Objective:To understand the prevalence of major chronic diseases of diabetes, cardiovascular disease and malignant tumor in people living with HIV in Taizhou.Methods:The data were collected from China Information System for Disease Control and Prevention and Taizhou Chronic Disease Information Management System. A total of 5 126 people living HIV under follow-up in Taizhou from 1998 to 2022 were included in the analysis. Software SAS 9.4 was used for χ 2 test, trend analysis and logistic regression analysis. Results:In the 5 126 people living with HIV, the reported prevalence rates of diabetes,cardiovascular disease and malignant tumor were 10.28% (527/5 126),3.98% (204/5 126) and 6.01% (308/5 126), respectively. 37.00% (195/527) and 48.58% (256/527), 40.20% (82/204) and 48.53% (99/204), 37.66% (116/308) and 48.38% (149/308) were diagnosed as diabetes, cardiovascular disease and malignant tumor before and after confirmation of HIV infection. From 2013 to 2022, the proportion of HIV infected people diagnosed with diabetes, cardiovascular disease and malignant tumor after confirmation increased (trend χ2=79.98, P<0.001; trend χ2=17.44, P<0.001; trend χ2=32.06, P<0.001). Based on the analysis on the factors for complicated chronic diseases in people living with HIV, it was found that women under 60 years old (a OR=0.66, 95% CI: 0.50-0.86) and those with access to antiviral treatment for >5 years before 2016 (a OR=0.54,95% CI:0.37-0.78) were less likely to develop complicated chronic diseases, and those under 60 years old with initial CD4 +T lymphocytes counts <200 cells/μl (a OR=1.32, 95% CI: 1.02-1.70), those aged 40-49 and 50-59 years (a OR=2.88, 95% CI:2.20-3.79; a OR=5.43, 95% CI: 4.10-7.21) as well as those without a record of treatment medication use after 2016 (a OR=1.95,95% CI:1.20-3.16) were more likely to develop complicated chronic diseases. The probability of developing complicated chronic diseases might increase with age in people living with HIV. Conclusions:From 1998 to 2022, there was a certain proportion of complicated chronic diseases among HIV infected individuals in Taizhou, and the proportion of diagnosed cases increased after HIV infection was confirmed. It is necessary to conduct early chronic disease screening, behavior intervention and standardized management in people living with HIV.

Objective:To investigate the training effect of order-oriented medical students in Yunnan Province of China and related influencing factors and targeted suggestions, and to improve the training effect of order-oriented medical students in residency training bases in Yunnan Province.Methods:The stratified cluster sampling method was used to select 8 general residency training bases, and a questionnaire survey was performed among the 621 order-oriented students in these training bases. Finally, 616 valid questionnaires were collected. SPSS 26.0 was used to perform the two-sample rank sum test, the K-W test, and the ordered multinomial logistic regression analysis.Results:The training effect of the "5+3" order-oriented medical students in Yunnan Province was between generally good (48.29%) and good (45.37%). The effect of the provincial general training base is better than that of the municipal general training base, and most training students at the province level (167, 59.64%) thought that the training effect was good, while most of the training students at the prefecture or municipal level (194, 57.91%) thought that the training effect was generally good. When the teaching level of the teachers can meet the teaching work, the residential training effect of the order-oriented residential training students is well evaluated (197,68.17%). When skill training was carried out by the base at least once a month, most of the order-oriented trainees (96, 48.73%) thought that the training effect was good. The ordered multinomial logistic regression analysis showed that the nature of the base, sex, attitude towards policy, psychological state, teaching competency of teachers, perfection of the fund guarantee system, consistency of training plan with requirements, consistency of training process with requirements, and consistency of teaching activities with requirements were influencing factors for the training effect of "5+3" order-oriented medical students in residency training bases of Yunnan Province ( P<0.05). Conclusions:The training effect of "5+3" order-oriented medical students in residency training bases of Yunnan Province was between generally good and good. The training effect of bases can be improved by strengthening the construction of infrastructure, giving full play to the role of base linkage, perfecting the training plan, improving implementation and execution, building up a perfect fund guarantee system, enhancing the construction of general teaching team, emphasizing skill practice training, and implementing diversified training activities.

Objective:To retrieve, evaluate, and integrate the best evidence of general anesthesia health education for adult patients undergoing elective surgery, so as to provide a basis for clinical health education guidance.Methods:Evidence-based questions were established based on the population, intervention, professional, outcome, setting and type of evidence (PIPOST) model. All evidence on general anesthesia health education for adult patients undergoing elective surgery were retrieved from databases or professional association websites such as Cochrane Library, British Medical Journal (BMJ) Best Practice, UpToDate, Agency for Healthcare Research and Quality, Guidelines International Network, National Institute for Health and Clinical Excellence, Clinical Guidelines Library, PubMed, China National Knowledge Infrastructure, WanFang Data, Medlive, American Society of Anesthesiologists, and Society of Anesthesiology of the Chinese Medical Association. The search period was from database establishment to June 18, 2023. Two researchers screened and evaluated the quality of the included literature, extracted and integrated the evidence to form the best evidence for general anesthesia health education in adult patients undergoing selective surgery.Results:A total of 10 articles were included, including four guidelines, three clinical decision-making, and three expert consensus. A total of 41 pieces of evidence on general anesthesia health education for adult patients undergoing elective surgery were extracted, including six aspects of anesthesia overview, pre-anesthesia evaluation, pre-anesthesia preparation, anesthesia process and cooperation, anesthesia recovery period management, and postoperative management.Conclusions:The best evidence of general anesthesia health education for adult patients undergoing selective surgery summarized can provide a basis for comprehensive and systematic education of anesthesia health educators.

Objective To investigate the changes and clinical significance of the expression of neutrophil gelatinase-associated li-pocalin(NGAL)and autophagy during different time of renal ischemia/reperfusion(I/R)injury in rats.Methods The rat renal I/R in-jury model was established,thirty male Wistar rats were divided by random number table method into sham operation group(Sham group)and I/R group,according to the different time of reperfusion after I/R injury,the I/R group was divided into 4subgroups:2h group,6h group,24h group,48h group.Blood,urine and renal tissue samples were collected at different time points,NGAL levels of blood and u-rineweredetectedbyenzyme-linkedimmunoadsordentassay(ELISA)method.Bloodureanitrogen(BU)and serum creatinine(SCr)were detected by automatic biochemical analyzer.Hematoxylin-eosin staining was used to detect the degree of histopathological injury and score the degree of injury.TdT-mediated dUTP nick end labeling(TUNEL)method was used to detect the apoptosis of renal tubular ep-ithelial cells;the expression of autophagy related genes LC3 and Beclin-1gene was detected by real-time quantitative polymerase chain reaction(RT-qPCR)method.Results The expression levels of NGAL in blood and urine were elevated in the 2h after I/R injury,and peaked at 6h of reperfusion,and showed a downward trend at 24h.BU and Scr values began to increase after the 6h reperfusion of I/R in-jury and peaked at 24h of reperfusion.TUNEL positive cells began to increase at 6h after I/R injury,the number of the highest was at 24h reperfusion of I/R injury.Hematoxylin-eosin staining showed that there were different degrees of swelling and necrosis of renal tubular epithelial tissue in all groups after I/R injury.The expression of LC3 and Beclin-1 gene began to increased after the 6h reperfusion of I/R injury and peaked at 24h of reperfusion.Conclusion The expression level of NGAL increased at the early stage of renal I/R injury in rats,which was earlier than the changes of BU and SCr levels,and could be used as a molecular indicator for early diagnosis of renal I/R injury.During the aggravation of renal I/R injury,the expression of NGAL was increased and autophagy was activated,which indica-ted that NGAL and autophagy played a certain role in the process of renal I/R injury.

Objective:To evaluate the value of autologous platelet-rich plasma (aPRP) separation-retransfusion for blood conservation in the patients undergoing thoracolumbar laminectomy.Methods:Sixty American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ patients, aged 18-60 yr, with body mass index of 19-30 kg/m 2, scheduled for elective thoracolumbar laminectomy, were divided into 2 groups ( n=30 each) using a random number table method: conventional blood conservation group (group C) and aPRP blood conservation group (group aPRP). Group C received tranexamic acid and autologous blood salvage-retransfusion. Group aPRP received aPRP separation-retransfusion, tranexamic acid and autologous blood salvage-retransfusion. The volume of allogeneic blood transfused, percentage of patients who did not need the allogeneic blood transfusion and adverse reactions were recorded. Venous blood samples were collected for blood routine examination and for determination of the plasma concentrations of interleukin-6 (IL-6) and IL-10 at 1 day before operation (T 0), when the volume of blood loss reached 500 ml (T 1), immediately after surgery (T 2), and at 24 and 48 h after surgery (T 3, 4). The incidence of hypoxemia and amount of 24-h wound drainage were recorded. Results:Compared with group C, the amount of allogeneic red blood cells, plasma transfused and 24-h wound drainage were significantly decreased ( P<0.05), the percentage of patients who did not need the allogeneic red blood cell and plasma transfusion was increased (30% vs 47%, 10% vs 60%, P<0.05), the plasma concentrations of IL-6 and IL-10 at T 2-4 were significantly decreased ( P<0.05), and the incidence of hypoxemia in PACU was decreased in group aPRP (27% vs 10%, P<0.05). Conclusions:aPRP separation-retransfusion can provide marked improvement in conventional blood conservation in the patients undergoing thoracolumbar laminectomy.

ObjectiveTo analyze the changes in HIV， syphilis and hepatitis C prevalence among men who have sex with men （MSM） in Taizhou City， Zhejiang Province from 2017 to 2022， and the utilization of HIV intervention services and its influencing factors. MethodsMSM participants were recruited from HIV sentinel surveillance in Taizhou through snowball sampling method. Participants’ socio-demographic characteristics， sexual behavior characteristics， knowledge of HIV and utilization of HIV intervention services were collected and statistically described by questionnaire survey. Blood samples from MSM sentinel population were also collected for HIV， syphilis， and HCV antibody testing. Multivariate logistic regression analysis was used to analyze the influencing factors for utilizing HIV intervention services among MSM. ResultsA total of 2 499 MSM were included in the analysis from 2017 to 2022， with HIV prevalence of 5.8%， syphilis prevalence of 4.0%， and HCV prevalence of 0.6%. The infection rate， proportion of homosexual anal sex and heterosexual sex showed a decreasing trend， while the proportion of condom use during homosexual anal sex， condom publicity and distribution， AIDS consultation and testing， acceptance of peer education， and online temporary homosexual sex showed an increasing trend. All these differences were statistically significant. Multivariate logistic regression analysis showed that COVID-19 epidemic （aOR=1.66， 95%CI：1.04‒2.64） and HIV knowledge awareness （aOR=2.57， 95%CI：1.22‒5.40） were positively correlated with increased acceptance of condom publicity and distribution， and utilization of AIDS counseling and testing. Those who sought male sexual partners through offline route （aOR=3.44， 95%CI： 1.16‒10.21）， and had a history of sexually transmitted diseases within one year （aOR=5.47， 95%CI： 1.04‒28.76） were positively correlated with community-based methadone maintenance therapy， clean needle provision and exchange services， while COVID-19 epidemic （aOR=0.35， 95%CI： 0.14‒0.88） was negatively correlated with the utilization of these services. COVID-19 epidemic （aOR=2.11， 95%CI： 1.54‒2.89）， HIV knowledge awareness （aOR=2.09， 95%CI： 1.08‒4.02）， offline search for male sexual partners （aOR=1.47， 95%CI： 1.03‒2.11）， and awareness of HIV infection of sexual partners （aOR=2.09， 95%CI： 1.62‒2.69） were positively correlated with the increased use of peer education service， while married or cohabited （aOR=0.73， 95%CI： 0.55‒0.98） and VCT （aOR=0.61， 95%CI： 0.46‒0.82） were negatively correlated with utilization of peer education service. ConclusionHIV infection rate of sentinel MSM population in Taizhou decreases， while the utilization of HIV intervention services increases in general. Targeted measures should be developed according to the changes in sexual behavior and HIV intervention services among MSM populations in Taizhou to improve the HIV intervention services for the MSM population.

Humans ; Pulmonary Disease, Chronic Obstructive ; Smoke/adverse effects* ; Tobacco ; Tobacco Smoke Pollution

Objective:To determine whether insulin resistance is associated with all-cause mortality in subjects without diabetes.Methods:A total of 505 participants without diabetes, 198 with normal glucose tolerance (NGT) and 307 with impaired glucose tolerance (IGT), were recruited from the Daqing Diabetes Study. The participants were followed up for 30 years. They were stratified into three groups (tertiles) according to baseline homeostasis model assessment of insulin resistance(HOMA-IR) levels, as the HOMA-IR 0, the HOMA-IR 1 and the HOMA-IR 2 groups, to assess the predictive effect of insulin resistance on risk of all-cause mortality.Results:During the 30-year follow-up, 52, 56 and 78 participants died across the three HOMA-IR groups, respectively. The corresponding mortality per 1 000 person-years (95 %CI) were 12.12 (9.56-15.01), 13.10 (10.46-16.03) and 19.91 (16.73-23.15), respectively. Participants in the HOMA-IR 2 group had a significantly higher risk of death than those in the HOMA-IR 0 group after adjustment of age, sex and smoking status ( HR=1.97,95 %CI 1.38-2.81, P<0.001). Cox analyses showed that a one standard deviation increase in HOMA-IR was associated with a 22% increase in the mortality after adjustment of potential confounders ( HR=1.22, 95 %CI 1.08-1.39, P=0.002). Conclusions:Insulin resistance is associated with increased risk of all-cause death in Chinese people without diabetes, suggesting that improving insulin resistance could be beneficial for people without diabetic in reducing risk of long-term all-cause mortality.

OBJECTIVES: Fluorouracil chemotherapeutic drugs are the classic treatment drugs of gastric cancer. But the problem of drug resistance severely limits their clinical application. This study aims to investigate whether hypoxia microenvironment affects gastric cancer resistance to 5-fluorouracil (5-FU) and discuss the changes of gene and proteins directly related to drug resistance under hypoxia condition. METHODS: Gastric cancer cells were treated with 5-FU in hypoxia/normoxic environment, and were divided into a Normoxic+5-FU group and a Hypoxia+5-FU group. The apoptosis assay was conducted by flow cytometry Annexin V/PI double staining. The real-time reverse transcription-polymerase chain reaction (RT-PCR) and Western blotting were used to detect the expression level of hypoxia inducible factor-1α (HIF-1α), multidrug resistance (MDR1) gene, P-glycoprotein (P-gp), and vascular endothelial growth factor (VEGF) which were related to 5-FU drug-resistance. We analyzed the effect of hypoxia on the treatment of gastric cancer with 5-FU. RESULTS: Compared with the Normoxic+5-FU group, the apoptosis of gastric cancer cells treated with 5-FU in the Hypoxia+5-FU group was significantly reduced (P<0.05), and the expression of apoptosis promoter protein caspase 8 was also decreased. Compared with the the Normoxic+5-FU group, HIF-1α mRNA expression in the Hypoxia+5-FU group was significantly increased (P<0.05), and the mRNA and protein expression levels of MDR1, P-gp and VEGF were also significantly increased (all P<0.05). The increased expression of MDR1, P-gp and VEGF had the same trend with the expression of HIF-1α. CONCLUSIONS Hypoxia is a direct influencing factor in gastric cancer resistance to 5-FU chemotherapy. Improvement of the local hypoxia microenvironment of gastric cancer may be a new idea for overcoming the resistance to 5-FU in gastric cancer.
Humans ; Fluorouracil/therapeutic use* ; Vascular Endothelial Growth Factor A/metabolism* ; Stomach Neoplasms/drug therapy* ; Drug Resistance, Multiple ; Vascular Endothelial Growth Factors/metabolism* ; Hypoxia ; ATP Binding Cassette Transporter, Subfamily B/genetics* ; ATP Binding Cassette Transporter, Subfamily B, Member 1/genetics* ; Cell Line, Tumor ; Cell Hypoxia ; RNA, Messenger/metabolism* ; Hypoxia-Inducible Factor 1, alpha Subunit/genetics* ; Tumor Microenvironment

Objective:To investigate the status quo and training needs of general practitioner (GP) job-transfer training program in Hebei Province.Methods:An online survey with self-designed questionnaire was conducted on May 2019 through WeChat among 165 trainees in the General Practice Training Center of Hebei Province. A total of 165 questionnaires were distributed and 149 were valid with an effective rate of 90.3%. The contents of the questionnaire included the basic information of the trainees, the evaluation of the current training, and the needs of the GPs′ job-transfer training.Results:Among 149 participants, there were 131 (87.9%)from the secondary hospitals or above, 146(98.0%)with bachelor′s degree or above, and 128 (85.9%)with intermediate or above professional titles. The survey showed that 72.0%(67/93)thought the main reasons affecting participation in the training were busy work load and insufficient personnel, the main problems of training were too short training duration(45.2%, 42/93), the not focused training contents(38.7%, 36/93) and lack of practice(37.6%, 35/93). In the 149 trainees, 136(91.3%) thought that the most important contents should be standardized diagnosis and treatment of common diseases; 104(69.8%), 118(79.2%), 115(77.2%) and 98(65.8%) considered that the knowledge of prevention and health-protection, first aid, latest progress and chronic disease management were needed for training; 110(73.8%)and 80(53.7%)thought the mastery of clinical practice and basic theory were needed. And 57.7% (86/149)of the trainees believed that research training was needed, and there was significant difference in the demand for research training among participants from different work units and with different professional titles (χ 2=15.371,10.625,all P<0.05). The accepted training methods were case study(53.7%, 81/149) and practical work(37.6%, 56/149). For training duration, 43.6% (65/149) thought it should not exceed 6 months and 56.4% (84/149) preferred more than 1 year; there was a significant difference in demanded training duration among trainees from different work units, with different education background and professional titles (χ 2=16.225,6.243,25.966, all P<0.05). Conclusion:We need a multi-channel and multi-level training model to establish a better job-transfer training system for general practitioners, in order to meet different training needs and to improve the effectiveness of the training.