Abstract: Objective To understand the morphological characteristics and ultrastructure of the dominant species of Rhipicephalus sanguineus in Hainan at different developmental stages, and provide theoretical basis for the identification of the lineage and control of Rhipicephalus sanguineus. Methods The external morphology of different developmental stages of the dominant species of Rhipicephalus sanguineus, including larva, nymph and adult tick in Hainan were observed by scanning electron microscope. Results The division between each segment of larva pedipalps was not obvious, and setae was serrated; dental formula type 2 | 2; 3 pairs of podomere; a pair of setae on the anal valve; none of anal groove, spiracular plate, porous area and genital aperture. There was a clear boundary at the beginning of each segment of nymph pedipalps; dental formula type 2 | 2; 4 pairs of podomere; 3 pairs of setae on the anal valve; anal groove; none of porous area and genital aperture. The male adult tick's trichotheca are covered by the pedipalps, and the whole bristles are conical; dental formula type 3 | 3; 4 pairs of podomere; anal groove and paraprocts; 7 setae on the anal valve; genital aperture was oval. The female of adult tick can be distinguished by dental formula 3 | 3; pairs of podomere; porous areas with 3 short setae; anal groove; 4 pairs of setae and 2 pores on the anal valve; genital pore was broadly U-shaped. In addition, the male adult's scutum occupies almost the entire dorsal surface, the basis capituli of larva, nymph and adult tick all were hexagonal, and the existence of Haller's organ was found on the first pair of legs. Conclusions Scanning electron microscopy observation of the different developmental stages of R.sanguineus revealed clear morphological features, preliminarily suggesting that R.sanguineus in Hainan Province may belong to the tropical lineage, which provide a certain experimental basis for the identification of the tick and the comprehensive prevention and control of local tick-borne diseases.

Objective To study the effective therapy of breast intraductal papilloma . Method One hundred and thirty-two patients with breast intraductal papilloma (four patients with cancerization)were treated by resection of the tissue stained by methylene blue. The effect was evaluated. Results The pathological diagnosis were 91 patients with breast intraductal papilloma and 41 breast intraductal papillomatosis, and 4 of them were cancerization. One hundred and ninteen patients(90.1%) were followed up for 3～46 months, all patients were cured without recurrence after operation. Conclusions Resection of the tissue stained by methylene blue in treating breast intraductal papilloma is a reliable and effective method.

Objective To explore the diagnostic value of needle stereotaction marking by steel wire(NSMSW) under mammography for nonpalpable early stage breast carcinoma (BC). Methods 29 patients with nonpalpable breast lesions were performed NSMSW under mammography,and the lesions were removed for biopsy to make the diagnosis. Results Nine patients(31.0%) were definited as early stage BC and twenty(69.0%) benign disease.The pathologic results in freezing sections and in parafin sections were the same. Conclusions NSMSW under mammography can resolve the problem of accurate location of nonpalpable breast lesions during operation .It is a credible, useful and practical method for diagnosis of nonpalpable early stage BC.

ObjectiveTo understand the difference in characteristics between juvenile dermatomyositis (JDM) and adult dermatomyositis (ADM).Methods Sixty-one cases of JDM were retrospectively analyzed and compared with 30 cases of ADM. Results The rashes were presented as the initial symptom in all expect one JDM patients. Gottron’s papules were presented in 90% JDM patients and 67% ADM patients. Calcium deposition was presented in 7% JDM patients and none of the ADM patients. The cardiovascular system was involved in 7 % JDM patients and 23% ADM patients. Cancer occurred in none of JDM patients and 13% ADM patients. In JDM and ADM patients, the ratio of elevated muscle enzymes from highest to lowest was LDH, hy-droxybutyric acid enzyme, CK-MB, AST, and CK. The positive ratio of magnetic resonance (MRI) all exceeded 80% in JDM and ADM groups. Two cases died in each group.Conclusions The clinical presentation of JDM is basically the same as that of ADM. The most common initial symptoms in JDM are skin rashes and Gottron's papules. Cardiovascular disease and cancer are less in JDM than in ADM. MRI is valuable in the diagnosis of DM.

Objective To understand the prevalence state of drinking-tea type fluorosis in Hainan Prefecture,Qinghai Province,and provide scientific data for its prevention and control.Methods In 2016,a cross-sectional survey method was used to select five counties of Guide,Guinan,Xinghai,Gonghe and Tongde in Hainan according to "National Investigation Measure of Prevalence of Drinking-tea Type Fluorosis".In each county,5 villages (towns) were selected according to the directions of east,west,north,south and center positions,and 1 administrative village was randomly selected in each village (town) as the survey site.All the children aged 8 to 12 years old at the survey site and 60 adults aged 16 years old and older at each survey site were selected as the survey subjects.We investigated the volume of brick-tea water consumed per day among objective population with questionnaire,and collected water,brick-tea water and urine samples (if each region has one water source,we collected one water sample,if this place have different water sources,we collected all the water samples from each water source;brick-tea water samples were collected based on different locations;more than 12 urine samples were collected in each survey site).The fluoride concentration in water,urine and tea water were detected with fluoride ion-selective electrode,the dental fluorosis of children aged 8-12 years were diagnosed by "Diagnosis of Dental Fluorosis" (WS/T 208-2011),and clinic skeletal fluorosis of population was diagnosed based on the "Diagnostic Criteria for Endemic Skeletal Fluorosis" (WS 192-2008).Results The medians of fluoride in drinking water,drinking-tea water were 0.29 and 1.43 mg/L,respectively.The mean of daily fluoride intake of each person was 1.82 mg,and the geometric mean of urinary fluoride was 0.83 mg/L;the rate of dental fluorosis among children was 14.06％ (559/3 975),its index was 0.24,the prevalence rate of clinic skeletal fluorosis among adult was 8.01％ (119/1 484).The rate of dental fluorosis among children in Tongde County was the highest,about 15.96％ (83/520),while the rate of dental fluorosis among children in Guinan County was the lowest,about 10.76％ (111/1 032).The prevalence rate of clinic skeletal fluorosis among adult in Xinghai County was the highest,about 10.87％ (30/276),while Tongde County was the lowest,about 5.75％ (15/261).Conclusions The prevalence of drinking-tea type fluorosis is relative low.However,the local population are still under the risk of brick-tea with high fluoride,so it is necessary to strengthen the health education propaganda to keep the population healthy.

Objective To analyze the radiographic characteristics of right hand X-ray film of adult patients with Kaschin-Beck disease (KBD) in Qinghai Province, to understand the most affected locations in adult KBD. Methods According to the criteria of KBD diagnose (WS/T 207-2010), 111 cases of patients were taken X-ray films of right hands. Joint space narrow, joint deformity, subchondral sclerosis, osteophyte, coarse and irregularity of joint, marginal retraction sign and capsule changes were chosen as the descriptive indexes, and these indexes were analyzed with SPSS 17.0. Results A total of 111 cases adult patients with KBD were examined right hand by X-ray, abnormality on X-ray film were 103 cases, the abnormal rate was 92.79%. The most affected fingers were Ⅱ- Ⅳphalanx bones, Ⅱphalanx bones accounted for about 92.23% (95/103), Ⅲ phalanx bones accounted for about 99.03% (102/103), and Ⅳ phalanx bones accounted for about 99.03% (102/103). There was significant difference of the abnormality between th e proximal phalanx and the middle phalanx among the Ⅱ - Ⅳ phalanx bones(χ2=79.33, P<0.05). Abnormal numbers of joint deformity, marginal retraction sign, coarse and irregularity of joint, osteophyte, capsule changes and joint space narrow in the proximal phalanx were 212, 7, 134, 47, 15 and 115 in Ⅱ - Ⅳ proximal phalanx, respectively; while the abnormal numbers of joint deformity, marginal retraction sign, coarse and irregularity of joint, osteophyte, capsule changes and joint space narrow in the middle phalanx were 77, 37, 137, 26, 19 and 126 in Ⅱ - Ⅳmiddle phalanx, respectively. Conclusion The Ⅱ - Ⅳ phalanx bones of right hand are the most affected locations in adult KBD.

Objective To observe the illness change trend of drinking water type endemic arsenic poisoning in Qinghai Province, comprehensively evaluate the effect of prevention and control measures, in order to provide a scientific basis for timely adjustment of the prevention and control measures. Methods From 2010 to 2013, according to the Drinking Water Type Endemic Arsenic Poisoning Monitoring Programs, 3 villages in 2 counties within Qinghai Province were randomly selected as monitoring sites. The arsenic content in drinking water of residents was measured, water improvement projects in all monitoring villages were investigated; at the same time an investigation of arsenic disease in resident population was conducted, and urinary arsenic content was monitored. Arsenic in drinking water and urine was determined by hydride generation atomic fluorescence spectrometry, and arsenic poisoning was diagnosed using Endemic Arsenic Poisoning Diagnostic Criteria (WS/T 211-2001). Results Of the three water improvement projects, two were water arsenic exceeded the standard, and one was intermittently operated. From 2010 to 2013, the arsenic poisoning detec tion rate in Baoning Village was 27.30% (193/707), 31.90%(245/768), 29.35%(221/753) and 28.22%(219/776); in Kecai Village was 32.62%(107/328), 34.83%(124/356), 31.26%(131/419) and 29.35%(118/402);and in Manimotai Village was 56.58%(43/76), 52.81%(47/89), 45.10%(46/102) and 34.69% (34/98), there was no significant difference statistically of the arsenic poisoning detection rates in the three monitored villages in the 4 years (χ2 =3.09, 0.04, 0.92, all P>0.05). From 2010 to 2013, women arsenic poisoning detection rate was 36.45%(203/557), 40.59%(246/606), 36.12%(225/623) and 34.77%(218/627), respectively;men was 25.27%(140/554), 28.01%(170/607), 26.57%(173/651) and 23.57%(153/649), respectively;women arsenic poisoning detection rates were higher than those of men (χ2 = 16.25, 21.32, 13.49, 19.38, all P < 0.05). Arsenic poisoning detection rate of people younger than 60 years old had a tendency to increase with age. In 2012 and 2013, 105 and 93 urine samples were tested, respectively; urinary arsenic geometric mean was 0.113 and 0.149 mg/L. Conclusions Water improvement projects and water quality are not optimistic, and prevalence of arsenic poisoning is still at a higher level. A sound long-term monitoring program should be established as soon as possible, the management and maintenance of water improvement projects should be strengthened, and the monitoring and prevention work should not be neglected.

Objective To understand the epidemiological prevalence of drinking-tea type fluorosis in Haidong Region,Qinghai Province,and provide scientific data for its prevention and control.Methods According to the investigation plan of drinking-tea type fluorosis in China,cross sectional survey was adopted to select 6 counties in Haidong Prefecture from May to July in 2016.Five townships were selected according to the eastern,western,north and south directions,1 administrative village was randomly selected in each township (town) as the survey site.Water and brick tea samples were collected to test fluoride ion concentration;dental fluorosis in children aged 8 to 12 years and adult skeletal fluorosis were examined.Fluorine ion selective electrode was used to determine fluoridated fluoride (WS/T 106-1999),fluorine in urine (WS/T 30-1996) and fluorine content in brick tea (GB 19965-2005).Dental fluorosis was examined by Deans method.The diagnosis of skeletal fluorosis was referred to the "Diagnostic Criteria for Endemic skeletal Fluorosis" (WS 192-2008).Results Fifty-seven drinking-water and 56 brick-tea samples were determined,the means of fluoride in drinking water and brick-tea were 0.25 mg/L and 724.71 mg/kg [which was significantly higher than the national standard (300 mg / kg)],respectively.Totally 1 207 urinary samples of children and 1 428 urinary samples of adults were determined,the geometric means of urinary fluoride of children and adults were 0.57 and 0.62 mg/L,respectively;2 677 children and 1 968 adults were examined,the rate of dental fluorosis among children was 15.09％ (404/2 677),its index was 0.26,the prevalence rate of clinic skeletal fluorosis among adults was 2.44％ (48/1 968).Conclusion The fluoride content of brick tea in 6 counties of Haidong Prefecture of Qinghai is higher than that of the national standard.Local residents are still exposed to high fluoride brick tea,and health education and publicity should continue to be strengthened.

Objective To investigate the changes of sex hormone and androgen receptor levels and evaluate the relationship of the sex hormones and androgen receptor with coronary heart disease (CHD) in elderly men. Methods A cross-sectional study was performed in 539 elderly men, including 400 healthy people aged 62-92 years and 139 CHD patients aged 60-88 years. The plasma concentrations of total testosterone (TT), free testosterone (FT), dehydroepiandrosterone sulfate (DHEAS), sex hormone binding globulin (SHBG), estradiol (E2), luteinizing hormone (LH) and follicle-stimulating hormone (FSH) were measured. The androgen receptor (AR) level was tested by flow cytometry. Results The fluorescence intensity of DHEAS, TT, SHBG, FT and AR were significantly lower in CHD group than in healthy group (P<0.01);however, FSH and E2 in CHD group were higher(P(0.01). Age was negatively correlated with TT(r=-0.28,P<0.01) and FT (r=-0.17,P<0.05), and positively correlated with SHBG(r=0.14,P<0.05) and E2 (r=0.33, P<0.01). AR fluorescence intensity was negatively correlated with systolic blood pressure (r=-0.12,P<0.01). Logistic regression analysis indicated that TT (OR=1.065,9% CI: 1.012～1.121,P<0.05), SHBG(OR=0.994,95% CI:0.990～0.998,P<0.01) and AR (OR=0.971,95%CI:0.956～0.986, P<0.01)were significantly associated with CHD in elderly male patients. Conclusions The levels of DHEAS, TT, SHBG, FT and AR are lower in elderly men with CHD than in elderly healthy men;however, the FSH and E2 concentrations are higher. Low levels of TT, SHBG and AR may be the independent risk factors for CHD in elderly men.

Objective To analyze the operation of water improvement projects in drinking water-borne fluorosis areas of Qinghai Province and the trend of dental fluorosis in children aged 8 to 12 years, and to evaluate the effects of prevention and control measures comprehensively, so as to provide basis for improving prevention and control strategies. Methods In 2009 - 2017, according to the "Qinghai Drinking Water Endemic Fluorosis Surveillance Program", four project counties of Huangyuan, Minhe, Hualong and Guide were selected in Qinghai Province. Three villages in each project county were selected according to their mild, moderate and severe conditions, and monitored the operation of water improvement projects, water fluoride content and dental fluorosis among children aged 8 to 12-year-old in each diseased village. Results In 2009-2017, the normal operation rate of water improvement projects increased from 2/8 to 7/8; the batch operation rate of the projects decreased from 5/8 to 1/8; the number of abandoned projects decreased from 1 to 0; the number of people covered by qualified water fluoride increased from 9962 to 80760 people; there was no significant difference in water fluoride content between different years (F = 0.758, P > 0.05). The total detection rate of children's dental fluorosis was 33.01％(1812/5489) from 2009 to 2017, the index of dental fluorosis was 0.65, and the epidemic intensity was slightly prevalent;the detection rate of children's dental fluorosis was 30.02％(951/3168) in villages with normal operation of water improvement projects and qualified water fluoride content, the index of dental fluorosis was 0.58, and the epidemic intensity was marginal;the detection rate of children's dental fluorosis was 32.72％(583/1782) in villages with abnormal operation of water improvement projects or excessive fluoride, the index of dental fluorosis was 0.66, and the epidemic intensity was slight; the detection rate of children's dental fluorosis in villages without changing the water was 51.58％ (278/539), and the index of dental fluorosis was 1.04, belonging to the moderate epidemic intensity; the detection rate of children's dental fluorosis in villages without changing the water was significantly higher than that in villages with normal operation of water improvement projects and qualified water fluoride content (χ2 = 102.30, P < 0.01). Conclusions The water improvement project in drinking water-borne fluorosis areas is running well and the operation rate is increasing year by year. The detection rate of dental fluorosis in children aged 8-12 years old in villages with normal operation of water improvement projects and qualified water fluoride content was significantly lower than that in villages without changing the water. The monitoring of fluorosis and the maintenance of water-renovation projects should be strengthened, and the problem of drinking water for residents in villages without changing the water should be resolved as soon as possible.