials, which clinical nurses should pay great attention to. We should carry out individualized health education for patients with different backgrounds and characteristics.

Objective : To understand the spatial distribution of iodine in drinking water in Wenzhou,and to provide reference for preventing iodine deficiency disorders. Methods : Drinking water was sampled from 182 townships of all 11 counties under the jurisdiction of Wenzhou according to different ways of water supply. The iodine in water was detected by cerium sulfate catalytic spectrophotometry. The water iodine data was matched with the electronic map by ArcGIS10.2 to construct a spatial database; spatial autocorrelation analysis by GeoDa1.10 and spatial scanning analysis by SaTScan 9.4 were conducted to obtain the water iodine concentration range in Wenzhou. Results : The contents of iodine in 998 out of 1 008 drinking water samples were less than 10 μg/L,accounting for 99.01%. The median of water iodine in all townships of Wenzhou was 1.8 μg/L. The results of geospatial distribution analysis demonstrated that the iodine distribution in drinking water had positive spatial autocorrelation in Wenzhou（Moran's I= 0.40,Z=15.65,P< 0.05）; there were four kinds of local aggregation models for water iodine in 78 townships（P< 0.01）. Three cluster areas of the water iodine were detected by space scanning,with three townships in Dongtou as the first high cluster areas,seven coastal townships in Cangnan as the second high cluster areas and 49 mountainous townships in Yongjia,Yueqing and Lucheng as the low cluster areas. Conclusion The iodine in drinking water in Wenzhou was low and exists spatial aggregation.

Objective To evaluate the preventive effects of predictive phased intervention on lower extremity deep vein thrombosis in ICU patients.Methods A total of 82 cases of critically ill patients admitted to our hospital from June 2013 to June 2016 were divided into observation group and control group according to the random number table method, with 41 cases respectively. Patients in the observation group received predictive phased intervention, while patients in the control group received routine nursing intervention. After 4 weeks of intervention, the lower extremity deep venous thrombosis rate, lower limb perimeter and blood flow velocity of lower extremity venous were compared between two groups.Results The incidence of lower extremity deep venous thrombosis was 2.44% in the observation group and 19.51% in the control group. The difference between two groups was statistically significant (x2=6.604,P<0.05). After the intervention, the lower limb perimeter of patients in the observation group was (30.01±2.34) cm, which was significantly lower than that of the control group; the venous blood flow velocity of the lower extremity of patients in the observation group was (25.43±3.01) cm/s, which was significantly higher than that of the control group (t=2.285, 2.357;P<0.05).Conclusions Predictive phased intervention has obvious advantages in the prevention of lower extremity deep venous thrombosis in ICU patients and it is worth clinical promotion.

Objective To explore the influences of self-efficacy intervention on compliance and self efficacy of liver transplantation recipients during hospitalization.Methods A total of 64 liver transplantation recipients in liver transplantation center of 302 Military Hospital of China from October 1 st 201 2 to September 30th 201 4 were recruited and divided into intervention group (targeted measures to enhance self efficacy)and control group (routine nursing and health education)according to the serial number designed by sequence of operation.General information of patients was collected by transplantation registration system.Besides,self-efficacy level before operation,self-efficacy and compliance level at 1 ,6 months after operation was evaluated by questionnaire.And then,self-efficacy and compliance were compared between two groups.Results There were statistically significant differences in the score of self efficacy of patients between two groups at 1 st and 6th month (P <0.01 ).The scores of self-efficacy of patients in two groups before and after intervention were analyzed with repeated measurement analysis of variance.The results showed that it was an obvious difference between two groups.At the same time,there was a statistical difference between two groups with the time changing (P <0.05).The scores of compliance,self-monitoring nursing and life habits of patients in intervention group at 1 st and 6th month were higher than those in control group with significant differences (P <0.01 );however,there was no significant difference in medication compliance and scores of two sub-scales (P >0.05).Besides,there was no significant difference on whether complications occurred (P >0.05 ).Conclusions Self-efficacy intervention can enhance self-efficacy of liver transplantation recipients after operation,improve patients′ability of self-care,promote their health behavior and improve patients′compliance so as to improve the quality of life of patients after operation.

Objective To analyze the clinical characteristics and risk factors for adult community-acquired pneumonia (CAP) caused by Gram-negative bacilli in Tangshan, and provide reference for the early identification of Gram-negative bac?teria CAP and the clinical use of antibiotics. Methods Data of retrospective general information, physical examination, aux?iliary examination and pathogen were collected in patients with CAP in respiratory department from 6 hospitals in Tangshan between October 2011 to September 2012. According to the above data, the prognosis of patients with the team score (PORT) was calculated. The sputum samples were isolated for pathogen identification. Univariate logistic regression analysis and multivariate logistic regression analysis were performed for risk factors of Gram-negative bacilli. Results A total of 195 strains were isolated from 172 (32.45%) patients in 530 patients with CAP. There were 154 strains of Gram-negative ba?cilli (78.97%) and 41 strains of Gram-positive bacteria (21.03%) in 195 bacterial strains. Univariate logistic regression anal?ysis showed the possible risk factors of Gram-negative bacilli in patients with CAP including age≥65 years old, using antibi?otics before hospitalization, basic diseases, cerebrovascular disease, malnutrion, white blood cell abnormal, neutrophil count<1 × 109/L, PORT classification≥Ⅲ, total bilirubin>17.1μmol/L and blood urea nitrogen>7.1 mmol/L. Multivariate logistic regression analysis showed the independent risk factors of Gram-negative bacilli in patients with CAP including us?ing antibiotics before hospitalization (OR=2.327, 95%CI 1.453-3.725), white blood cell abnormal (OR=2.904, 95%CI 1.879-4.490), PORT classification≥Ⅲ(OR=3.839, 95%CI 2.427-6.071), and blood urea nitrogen elevated (OR=4.133, 95%CI 2.585-6.606). Conclusion Clinical empirical anti-infection treatment should consider the risk factors including using antibiotics before hospitalization, white blood cell abnormal, PORT classification≥Ⅲ and blood urea nitrogen>7.1 mmol/L in patients with susceptible to Gram-negative bacteria infection.

Objective To evaluate the protective effects of different modes of ventilation on the lungs on the operated side during one-lung ventilation (OLV ) in patients undergoing thoracic surgery .Methods Forty-five ASA physical status Ⅰ or Ⅱ patients of both sexes ,aged 45-64 yr ,weighing 65-80 kg ,were randomly divided into 3 groups (n=15 each) using a random number table :group A ,group B and group C .After induction of anesthesia ,the patients were intubated with double-lumen tube and OLV was performed .During OLV ,the lung on the operated side was collapsed naturally in group A ,positive pressure ventilation (FGF 2 L/min) was applied in the lung on the operated side in group B ,and high-frequency jet ventilation (frequency 100 beats/min ,driving pressure 0.5 kg/cm2 ) was used in the lung on the operated side in group C .Immediately after intubation (T0 ) , and at 1.5 h (T1 ) and 2 h (T2 ) of OLV ,blood samples were taken from the central vein and radial artery for determination of the serum interleukin-6 (IL-6 ) and IL-8 concentrations .The net release of IL-6 and IL-8 was calculated .Blood samples were taken from the radial artery at T0-2 for blood gas analysis and for determination of surfactant protein A (SP-A) concentration in the serum .Respiratory index (RI) was calculated .The non-cancer tissues 1.0 cm × 1.0 cm × 1.0 cm which were extracted from the lung cancer specimens were used for microscopic examination of the pathological changes of lungs which were scored .Results Compared with group A ,the net release of IL-6 and IL-8 ,serum SP-A concentration ,RI and pathological scores were significantly decreased at T1 ,2 in B and C groups ( P<0.05) .Compared with group B ,the serum SP-A concentration and RI were significantly decreased at T1 ,2 , and the net release of IL-6 was increased at T2 in group C ( P< 0.05 ) .Conclusion Continuous positive ventilation and high-frequency jet ventilation both can effectively protect the lungs on the operated side during OLV in patients undergoing thoracic surgery ,and the efficacy of high-frequency jet ventilation is better .

OBJECTIVE To investigate whether the pulmanary fibrosis formed after a single PFIB exposure.METHODS A total of 70 male mice were exposed to PFIB 130 mg·m-3 for 5 min.Pulmonary edema of 10 mice was evaluated by lung indices at 24 h after PFIB exposure.Pathological changes and collagen deposition were detected by hematoxylin and eosin (HE) and Sirius red stainings in the other mice,changes in collagen content in lungs and plasma by measuring the respective hydroxyproline content at 2,4,6,8,12 and 16 weeks after PFIB exposure.RESULTS Severe pulmonary edema was observed at 24 h after PFIB exposure.At day 14 after PFIB exposure,inflammatory cell infiltration,alveolar septum thickening,interstitial and alveolar edema and protein leakage were noticed.Collagens types Ⅰ and Ⅲ on the wall of vessel and bronchi were severely damaged,but considerable amount of collagen type Ⅲ deposited on the alveolar wall.The content of hydroxyproline considerably decreased in the lungs but increased significantly in the plasma up to six weeks.Hydroxyproline in lungs and plasma began to recover at the end of 8 weeks,and then returned to normal.At 16 weeks,they recovered to normal level.At the end of 4 weeks,the lung lesions and the collagens at the wall of vessel and bronchi began to recover gradually; collagen typeⅢ at the alveolar wall was gradually absorbed,too.At 16 weeks,the lungs almost recovered to normal level.CONCLUSION At earlier phase after PFIB exposure,the excessive collagens destruction in lungs is observed,but no pulmonary fibrosis forms at the later phase.