Objective:To understand the knowledge and skills of professional technicians in prevention and control of parasitic diseases in Shandong Province, and to provide a basis for further capacity building.Methods:On October 12 and 13, 2017, five professional technicians from each of 17 prefectures and cities in Shandong Province participated in the "Shandong Province Parasitic Diseases Prevention and Control Job Skills Competition in 2017". This competition included theoretical knowledge examination (written test) and operation skill examination (operation test). The written test included basic knowledge of parasites life history, pathogen, diagnosis, epidemic and prevention; the operation test included blood smear making, Kato-Katz thick smear making, microscopic examination of Plasmodium and Helminth eggs. The competition results of the competitors were statistically analyzed, and the pass rate, correct answer rate and accuracy of microscopic examination were calculated. According to the report of malaria cases from 2010 to 2017, 17 prefectures and cities in Shandong Province were divided into malaria classⅠreport area (≥100 cases) and malaria classⅡreport area (< 100 cases), and the competition results of the two types of areas were compared. Results:A total of 85 competitors in Shandong Province participated in the competition, including 19 males (22.35%) and 66 females (77.65%); the age was (34.67±6.04) years old, the youngest was 25 years old, and the oldest was 51 years old. The scores of written test and operation test were (67.06±12.73) and (59.31±14.23) points, respectively, and the difference between them was statistically significant ( t=4.949, P < 0.01). The pass rate of written test was 74.12% (63/85); the correct answer rates of morphology, life history, pathogenicity, diagnosis, epidemic and prevention were 71.76% (366/510), 71.61% (913/1 275), 67.94% (462/680), 71.18% (847/1 190), 66.91% (455/680) and 65.76% (1 062/1 615), respectively, there was statistically significant difference in the correct answer rates of different knowledge points (χ 2=18.185, P < 0.01). The pass rate of operation test was 55.29% (47/85); among them, the pass rates of blood smear making, Kato-Katz thick smear making, microscopic examination of Plasmodium and Helminth eggs were 98.82% (84/85), 98.82% (84/85), 70.59% (60/85) and 31.76% (27/85), respectively. Four Plasmodium species were examined, and the overall accuracy of microscopic examination was 61.41% (261/425), there was no statistically significant difference in the accuracy of microscopic examination between different Plasmodium species (χ 2=4.791, P > 0.05). Nine common Helminth eggs were examined, and the overall accuracy of microscopic examination was 47.29% (402/850), there was statistically significant difference in the accuracy of microscopic examination between different Helminth eggs (χ 2=180.064, P < 0.01). The scores [(28.27±3.74) and (23.20±3.39) points, n=30] of microscopic examination of Plasmodium and Helminth eggs in the malaria classⅠ report area were higher than those in the malaria classⅡreport area [(22.40±5.81) and (18.25±3.41) points, n=55], and the differences were statistically significant ( t=2.217, 2.860, P < 0.05). Conclusions:For professional technicians, the mastery of theoretical knowledge in prevention and control of parasitic diseases is better than operation skills in Shandong Province. So the training and assessment of prevention and control skills of parasitic diseases should be strengthened in areas with weak abilities.

Objective:To investigate the correlation between lipoprotein(a)[Lp(a)]levels and parameters for left ventricular structure in elderly hypertensive patients.Methods:A total of 65 patients aged ≥65 years diagnosed with essential hypertension were enrolled in this retrospective analysis.Left atrial diameter dilation(LAD)was measured to evaluate the degree of cardiac involvement.According to the existence of LAD, patients were divided into the negative group(n=43)and the positive group(n=22). The differences in levels of blood lipids including Lp(a)and LAD as well as other echocardiographic indexes between the two groups were compared, and their correlations were analyzed.Results:Compared with the negative group, the duration of hypertension, LAD, and Lp(a)level increased in the positive group( P<0.05). LAD was correlated with age, duration of hypertension, left ventricular end diastolic diameter and Lp(a)level.The Lp(a)level was correlated with age and LAD( P<0.05). Logistic regression analysis showed that duration of hypertension( OR=1.060, 95% CI: 1.008-1.116)and Lp(a)level( OR=6.394, 95% CI: 1.038-39.396)were independent risk factors for LAD.The area under the receiver operating characteristic(ROC)curve of Lp(a)for LAD was 0.665(0.524, 0.806). Conclusions:Laboratory testing for serum lipoprotein(a) levels will help assess the degree of cardiac involvement in patients with hypertension and has practical value for the risk assessment of cardiac remodeling in elderly hypertensive patients.

Objective:To investigate differences in the value of three chronic kidney disease epidemiology collaboration(CKD-EPI)estimation formulas in the evaluation of renal function damage in elderly patients with hypertension.Methods:A total of 58 patients with essential hypertension over 65 years of age were enrolled from November 2018 to March 2019 in this retrospective analysis.Patients with abnormal results in one or more items out of serum creatinine(Scr), blood urea nitrogen and urine protein were included in the hypertensive renal damage group(the positive group, n=25)and patients without abnormal results were included in the simple hypertensive group(the negative group, n=33). We measured Scr and cystatin c(Cys C)levels in fasting blood for each group.The estimated glomerular filtration rates(eGFR Scr, eGFR Cys C and eGFR Scr-Cys C)were calculated using the CKD-EPI formulas. Results:There was no statistically significant difference in gender, age, body mass index, grade of hypertension, onset time of hypertension, total cholesterol and triglycerides between the two groups( P> 0.05). There were significant differences in Cys C, eGFR Scr, eGFR Cys C and eGFR Scr-Cys C between the two groups( P<0.05). Spearman correlation analysis showed that Cys C was positively correlated with Scr( r=0.427, P<0.01), serum urate( r=0.266, P<0.05)and blood urea nitrogen( r=0.357, P<0.01)and was negatively correlated with eGFR Scr( r=-0.369, P<0.01), eGFR Cys C( r=-0.982, P<0.01)and eGFR Scr-Cys C( r=-0.845, P<0.01). Of the three formulas, eGFRScr-Cys C had the largest area under the receiver operating characteristic(ROC)curve(AUC)and its value was 0.707(0.565, 0.849). Conclusions:For the three estimation formulas, CKD-EPI Scr-Cys C has slightly better diagnostic efficiency than the others and may help improve the diagnosis of renal damage in elderly patients with hypertension.

Objective:To understand epidemiological characteristics of imported cases of malaria in Shandong province and provide scientific basis for timely adjustment of prevention and control measures.Methods:The incidence data of malaria, case investigation data and case review data by Shandong Provincial Reference Laboratory for Malaria Diagnosis from 2017 to 2018 were collected. Software SPSS 18.0 was used for statistical analysis and software QGIS 2.18 was used for mapping.Results:A total of 442 imported cases of malaria were reported in Shandong from 2017 to 2018, and the main infection source was in Africa (97.96%, 433/442). All the 17 prefectures in Shandong reported imported malaria cases, mainly in Jining (88 cases), Yantai (65 cases), Weihai (46 cases), Qingdao (44 cases) and Dezhou (42 cases), accounting for 64.48% (285/442). The cases were distributed in 77.37%(106/137) of counties of the province. The cases were reported in every month without seasonal characteristics. The median ( M) of time interval between onset and the first medical care seeking was 2 days, and the interquartile range ( IQR) was 3 days. The M of time interval between the first medical care seeking and final diagnosis was 0 day, and the IQR was 3 days. The proportion of medical care seeking on onset day was only 27.83% (123/442). Only 69.68% (308/442) of cases were diagnosed with malaria in the first medical care seeking, and the diagnostic accuracy of medical institutions below the county level was lower than other medical institutions (all P<0.01). Only 51.13% (226/442) of cases were diagnosed with malaria in the first medical care seeking, the differences in the rates among medical institutions at different levels were not significant ( P>0.05). Conclusions:The imported malaria in Shandong was characterized by a large number of cases, multiple infection sources and wide area distribution during 2017-2018. The awareness of timely medical care seeking in the cases was low, meanwhile the awareness and ability of malaria diagnosis and treatment in primary medical institutions were still inadequate. It is necessary to adjust the prevention and control measures accordingly.

Objective To explore the CT features of gastrointestinal tract diospyrobezoar and its complications,to improve the recognition. Methods The plain CT scan of 36 patients with gastrointestinal tract diospyrobezoar confirmed by gastroscope and surgery were analyzed retrospectively.Results The number and location of diospyrobezoar showed by CT were consistent with the results of gastroscope and surgery.There were 1 1 cases of stomach diospyrobezoar,1 9 cases of small intestine diospyrobezoar,and 6 cases of stomach and small intestine diospyrobezoar.32 cases were solitary lesion,and 4 cases were multiple lesions.A total of 41 diospyrobezoars were removed, most of which were wel-l defined ovoid mass.3 1 lesions presented mottled internal gas bubbles with high-density encapsulating wall.6 lesions showed mottled gas pattern without encapsulating wall.4 lesions showed uneven high density.Over time,1 lesion moved in the digestive tract and the boundary and density were changed.Complications:gastric and duodenal diospyrobezoar accompanied by gastric retention,which manifested as a significant expansion of the gastric cavity effusion.Small intestine diospyrobezoar was accompanied by small bowel obstruction,which showed that the proximal intestinal tube of the diospyrobezoar was obviously dilated,and the distal intestine was suddenly collapsed.There was a focal transition zone between them.Conclusion Gastrointestinal tract diospyrobezoar has a variety of CT manifestations,of which oval shape,clear boundary,uneven mass composed of gas and soft tissue are common.

Objective To explore the CT manifestations of primitive neuroectodermal tumor (PNET) of adrenal gland,aiming to increase the cognition on this disease.Methods The CT manifestations of 7 patients who were pathologically diagnosed with adrenal gland PNET were analyzed retrospectively.Results The age of patients was 24-63 years old,with average age of (47.6±13.7) years,including 6 females and 1 male.Location of PNET:4 in left adrenal gland and 3 in right adrenal gland.Clinical manifestations:3 cases had upper abdominal distension,2 cases suffered from pain of waist and back,1 case was discovered in physical examination and another 1 had fever.No abnormality was found in laboratory and endocrinological examinations.After operation,4 cases had recurrence and 2 had distant metastasis.During follow-up,6 patients died and only 1 still alive.CT showed that the tumor,whose maximum diameter was 10.1-19.4 cm,was elliptic or lobulated in shape.The tumor was clear in boundary in 2 patients,but was unclear in boundary and involved adjacent organs in 5 patients.The plain scanning showed equidensity or slightly low density,complicated with necrosis and cystic lesions without calcification.The enhanced scanning suggested progressive uneven enhancement,with multiple interatrial septum-like changes and latticed enhancement inside.Conclusion CT manifestations of adrenal gland PNET can prompt the diagnosis,pathological examination is still required for confirmation.CT can accurately describe the internal structures,adjacent relationship and the metastasis of tumors.

Objective To investigate the imaging findings of giant cell glioblastoma(GCG).Methods Imaging findings of 8 cases with pathology-confirmed GCG were retrospectively reviewed and correlated with pathologic findings.Results All of the 8 cases were located in the cerebral hemisphere.On CT images, 1 lesion case was shown appeared as mixed density,4 lesions were shown as cystic and solid mass.Mural nodule were slightly hyperdense.On MRI images, all of 4 cases lesions were hypointensity on T1WI, mixed signal intensity or hyperintensity on T2WI and FLAIR, low signal intensity on DWI.The lesion showed nonuniform enhancement,with enhanced mural nodules and cyst walls,and mildmoderate or no peritumoral edema.Microscopically, the cells were arranged in perivascular pseudorosettes to form palisades.Cellular pleomorphism was a typical feature, including monstrous and multinucleated giant cells.Mitotic figures were usually numerous.Reticulin was abundant in the stroma.Immunohistochemistry showed staining for S-100, Vim, p53, GFAP.The proliferation rate determined by Ki-67 immunohistochemistry was 30%.Conclusion GCG has certain imaging characteristics,CT and MRI are effective in detecting the disease.

According 1o the genome sequences of α.β,e,ι toxins of Clostridium perfringens in GenBank,four pairs of primers targeting α,β,ε,ι toxin genes were designed.After the multiplex PCR reaction condition was optimized,the multiplex PCR for identification and toxintyping of C.perfringens strains was developed.The specificity test showed that the expected fragments of C.perfringens reference strains including A.B,C,D,E five toxin types were amplified successfully from genomic DNA of C.perfringens,respectively.However,a band could not be amplified from Clostidrium novyi and Clostridium septicum as negative control groups.The sensitivity test showed that the limit detection of multiplex PCR was 9.0,17.8,12.2,13.8,18.5 pg DNA of A,B,C,D,E five toxin types C.perfringens,respectively.Repetitive testing showed that the established method had a good repeatability.Nine type A strains of and 1 type C strains of C.Perfringens from 21 clinical samples of dead goat were detected by the multiplex PCR developed in this study.This study establishes the multiple PCR method which not only can detect C.perfringens rapidly but also can identify five toxin types of C.perfringens.

Objective To compare the effect of pressurized rapid intravenous drip of Shenfu and micro-pumping of dopamine on hypoperfusion in percutaneous coronary intervention (PCI) of acute inferior wall myocardial infarction.Methods A total of 80 patients with acute inferior wall myocardial infarction treated with emergency PCI in Chest Pain Unit of Yantaishan Hospital of Yantai City from May 2014 to May 2015 were enrolled. Then these patients were divided into observation group (n=40,pressurized rapid intravenous drip of normal saline and Shenfu) and control group (n=40,pressurized intravenous drip of normal saline with the same pressure combined with micro-pumping of Dopamine) according to random number table. Blood pressure and heart rate per five minutes were observed and recorded before intravenous drug,five to forty minutes after intravenous drug. Besides,the incidence rates of malignant arrhythmia,vomitting,TIMI grade three flows after intrqvenous drug and major adverse cardiovascular events after 30 days of a follow-up were also observed and recorded.Results Systolic pressure,diastolic pressure and mean arterial pressure of patients between two groups all met and maintained to the expectation after treatment with significant differences between two groups (P<0.05). The incidence rates of malignant arrhythmia,nausea and vomitting in observation group were lower than those in control group with significant differences (P<0.05). There was no statistically significant difference in the proportion of TIMI grade three flows and the incidence of major adverse cardiovascular events after 30 days of a follow-up (P>0.05).Conclusions When the hypoperfusion appears during PCI of acute inferior wall myocardial infarction,the pressurized rapid intravenous drip of Shenfu can improve hypoperfusion which is better than Dopamine in the effects of correcting hypotension and reducing the occurrence of adverse events.

OBJECTIVETo explore the optimal time of acupuncture intervention in the assisted reproduction.

METHODSOne hundred and twenty female mice and 60 male mice were collected. 20 female mice were selected in the natural period group and the rest 100 female mice were prepared as the model of controlled ovarian hyperstimulation (COH). The model mice were randomized into a COH group, a down-regulation group, a gonadotropins (Gn) start group, an injection of human chorionic gonadotropin (HCG) group and an embryo culture group, 20 mice in each one. The donor mice and receptor mice were subdivided in each group, 10 mice in each subgroup. One week before the experiment, vas deferens ligature was done in 30 male mice and the other 30 male mice did not receive ligature. In the down-regulation group, the Gn start group, the HCG injection group and the embryo culture group, electroacupuncture (EA) was applied to "Guanyuan" (CV 4), "Zhongji" (CV 3) and "Sanyinjiao" (SP 6) at the time points accordingly. EA stimulation was in the condition of continuous wave, 2 Hz and 1 mA. No inter-vention was given in the natural period group and the COH group. On the day of HCG injection, the donor mice and the non-ligatured male mice were put in the same cage of each group. The fertilized ovum was collected with the date of fertilization marked and was fostered in the incubator. At the ratio of 1:1, the receptor mice and ligatured mice were put in the same cage in each group. The vaginal plug was examined in the next morning. The pseudopregnancy was marked with the date of plug observed. In the 68th hour of embryo culture, the embryo of the donor was shifted to the receptor on the same day when the plug was observed. The clinical pregnancy rate and embryo imbed site number were observed. RT-PCR assay was adopted to determine the expression of insulin-like growth factor-1 (IGF-1) mRNA in endometrium.

RESULTSIn the COH group, the pregnancy rate, average imbed site number and endometrial IGF-1 mRNA expression were all significantly lower than those in the natural period group (all<0.01). After EA treatment, in the Gn group, the HCG injection group and the embryo culture group, the pregnancy rates were higher significantly than those in the COH group (<0.05,<0.01). In the HCG injection group, the average imbed site number and IGF-1 mRNA expression were increased apparently as compared with those in the COH group (both<0.01), better than those in the Gn group and the embryo culture group (all<0.01).

CONCLUSIONSIn the treatment with acupuncture combined with IVF-ET for infertility, the intervention of acupuncture on the day of HCG injection is the optimal time point. It increases the secretion of endometrial IGF-1 so as to improve the clinical pregnancy rate, the mean imbed site number and the embryo implantation.