Objective To reveal the hepatitis A vaccine (HepA) coverage among pre-school children in Shandong province before Hepatitis A vaccine was introduced to the EPI and to provide evidence for improving the strategy for hepatitis A control.Methods A cross-section survey was conducted among children aged between 2 and 6 years old in Shandong province in March 2008.The study population was selected by random sampling method and HepA immunization history was obtained by immunization record or recall.Results 78.90% had received one dose of HepA at least.The coverage rate decreased with age and the differences in three age groups were statistically significant (x 2 =11.54,P=0.02).The coverage rates among the boys and girls were 77.67% and 80.30% respectively,the difference was not significantly(x 2 =1.17,P=0.28).The HepA coverage rates among the children living in the eastern areas and in the richer areas were higher than the centrale and western areas and poverty areas,the difference has statistic significance (x 2 =27.25,58.17,P

Objective To observe the changes of circulating Tc 17 and Treg cells in the patients with colorectal adenoma(CRA)and the patients with colorectal cancer (CRC)and to investigate the correla-tions between them.Methods Peripheral bloods were collected from 63 patients (30 CRA and 33 CRC) and 20 healthy subjects .The proportions of circulating Tc 17 and Treg cells in peripheral blood mononuclear cells ( PBMCs) were detected by flow cytometry .The serum levels of IL-17A and IL-23 were measured by ELISA.Results Compared with healthy controls , the proportions of circulating Tc 17 and Treg cells as well as the serum levels of IL-17 A and IL-23 in CRA and CRC groups were significantly up-regulated ( P<0.05).The proportions of circulating Tc17 cells and the serum levels of IL-17A and IL-23 in CRC group were significantly higher than those in CRA group (P<0.05), but there was no significant difference in the expressions of Treg cells between the two groups .As the disease progressed , the proportions of circulating Tc17 cells and the serum levels of IL-17A and IL-23 in CRAⅠgroup and the early CRC group were respec-tively higher than those in CRAⅡgroup and the advanced CRC group (P<0.05), while the expressions of Treg cells was just the opposite , and no correlation between the expressions of Tc 17 and Treg cells was found (r=-0.227, P=0.073).Conclusion The changes in the percentage of Tc17 cells in peripheral blood are contrary to Treg cells in patients with CRA or CRC as the disease progresses , but there is no correlation be-tween them .

Objective To compare ratio of circulating Th17 over Tc17 cells in patients with colorectal polyp (CRP), colorectal adenoma (CRA) and colorectal cancer (CRC),and analyse their relationship. Methods The ratio of circulating Th17 over Tc17 cells in 93 patients(17 CRP, 34 CRA and 42 CRC)and 17 healthy donors were examined by flow cytometry;Serum levels of IL-17A and IL-23 were tested by ELISA. Results The ratio of circulating Th17 over Tc17 cells and the se-rum levels of IL-17A and IL-23 were the lowest in healthy control groups, medium in CRP and CRA groups and the highest in CRC groups (P＜0.05). The proportions of Tc17 cells in CRA groups were significantly higher compared to those in CRP groups,but no statistical significance of proportion of circulating Th17 cells as well as serum levels of IL-17A and IL-23 be-tween CRA and CRP groups was observed (P>0.05). Further analysis showed that there was a positive correlation between proportions of circulating Th17 and Tc17 cells (rs=0.594, P＜0.001). Conclusion The proportions of circulating Th17 and Tc17 cells were positively related and the ratio of Th17 over Tc17 was markedly increased from CRP group or CRA group to CRC group.

Objective:To explore the changes and possible mechanisms of circulating Tc 17 cells in patients with colorectal cancer ( CRC) following disease progression .Methods:The peripheral blood were collected from 54 patients with colorectal cancer . the proportions of Tc17 cells in peripheral blood mononuclear cells (PBMCs) and cultured PBMCs treated by IL-1β, IL-6 and TGF-βin different concentrations were determined by flow cytometry;the levels of IL-1β, IL-17A, IL-23 and IL-6 in sera were measured by ELISA.Results:The proportions of Tc17 cells and the levels of IL-1β, IL-17A, IL-23 and IL-6 were significantly higher than those in healthy controls (P<0.05).Compared with early CRC, the proportions of Tc17 cells and the levels of IL-1β, IL-17A in advanced CRC were significantly decreased, but the level of IL-6 was significantly increased (P<0.05).The difference of IL-23 level between early and late groups was not significant (P>0.05).In vitro experiments confirmed that IL-1βor high concentrations of IL-6 and TGF-βcould significantly increase the number of Tc 17 cells in PBMCs.Conclusion: The changes of circulating Tc 17 cells in the progression of colorectal cancer are possibly modulated by IL-1β, IL-23, IL-6 and TGF-β.

ObjectiveTo identify the pathogen of an aseptic meningitis outbreak which occurred in Linyi City of Shandong Province during the summer of 2009,and to analyze the genetic variations of Coxsackicvirus B5 (CVB5) isolates.MethodsForty-two cerebrospinal fluids (CSF) specimens were collected from aseptic meningitis cases and virus isolation was performed. The viral RNA was extracted and amplified from the positive specimens using reverse transcription polymerase chain reaction (RT-PCR).The partial VP1 coding region was purified and sequenced. The phylogenetic trees based on VP1 sequences were constructed among CVB5 isolates and those in GenBank.ResultsSeventeen enteroviruse strains were isolated from 42 CSF samples with 40.5％ isolation positive rate. All these strains were identified as CVB5 using both microneutralization test and molecular typing methods. Homology comparisons indicated that the nucleotide acid identities and amino acid sequence identities were 92.3 ％- 100.0％ and 98.7 ％- 100.0％,respectively among these CVB5 isolate.s,and compared with the Faulkner prototype strain,which were 81.0％-82.4％ and 96.6％97.0％,respectively.Phylogenetic analysis on VP1 sequences showed that all CVB5 could be separated into four genogroups of A,B,C and D.Isolates of this outbreak belonged to genogroup D.Interestingly,two distinct genogroups in the phylogenetic tree were observed among the 17 isolates.Conclusions CVB5 is responsible for the outbreak of aseptic meningitis in Linyi City of Shandong Province,China. The genetic diversity is high among the isolates and all belong to genogroup D.

In order to study the the impact of cognitive difference between doctors and patients on doctor-patient relationship, five tertiary hospitals in city B were investigated with questionnaire and quantitative interviews, and the outcomes were analyzed with SPSS16. 0 software. Cognitive differences were found in the nature of the relationship, the main part of responsibility for the relationship, and principles for communication between the parties. By analyzing the causes of the difference and their impact on the relationship, it draw the conclusion that this cognitive difference found between the two parties functions as a key to the conflicts between doctors and patients. Return of health care back to non-profit nature, encouragement of patient-doctor communication and mutual understanding will be conducive to minimizing such a cognitive difference, and building a harmonious doctor-patient relationship.

Objective To analyze the genetic characteristics of echovirus 6 ( E-6) strains isolated from patients with acute meningitis/encephalitis syndrome ( AMES) in 2014 and sewage samples in 2013—2014 in Shandong province and to investigate their correlations.Methods Enterovirus strains were isolated from cerebrospinal fluid, stool and throat swab samples collected from 940 cases of AMES and 96 sewage samples used for environmental surveillance.The positive isolates were identified by molecular typing meth-od.Homologous and phylogenetic analyses based on the VP1 sequences of E-6 isolates were performed.Re-sults Altogether 47 E-6 strains were isolated from patients with AMES in 2014, accounting for 29.56%of all isolated enteroviruses ( EVs) strains.No E-6 strains were isolated from AMES cases in 2013.Data of the environmental surveillance showed that E-6 virus strains had been frequently detected in sewage samples since the summer of 2013 to the end of 2014.In total, 40 E-6 virus strains were isolated (7.87% of total isolated EVs strains) in 2013 and 139 E-6 virus strains (26.18%) in 2014.Phylogenetic analysis indicated that the E-6 isolates recruited in this study belonged to clusters A and C with high intracluster sequence iden-tities between AMES and environmental isolates.The nucleotide identities were 98.3%-100% among cluster A E-6 virus strains isolated from AMES cases in 2014 and 96.6%-100% among cluster A E-6 virus environ-mental isolates during the surveillance year 2013—2014.The cluster A E-6 virus strains shared 97.1%-100% nucleotide identities between the AMES and environmental isolates.For cluster C E-6 virus strains, the nucleotide identities were 100%, 98.7%-100% and 99.1%-100%, respectively.Conclusion The epidemic of viral encephalitis in Shandong province in 2014 was associated the transmission of two lineages of E-6 virus.Environmental surveillance revealed the potential epidemic of E-6 virus even before the epidemic of viral encephalitis in Shandong province, indicating the possibility of using environmental surveillance for early warning of related diseases.

Objective To evaluate the imaging performance and characteristics of peripheral primitive neuroectodermal tumors (pPNET), in order to raise awareness of the disease and the diagnostic accuracy. Methods Thirteen patients with pPNET who confirmed by puncture or pathology were enrolled in this study. The CT and MRI features were retrospectively analyzed. Four patients received simple routine CT examination, and 9 patients had MRI examination based on X-ray, CT examination. Results The part of body involved was more widely.Two patients occurred in the sinuses, 1 patient in the chest wall, 1 patient in the lung, and 3 patients in the abdominal and pelvic(1 patient involved the pelvic floor through the pelvic wall lesions to basins), 1 patient in the spine, and 5 patients located in the extremities. The characteristics of pPNET by CT and MRI in soft tissue of 8 patients showed single large soft tissue mass, and the biggest was 11.2 cm × 10.6 cm. In bonds and joints of 5 patients, CT and MRI showed wide range of soft tissue mass, mixed internal signal/density with obviously uneven enhancement, significant bone destruction and dissolvable osseous changes, and no obvious tumor bone and calcification. Conclusions Each site has its relative imaging characteristics of pPNET. CT and MRI can show lesions involving the scope, internal structure, with or without adjacent tissue invasion and metastasis, and provide guidance for clinical treatment and selecting treatment regimen. But in the end, it depends on the diagnosis of pathological and immunohistochemical examination.

Objective:This study was conducted to investigate the levels of IL-23 and IL-17 in sera and tumor tissues and to ana-lyze their association with clinico-pathological parameters in patients with colorectal cancer (CRC). Methods:A total of 24 healthy sub-jects and 56 patients with CRC were recruited in this study. Enzyme-linked immunosorbent assay was performed to measure the concen-trations of IL-23 and IL-17 in the sera of CRC patients and healthy controls and in cultured normal tissues and tumor tissues from CRC patients. Results:The levels of serum IL-23 and IL-17 were significantly higher in CRC patients than in healthy controls (P<0.01). The supernatant levels of IL-23 and IL-17 in tumor tissues were significantly higher than in normal tissues (P<0.05). Serum IL-17 level was correlated with tumor location, lymph node metastasis, and TNM stage (P<0.05), whereas serum IL-23 level showed no correlation with all clinico-pathological parameters (P>0.05). Tumor supernatant IL-17 level was correlated with tumor differentiation, lymph node metastasis, and TNM stage (P<0.05), whereas tumor supernatant IL-23 level was correlated only with TNM stage (P<0.05). Conclu-sion:IL-23 and IL-17 may be involved in the immuno-pathogenesis of CRC progression.

Objective To improve the orotracheal intubation verifying technique and reduce the complication of backflow in rat experiment.Methods A new position evaluation of anti-backflow device was designed and made of safety IV catheter and closed IV catheter system.60 adult male Sprague Dawley rats 216±20 g were randomly assigned to two groups: group A (n=40) for verifying placement, group B (n=20) for anti-backflow test.Group A was further divided into group A1 using self-designed positioning device, group A2 using aerosol, group A3 taking cotton fiber for positioning judgment.The group B was divided into two subgroups, B1 and B2, counting escaped bubbles as a means of positioning observation, the difference is that group B1 using frustum of a cone shape anti-backflow device, while the group B2 using common airway tube.Routine endotracheal intubation was performed to observe and record the time of positioning, the location of exhalation phase, and the length of inspiratory phase countercurrent water column.The group A1 further performed tracheotomy under direct vision clearly to confirm the anatomic positioning status.Results During the exhalation cycle,three or more bubbles were observed to escape continuously, indicating that the intubation tube was properly placed and open in the airway.Positioning time: It took 1.75±1.02 respiratory cycles in group A1,3.30±0.95 respiratory cycles in group A2 and 4.10±0.99 respiratory cycles in group A3 to complete the assessment the positioning status.There was no statistically significant difference between groups A2 and A3 (P> 0.05).The time needed for group A1 was significantly shorter than that of groups A2 and A3 (P < 0.01).The longest countercurrent water column length in group B1 was 3.23±0.53 cm, and 8.48±1.01 cm in the group B2.Conclusions The new designed anti-backflow positioning evaluation device is a simple and convenient appliance to evaluate the location of orotracheal intubation in rat experiment.It can effectively improve the positioning efficiency and has practical application value.