[Association between sedentary behavior and force expiratory volume in 1 second reduction in middle-aged and elderly adults in communities]

Objective: To analyze the relationship between sedentary behavior and the force expiratory volume in 1 second (FEV₁) reduction in middle-aged and elderly people in communities. Methods: The participants aged ≥40 years were randomly selected from a natural population cohort in Songjiang District, Shanghai, for pulmonary function tests and survey by using international physical activity questionnaire, a generalized additive model was used to analyze the association between sedentary behavior and FEV₁ reduction in the study population and different sex-age subgroups. Results: A total of 3 121 study subjects aged ≥40 years were included. The prevalence of FEV₁ reduction was 14.8%, which was higher in men than in women. There were 24.8% participants were completely sedentary. The prevalence of FEV₁ reduction in women aged <60 years in complete sedentary group was 2.04 (95%CI: 1.11-3.72) times higher than that in non-complete sedentary group. In men aged <60 years, the prevalence of FEV₁ reduction increased with daily sedentary time (OR=1.16, 95%CI: 1.04-1.29), and the prevalence of FEV₁ reduction was also higher in those with sedentary time >5 hours/day than those with sedentary time ≤5 hours/day (OR=3.02, 95%CI: 1.28-7.16). The sensitivity analysis also found such associations. Conclusions: FEV₁ reduction rate in age group <60 years was associated with sedentary behavior. Complete sedentary behavior or absence of moderate to vigorous physical activity played important roles in FEV₁ reduction in women, while men were more likely to be affected by increased sedentary time, which had no association with physical activity. Reducing sedentary time to avoid complete sedentary behavior, along with increased physical activity, should be encouraged in middle-aged and elderly adults in communities to improve their pulmonary function.

[Exposure level of neonicotinoid pesticides and their metabolites in pregnant women in the suburb of Shanghai]

In 2021, a total of 151 pregnant women were selected from the suburb of Shanghai. A questionnaire survey was conducted to obtain data about maternal age, gestational week, total annual household income, education level and passive smoking among pregnant women and one spot urine was collected. The concentrations of eight neonicotinoid pesticides and four metabolites in urine were measured by ultra-high performance liquid chromatography-tandem quadrupole time-of-flight mass spectrometry. The differences in detection frequencies and concentrations of neonicotinoid pesticides and their metabolites among pregnant women with different characteristics were compared, and the influencing factors of the detection of neonicotinoid pesticides in urine were analyzed. The results showed that at least one neonicotinoid pesticide was detected in 93.4% (141 samples) of urine samples. The detection frequencies of N-desmethyl-acetamiprid, clothianidin, thiamethoxam, and N-desmethyl-clothianidin were high, about 78.1% (118 samples), 75.5% (114 samples), 68.9% (104 samples), and 44.4% (67 samples), respectively. The median concentration of the sum of all neonicotinoid pesticides was 2.66 μg/g. N-desmethyl-acetamiprid had the highest detection concentration with a median concentration of 1.04 μg/g. A lower urinary detection frequency of imidacloprid and its metabolites was seen in pregnant women aged 30-44 years [OR (95%CI): 0.23 (0.07-0.77)]. A higher detection frequency of clothianidin and its metabolites was seen in pregnant women with per capita annual household income≥100, 000 yuan [OR (95%CI): 6.15 (1.56-24.28)]. There was widespread exposure to neonicotinoid pesticides and their metabolites in pregnant women from the suburb of Shanghai, which might pose potential health risks to pregnant women, and maternal age and household income were potential influencing factors of the exposure to neonicotinoid pesticides.

[Progress of researches on medical big data analytics technology]

The use of the big data analytics technology to collect, summarize and analyze medical big data is effective to precisely mine and explore the underlying information, which greatly facilitates medical science research and clinical practices. Currently, the medical big data analytics technology mainly includes artificial intelligence, databases and programming languages, which have been widely employed in medical imaging, disease risk prediction, disease control, healthcare management, follow-up, and drug and therapy development. This review summarizes the currently available medical big data analytics technologies and their applications, with aims to facilitate the related studies.

[Analysis of the new WHO guideline to accelerate the progress towards elimination of schistosomiasis in China]

On February 2022, WHO released the evidence-based guideline on control and elimination of human schistosomiasis, with aims to guide the elimination of schistosomiasis as a public health problem in disease-endemic countries by 2030 and promote the interruption of schistosomiasis transmission across the world. Based on the One Health concept, six evidence-based recommendations were proposed in this guideline. This article aims to analyze the feasibility of key aspects of this guideline in Chinese national schistosomiasis control program and illustrate the significance to guide the future actions for Chinese national schistosomiasis control program. Currently, the One Health concept has been embodied in the Chinese national schistosomiasis control program. Based on this new WHO guideline, the following recommendations are proposed for the national schistosomiasis control program of China: (1) improving the systematic framework building, facilitating the agreement of the cross-sectoral consensus, and building a high-level leadership group; (2) optimizing the current human and livestock treatments in the national schistosomiasis control program of China; (3) developing highly sensitive and specific diagnostics and the framework for verifying elimination of schistosomiasis; (4) accelerating the progress towards elimination of schistosomiasis and other parasitic diseases through integrating the national control programs for other parasitic diseases.

[Contribution to global implementation of WHO guideline on control and elimination of human schistosomiasis by learning successful experiences from the national schistosomiasis control program in China]

Schistosomiasis is a parasitic disease that seriously hinders socioeconomic developments and threatens public health security. To achieve the global elimination of schistosomiasis as a public health problem by 2030, WHO released the guideline on control and elimination of human schistosomiasis on February, 2022, with aims to provide evidence-based recommendations for schistosomiasis morbidity control, elimination of schistosomiasis as a public health problem, and ultimate interruption of schistosomiasis transmission in disease-endemic countries. Following concerted efforts for decades, great achievements have been obtained for schistosomiasis control in China where the disease was historically highly prevalent, and the country is moving towards schistosomiasis elimination. This article reviews the successful experiences from the national schistosmiasis control program in China, and summarizes their contributions to the formulation and implementation of the WHO guideline on control and elimination of human schistosomiasis. With the progress of the "Belt and Road" initiative, the world is looking forward to more China's solutions on schistosomiasis control.

[Incidence and risk factors of metabolic syndrome in rural community population on islands in Zhejiang province]

Objective: To estimate the incidence of metabolic syndrome and explore possible risk factors for metabolic syndrome in adults of rural communities in Yuhuan county, Zhejiang province, China. Methods: During June-December, 2018, a follow-up survey was conducted in participants without metabolic syndrome at baseline survey in 2012 to obtain the information collected in questionnaire survey, anthropometric data and laboratory data. The incidence of metabolic syndrome in the participants was estimated, and Logistic regression model was used to explore the risk factors, adjusted risk ratio (aRR) and 95%CI. Results: Among 3 162 participants, 522 new metabolic syndrome cases were identified. The 6-year cumulative incidence rate of metabolic syndrome was 16.5%, and the cumulative incidence rate was higher in women (20.6%) than that in men (12.3%, P<0.001). Those incidence rates were higher in those in jobless, smoking or drinking groups. Being women (aRR=1.96, 95%CI: 1.50-2.58) and family history of hypertension (aRR=1.31, 95%CI: 1.04-1.63) were independent risk factors for metabolic syndrome. Conclusion: The follow up indicated that the incidence of metabolic syndrome was relatively high in rural adults on islands in Zhejiang, and women or those with family history of hypertension were more likely to have metabolic syndrome.

Oridonin Enhances the Anti-Metastasis Effect of Oxaliplatinliplatin on Colorectal Cancer Liver Metastasis

The anti-metastasis effect of oridonin in combination with oxaliplatin on colorectal cancer liver metastasis was studied using a BALB/c nude mouse model. The liver condition, bloody ascites, cholestasis, and liver metastasis scores in the three groups receiving oxaliplatin combined with oridonin were significantly milder than in the control group and importantly the anti-migratory effect of oxaliplatin combined with oridonin was obviously the strongest (p<0.05). Oridonin possessed no hepatotoxicity; instead, it effectively alleviated liver injury caused by oxaliplatin. Oridonin alone or in combination with oxaliplatin significantly decreased serum levels of α-fetoprotein and carcinoembryonic antigen. Therefore, oridonin combined with oxaliplatin displays great potential to markedly increase the anti-metastasis effect of oxaliplatin in the treatment of liver metastases of colorectal cancer.

[Identification of factors affecting Oncomelania hupensis density in Eastern Dongting Lake regions]

OBJECTIVE

To evaluate the impact of water pollutants, water levels and meteorological factors on the Oncomelania hupensis density in Eastern Dongting Lake regions, so as to provide insights into schistosomiasis control.

METHODS

O. hupensis snails were surveyed using a systematic sampling method in snail-infested marshlands in Eastern Dongting Lake regions from 2007 to 2014, and data pertaining to water pollutants, water levels and meteorological factors were collected. The duration of submergence and the date of the start of submergence were calculated. The snail density and its influencing factors were descriptively analyzed, and a linear mixed model was generated to examine the impacts of variables on the snail density. In addition, smooth curves were fitted to investigate the relationship between snail density and variables.

RESULTS

The snail density appeared a fluctuation in Eastern Dongting Lake regions during the period from 2007 to 2014, with the highest density on October, 2010 (52.79 snails/0.1 m²) and the lowest density on January 2009 (2.15 snails/0.1 m²). Linear mixed-model analysis showed that permanganate index, total phosphorus and the date of the start of submergence affected the snail density (t = 6.386, -2.920 and -3.892, all P values < 0.01). Smooth curve analysis revealed that the associations of the snail density with the permanganate index and total phosphorus appeared an approximately quadratic curve. After the end of April, the earlier date of the start of submergence resulted in a higher snail density.

CONCLUSIONS

Permenganate index, total phosphorus and the date of the start of submergence affect the O. hupensis snail density in Eastern Dongting Lake regions.

[Using Markov Chain Monte Carlo methods to estimate the age-specific case fatality rate of COVID-19]

Objectives: The COVID-19 epidemic has swept all over the world. Estimates of its case fatality rate were influenced by the existing confirmed cases and the time distribution of onset to death, and the conclusions were still unclear. This study was aimed to estimate the age-specific case fatality rate of COVID-19. Methods: Data on COVID-19 epidemic were collected from the National Health Commission and China CDC. The Gamma distribution was used to fit the time from onset to death. The Markov Chain Monte Carlo simulation was used to estimate age-specific case fatality rate. Results: The median time from onset to death of COVID-19 was M=13.77 (P(25)-P(75): 9.03-21.02) d. The overall case fatality rate of COVID-19 was 4.1% (95%CI: 3.7%-4.4%) and the age-specific case fatality rate were 0.1%, 0.4%, 0.4%, 0.4%,0.8%, 2.3%, 6.4%, 14.0 and 25.8% for 0-, 10-, 20-, 30-, 40-, 50-, 60-, 70- and ≥80 years group, respectively. Conclusions: The Markov Chain Monte Carlo simulation method adjusting censored is suitable for case fatality rate estimation during the epidemic of a new infectious disease. Early identification of the COVID-19 case fatality rate is helpful to the prevention and control of the epidemic.

[Progress of schistosomiasis control in Dongting Lake regions]

As an ancient parasitic disease, schistosomiasis has been endemic in Dongting Lake areas for more than 2 100 years. In the early 20th century, the first human case of schistosomiasis in China was reported in Dongting Lake areas, which was paid extensive attention. After the founding of the People's Republic of China, large-scale schistosomiasis control activities were launched promptly in Dongting Lake areas, and great successes have been achieved following the three stages of control efforts, including the snail control-based stage, synchronous chemotherapy for humans and livestock-based control stage and infectious source control-based control stage. In 2015, transmission control of schistosomiasis was achieved in Hunan Province. This paper comprehensively describes the discovery and control of schistosomiasis, analyzes the challenges for the current schistosomiasis control programs and proposes the emphasis for future control activities in Dongting Lake areas, so as to provide insights into the schistosomiasis control program in this area.

[Impact of water body environments on the microbial community of Oncomelania hupensis snails in marshlands around the eastern Dongting Lake]

OBJECTIVE

To evaluate the effects of water body environments on the microbial community of Oncomelania hupensis snails in marshlands of the eastern Dongting Lake where natural extinction of O. hupensis snails are found, so as to explore the correlation between the natural extinction of O. hupensis snails and the microbial community in snails.

METHODS

Snails were caged water bodies in the Qianliang Lake marshland (Qianliang Lake regions) where natural extinction of snails was found and in the Junshan Park marshland (Junshan Park regions) in the eastern Dongting Lake for 30 days, and then all snails were collected and identified for survival or death. DNA sequencing of the fungi and bacteria was performed in snails before and after immersion in waters, and the biodiversity and abundance were analyzed.

RESULTS

The survival rates of O. hupensis snails were 28.0% (70/250) and 64.8% (162/250) in Qianliang Lake regions and Junshan Park regions 30 days after immersion in waters, respectively (χ² = 81.365, P < 0.01). The number of the fungal community and the biodiversity of the bacterial community were both greater in snails caged in Qianliang Lake regions post-immersion than pre-immersion, and there was a significant difference in the structure of the fungal and bacterial communities. The microbial community with a significant difference included Flavobacteriaceae,which was harmful to O. hupensis snails.

CONCLUSIONS

The water body environment affects the composition of the microbial community in O. hupensis snails in marshlands with natural snail distinction around the eastern Dongting Lake; however, further studies are required to investigate whether the natural distinction of snails is caused by water body environments-induced changes of the microbial spectrum in O. hupensis snails.

Fungicide Sensitivity Monitoring of Alternaria spp. Causing Leaf Spot of Sugarbeet (Beta vulgaris) in the Upper Great Lakes

Alternaria leaf spot (ALS), caused by Alternaria spp., can occur wherever sugarbeet is grown. Infection by Alternaria spp. and disease management has historically been considered a minor issue in sugarbeet production in the United States. An increase of both incidence and severity in 2016 of ALS high enough to cause yield loss has been observed in Michigan. With a renewed need to consider potential management of this disease, the sensitivity was determined for populations of Alternaria spp. to three classes of fungicides currently labeled for management of leaf spot on sugarbeet, including demethylase inhibitor (DMI), quinone outside inhibitor (QoI), and organo-tin fungicides. Leaves with symptoms of ALS were sampled from sugarbeet fields in east-central Michigan and southwestern Ontario, Canada. Monoconidial isolates were obtained to determine sensitivity to each fungicide class above. A spiral gradient dilution method was used to estimate the fungicide effective concentration (in milligrams per liter) that caused a 50% inhibition of fungal growth in vitro for all isolates. Significant temporal shifts were detected in the frequencies of sensitivity phenotypes to DMI and QoI but not organo-tin fungicides from 2016 through 2017. Individual isolates of Alternaria spp. were recovered with cross-resistance to DMI and multiple resistance to DMI, QoI, and triphenyltin hydroxide fungicides. To our knowledge, this is the first report of a fungus other than Cercospora beticola with resistance to organo-tin fungicides. Fungicide sensitivity monitoring indicates that an effective integrated disease management approach combining fungicide efficacy trials and monitoring pathogen biology is essential for developing effective resistance management recommendations.

[A cohort study on the association between dynamics of thyroid volume and the changes of physical growth as well as the comparison of different thyroid volume indexes in school-aged children]

Objectives: To investigate the association between the dynamics of thyroid volume and the changes of physical growth in school-aged children as well as to compare the applicability of different thyroid volume indexes, so as to explore more reliable methods for the assessment of thyroid volume. Methods: In October 2012, a multi-stage cluster sampling method was used to select a primary school in Minhang district of Shanghai, Haimen city of Jiangsu province and Yuhuan city of Zhejiang province, respectively. In these areas, a total number of 784 students aged 8-10 years were enrolled in the cohort. Demographic data was collected, while height and weight were measured, with BMI and body surface area (BSA) were calculated. Thyroid volume was examined by B-ultrasonography. Height volume index (HVI), weight and height volume index (WHVI), BMI volume index (BMIV) and BSA volume index (BSAV) were all applied to correct the thyroid volume. All students were followed up, one year later. Results: A total of 769 students with complete data on thyroid volume and physical growth were enrolled, including 378 boys (49.16%) and 391 girls (50.84%). Thyroid volume showed an increase with age, while growth of thyroid volume reduced with the increase of age (P<0.001). The thyroid volume showed a correlation with the changes of physical growth. The growth of height appeared as the dominant influencing factor for thyroid volume growth in those aged 8 and 10 years (P<0.05), while the growth of weight, BMI and BSA were all influencing factors for thyroid volume on students aged 9 years (P<0.05). Conclusions: Thyroid volume in school-aged children was a factor not only associated with age but also with physical growth which had not been considered in the currently used criteria. The inclusion of items as iodine intake, age, physical growth into the thyroid volume indexes seemed to be more reliable, in practice. For the assessment of goiter, HVI for students aged 8 and 10 years and BMIV for students aged 9 years might serve as better indicators.

[Spatial-temporal analysis of enterovirus infection in Macao Special Administrative Region, China, 2011-2016]

Objective: To understand the spatial-temporal distribution of enterovirus infection in Macao Special Administrative Region, China, from 2011 to 2016. Methods: The incidence data of enterovirus infections in child care settings and primary schools in Macao during this period, which were confirmed by the Health Bureau, were used for the spatial-temporal analysis. Bernoulli model was used as probability model. Software SPSS 20.0 was used for descriptive statistics of the study cases, and software SaTScan 9.4.4 was used for spatial and temporal scanning. Finally, software Google Earth was used for visualization of geographical information. Results: A total of 330 enterovirus infection events were reported in Macao from 2011 to 2016. The infection event number was highest in 2014 (101, 30.6%), the infections mainly occurred during May to June. A case clustering area with a radius of 0.7 km (high rates) was observed in northeast of Macao from 2011 to 2013 (log likelihood rate=13.4, P<0.001, RR=1.4). Conclusion: The annual prevention of enterovirus infection and related health education should be started in February and March in Macao, and the key area is the northeast of Macao island.

[The colonoscopic characteristics of colorectal endometriosis: a single-centered retrospective study]

Objective: To reinforce the awareness of colorectal endometriosis (EM) in colonoscopy examination. Methods: Patients diagnosed as colorectal EM at Peking Union Medical College Hospital between February 2002 and February 2017 were enrolled in this study. The clinical characteristics and endoscopic features of EM lesions were summarized and compared between pathologically positive group and negative group. Results: A total of 34 cases were included with average age of (38.3±8.9) years old. All EM lesions located within rectum and sigmoid colon. The endoscopic lesions manifested as protrusion in 21 cases (61.8%) and protrusion-depression in 13 cases (38.2%), local stenosis in 8 cases (23.5%); erosive surface in 33 cases (97.1%) with local spontaneous hemorrhage in 4 cases (11.8%); nodal surface in 23 cases (67.6%), and lymphangiectasis base in 9 cases (26.4%). Endoscopic biopsy specimens were obtained in all cases with average 3 (2, 4) pieces. Positive results were found only in 4 patients (11.8%) with 3 endometriosis and one (endometrial) adenosarcoma. Compared with negative group, spontaneous hemorrhage was more frequent in positive group (2/4 vs. 2/30, P=0.013). Mean biopsy sample number was significantly larger in positive group (5 vs. 3, P=0.004). Conclusions: Colorectal endometriosis is mostly located within rectosigmoid region. Endoscopic features mainly include protrusion or protrusion-depression lesions with erosive and nodular surface, or local stenosis. Spontaneous hemorrhage under colonoscopy yields higher positive rate for biopsy, thus increasing biopsy sample numbers may improve pathology results.

[A 22-year-follow-up cohort study on primary liver cancer in Haimen city of Jiangsu province]

Objective: A prospective cohort study was carried out to assess the mortality and potential risk factors for primary liver cancer (PLC) in Haimen city of Jiangsu province. Methods: The cohort involved 89 789 adult residents aged 25-69 years. Upon the entry of this project, each subject was asked to complete a questionnaire and to provide a blood sample of 10 ml. Surface antigen of hepatitis B virus (HBsAg) was tested by radioimmunoassay. All the subjects were followed-up every year for vital statistics and death certificate information until 2014. Cox proportional hazard model was used to estimate the hazard ratio (HR) and 95% confidence interval (95%CI) for PLC mortality associated with HBsAg status and other risk factors. Results: During the 1 299 611 person-years of follow-up, a total of 2 583 PLC cases were identified, including 2 149 men and 434 women. Mortality of the PLC for men and women were 247.80/100 000 person-years and 100.38/100 000 person-years, respectively. Among those who died of PLC, 73.87% had been tested HBsAg positive. HBV infection seemed the predominant risk factor for PLC and the HRs were 15.97 for men (95%CI: 14.29-17.85) and 21.63 for women (95%CI: 16.16-28.96) respectively. Ageing, cigarette smoking, previous history of hepatitis, and family history of HCC were factors associated with the increased risk for PLC. Conclusion: People living in Haimen city had a high risk on PLC. HBV infection appeared the most important risk factor for HCC mortality in this area.

[Evolutionary characteristics and positive selection site of hepatitis C virus isolated in intravenous drug users in Pudong new district, Shanghai]

Objective: To understand the genotypes of hepatitis C virus (HCV) circulating in intravenous drug users (IDUs) in Pudong new district, Shanghai, and explore the population growth and selection pressure of the HCV strains isolated. Methods: A total of 200 serum specimens sampled from IDUs in local methadone maintenance treatment clinic in Pudong were used for amplification of a HCV NS5B 377-nt partial sequence. Mean evolutionary rate and effective number of infections were estimated based on the 377-nt partial sequences of the HCV strains isolated from IDUs and isolated contemporarily from local voluntary blood donors, men who have sex with men and reported hepatitis C cases by using BEAST software. Selection pressure sites were identified with online Datamonkey software for subsequent comparison with direct-acting antiviral (DAA) drug binding sites. Results: A total of 39 (19.5%) serum specimens were positive for HCV RNA. The genotypes were determined based on the HCV NS5B 377-nt partial sequences as follows: subtype 3a (n=14), 3b (n=13), 1b (n=7), 6a (n=4) and 6n (n=1). The partial sequences of the HCV strains isolated in IDUs shared high homology with the sequences of the HCV strains isolated in other populations. The Bayesian Skyline Plot indicated that the estimated infections with HCV subtype 1b increased exponentially during the 1990s, whereas that of subtypes 3a and 3b increased slowly since the mid-1990s. In the NS5B 377-nt partial sequences of the HCV strains isolated in IDUs, there were two positive selection sites and seventy-eight negative selection sites recognized. The mutation rate was as low as 2.2% in the 377-nt partial sequences corresponding to the known seven DAA drug binding sites. Conclusions: HCV subtype 3a and 3b were the predominant genotypes in the IDUs in Pudong. Subtype 1b was prevalent in different populations and evolved very rapidly, and more infections might be caused, suggesting further attention to its prevention, control and treatment. Although DAA treatment based on HCV NS5B binding sites targeting local IDUs might be effective, it is still necessary to strengthen the surveillance.

[Impact of HIV/HBV infection and HIV/HBV co-infection on outcomes of pregnancy]

Both HIV and HBV infection have become major health problems, of global concern, due to the high prevalence in the past few decades. Data from cumulated epidemiological surveys have shown the links between maternal HIV or HBV infection and adverse outcomes on pregnancy. Maternal HIV or HBV infection may also increase the mother-to-child (MTCT) transmission of the two diseases. However, association between HIV-HBV co-infection and adverse pregnancy is still inconclusive. Does maternal HIV-HBV co-infection have an impact on mother-to-child transmission on either HIV or HBV? Study on effective precautionary measures to promote both maternal and child's health is deemed necessary.

[An analysis of clinical characteristics of twelve cases of mesenteric panniculitis]

Objective: Mesenteric panniculitis is an idiopathic, uncommon disease involving the adipose tissue of mesentery. The etiology, diagnosis and treatment are still unnoticed. We thus reported a case series to improve the understanding of this rare disorder. Methods: We retrospectively analyzed the clinical data of 12 patients with mesenteric panniculitis including manifestation, diagnosis, treatment and prognosis. Results: We found a male predominance (M∶F 3∶1) with the median age of 58 years old at diagnosis. The most common symptom was abdominal pain (9/12), followed by abdominal distension (3/12) and weight loss (3/12). Physical examination was unremarkable in the majority of patients (8/12). C reactive protein (9/12) and erythrocyte sedimentation rate (10/12) were normal in majority of patients. CT findings were of much diagnostic value. All patients had small intestinal mesentery involvement and multi-nodular appearance with increased fat density. Pseudo-capsule sign (8/12) and fat halo sign (6/12) were common. Pathological diagnosis was obtained in 4 cases showing fat tissue inflammation with local necrosis and fibrosis. Six cases all received prednisone, 2 with combined cyclophosphamide, 1 with azathioprine, 1 with tripterygium wilfordii. Short-term clinical response was achieved in all cases, but two patients relapsed. Conclusions: Mesenteric panniculitis occurs predominantly in middle-aged and elderly. Abdominal pain is the leading symptom. Inflammatory markers are often normal while computed tomography is the most important diagnostic tool. Surgery combined with cortical steroid and immunosuppressant agents is effective.

[Infestation status Aedes albopictus and related mosquito-borne infectious disease risk in central urban area in Shanghai]

OBJECTIVE

To evaluate Aedes albopictus infestation status in the central urban area of Shanghai, and analyze the related epidemic risk of mosquito-borne infectious disease.

METHODS

Consecutive mosquito surveillance was conducted in the green lands and residential areas in the central urban area of Shanghai during 2012-2014, the Aedes albopictus density and its seasonal fluctuation were observed; the sequence of Aedes albopictus in Shanghai was aligned with that in other epidemic area abroad, and the susceptibility of Aedes albopictus to mosquito-borne virus and endemic risk were analyzed.

RESULTS

No Aedes aegypti was found in the central urban area of Shanghai. As predominant species in both the residential area and the green lands, the proportion of Aedes albopictus in the residential area was significantly higher than that in the green lands(78.53% vs. 19.99%, χ(2) =15 525.168, P<0.001), and so was the density(11.91, 42.02 pcs/day · site in the residential area vs. 3.65, 2.18, 2.73 pcs/day · site in the green lands, all P value <0.001). In 2014, the density reached 42.02 pcs/day · site and the proportion reached 94.69% in the residential areas. Phylogenetic tree analysis showed that the genetic distance between Aedes albopictus in Shanghai and Aedes albopictus in Africa was quite far.

CONCLUSION

No Aedes aegypti was found in Shanghai and its surrounding areas, while Aedes albopictus infestation in the central urban area of Shanghai was serious. Strict measures should be taken to reduce the Aedes albopictus density for the effective control Zika virus spread.

Integrated Control Strategy of Schistosomiasis in The People's Republic of China: Projects Involving Agriculture, Water Conservancy, Forestry, Sanitation and Environmental Modification

Among the three major schistosome species infecting human beings, Schistosoma japonicum is the only endemic species in The People's Republic of China. Schistosomiasis is endemic in 78 countries and regions and poses a severe threat to public health and socioeconomic development. Through more than 60years of hard work and endeavour, The People's Republic of China has made considerable achievements and reduced the morbidity and prevalence of this disease to the lowest level ever recorded, especially since the introduction of the new integrated control strategy in 2004. This review illustrates the strategies implemented by giving successful examples of schistosomiasis control from the different types of remaining endemic areas. The challenge to control or eliminate S. japonicum is analysed in order to provide useful information to policy makers and scientists.

Use of PCR-RFLP Analysis to Monitor Fungicide Resistance in Cercospora beticola Populations from Sugarbeet (Beta vulgaris) in Michigan, United States

Genetic resistance to Quinone outside inhibitor (QoI) and benzimidazole fungicides may be responsible for a recent decline in efficacy of chemical control management strategies for Cercospora leaf spot (CLS) caused by Cercospora beticola in Michigan sugarbeet (Beta vulgaris) fields. The target genes and fungicide resistance mutations are known for these two fungicides. Based on this, two standard polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) assays were developed to detect the G143A and E198A point mutations in the fungal mitochondrial cytochrome b and the β-tubulin genes, respectively. These mutations confer a high level of resistance to either QoI or benzimidazole fungicides. The presence of the G143A and E198A mutations was monitored within C. beticola populations recovered from Michigan sugarbeet production fields collected in 2012. Both the QoI-resistant cytochrome b allele and the benzimidazole-resistant β-tubulin allele were detected directly from leaf tissue following a PCR-RFLP assay. Using either detection assay, the G143A and E198A mutations were detected in over 90% of the 118 field samples originating from Michigan sugarbeet production under fungicide management programs for CLS control. Monitoring of the G143A and E198A mutations in fields located in 9 counties and 58 townships indicated that the mutations were widespread in Michigan sugarbeet production areas. The PCR-based assays used and developed in this study were effective in detecting the presence of the G143A and E198A mutations in C. beticola field populations from Michigan.

Duration of viraemia in Chinese acute sporadic hepatitis E

Acute sporadic hepatitis E (ASHE) cases induced by hepatitis E virus genotype 4 (HEV-4) are increasing in China. Our study aimed to estimate the duration of HEV-4 viraemia in Chinese ASHE. A total of 619 serum specimens from 499 ASHE patients were examined for the presence of HEV RNA. The association between viraemia detection and serum sampling time was compared between subtypes. The cumulative probability of HEV viraemia detection was determined using Kaplan-Meier survival analysis, and the viraemia duration was estimated. A total of 42.7 % of serum specimens were positive for HEV RNA and all the isolated strains were identified as genotype 4 and subsequently assigned to five subtypes. Among the patients infected with subtypes 4d and 4i, the time interval from the initiation of clinical symptoms to serum specimen sampling was shorter than that among the patients with subtypes 4a, 4b and 4h. Kaplan-Meier analysis was conducted with 101 sequential specimens as well as with both 101 sequential specimens and 236 single negative specimens. The cumulative probability of HEV-4 viraemia detection was estimated to decline quickly to approximately 10 % within 32 days after the initiation of clinical symptoms and then to decline very slowly to 5 % by the 41st day and to zero by the 131st day. The majority of ASHE cases maintain detectable HEV-4 viraemia within one month after onset, whereas a small portion of cases maintain long-term viraemia and may act as a reservoir for further transmission.

First Report of QoI Insensitive Cercospora beticola on Sugar Beet in Ontario, Canada

Cercospora beticola Sacc. causes Cercospora leaf spot (CLS) of sugar beet (Beta vulgaris L.) and is the most destructive foliar disease of sugar beet worldwide (1). The QoI fungicide pyraclostrobin has been an important management tool for CLS in Canada since 2003. Beginning in 2010, some growers reported poor disease control after applying pyraclostrobin. Leaf disk samples with CLS lesions were collected in September 2012 from 16 commercial fields located in Kent and Lambton Counties, Ontario, Canada. These counties (ca. 300,000 ha) encompass the major commercial sugar beet production area in Ontario (ca. 3,925 ha). CLS severity ranged from low to severe among the sampling sites. Leaf discs with a single leaf spot were cut from leaves using a hole punch. Spots were up to 5 mm in diameter with tan, light brown, or sometimes gray centers. DNA was extracted from leaf discs using a Qiagen DNeasy Plant Mini Kit (Germantown, MD) according to the manufacturer's instructions. PCR was used to amplify a fragment of the C. beticola cytochrome b (CYTB) gene (4). Pure cultures were obtained by placing plant tissue in a moist chamber and transferring single spores to V8 juice agar. PCR products were sequenced for 32 samples at the Genomics Technology Support Facility (Michigan State University, East Lansing, MI) and 25 were confirmed to have 100% identity with the sequence of QoI-resistant C. beticola from Michigan (2) and to QoI-resistant isolates from GenBank (Accession Nos. JQ619933 and JQ360628). The remaining seven had 100% identity with a sensitive isolate (EF176921.1). Each resistant isolate contained a change in codon 143 that is predicted to lead to a substitution of G143A in the cytochrome b gene. This G143A mutation has been associated with QoI resistance in a number of fungi (3). To confirm the result, a conidium germination bioassay was carried out using nine isolates with the G143A mutation on sugar beet leaf agar covered with water agar amended with pyraclostrobin at concentrations ranging from 0 to 54.3 μg/ml and distributed on a spiral gradient using an Eddyjet II spiral plater. The medium was supplemented with salicylhydroxamic acid (SHAM) to block the alternate oxidation pathway. Following incubation at 25°C for 2 days, the distance between the center of the plate at which conidial germination was 50% of the maximum observed growth (EC) and the point at which conidial germination terminated were measured (TEC). The EC₅₀ values were determined from the SGE software for each isolate by entering the EC and TEC values, respectively. The estimated EC₅₀ for a representative wild type (sensitive) isolate was 0.03 μg/ml, while the value for the resistant isolate could not be calculated because it was greater than the highest concentration tested (54.3 μg/ml). Additionally, in the controls with no SHAM or fungicide, the resistant isolate showed a consistent reduced germination rate compared to the sensitive isolate (30.0% and 93.5% germination, respectively). Confirmation of fungicide insensitivity will require a re-evaluation of current management practices in Ontario to minimize economic losses due to CLS. References: (1) B. J. Jacobsen and G. D. Franc. Compendium of Beet Diseases and Pests, 2nd ed, APS Press, St. Paul, MN, 2009. (2) W. Kirk et al. New Dis. Rep. 26:3, 2012. (3) Z. Ma and T. J. Michailides. Crop Prot. 24:853, 2005. (4) A. Malandrakis et al. Pestic. Biochem. Physiol. 100:87092, 2011.

Antibody responses to lytic and latent human herpesvirus 8 antigens among HIV-infected patients in central China

Human herpesvirus 8 (HHV8) is an important opportunistic infection of HIV/AIDS. However, very little is known about antibody seropositivities to HHV8 lytic and latent antigens among HIV-infected patients in China. Therefore, a cross-sectional study was conducted to explore HHV8 serostatus among 316 HIV-infected patients in a rural area of central China. The antibody seropositivity to HHV8 ORF65 (lytic) and LANA (latent) antigens was 12.7% and 10.4%, respectively. Patients who were naïve to antiretroviral therapy (ART) were more likely to be seropositive for antibodies to ORF65 (OR: 3.79; 95% CI: 1.71-8.42) and LANA (OR: 3.77; 95% CI: 1.55-9.14) than patients receiving ART. Patients having CD4+ cell counts less than 200 cells/mm3 were more likely to be seropositive for LANA antibody (OR: 3.53; 95% CI: 1.44-8.64) and to have lower LANA antibody titer (p = 0.007). They were also more likely to be seropositive for ORF65 antibody (OR: 2.12; 95% CI: 0.94-4.78) and to have a lower ORF65 antibody titer (p = 0.065), though the difference was marginally significant. No associations between other viral coinfections studied and antibody seropositivity to either latent or lytic HHV8 antigens were identified. Study findings suggest that antibody responses to both lytic and latent HHV8 antigens among HIV patients in China were fairly high and were associated with immunodeficiency status and ART.

The Chinese physicians' CardiovAscular Risk Evaluation (CARE) survey: an assessment of physicians' own cardiovascular risks

OBJECTIVE

To estimate the 10-year risk of cardiovascular disease (CVD)/coronary heart disease (CHD) in physicians using two models (the Chinese and Framingham models).

METHODS

This was a multicentre, cross-sectional survey, which recruited cardiovascular physicians from 386 medical centres in all 31 provinces and municipalities in China. Cardiovascular risk factors such as body mass index, blood pressure and cholesterol were recorded during enrolment. Control rates (%) of hypertension, hypercholesterolaemia and diabetes were defined according to guidelines. Participants aged ≥35 years completed the Framingham model and participants aged ≤59 years completed the Chinese prediction model.

RESULTS

A total of 820 (41.5%) women and 1598 (78.7%) men had ≥1 markedly raised CVD risk factors. The Chinese prediction model showed that 22 (1.2%) women and 143 (7.6%) men had a 10-year risk of ischaemic CVD ≥5%, and an above-average level of 10-year ischaemic CVD risk factors was found in 20.6% of women and in 54.6% of men. When the Framingham model was used, 268 (13.6%) women and 724 (35.7%) men had a 10-year absolute risk of CHD ≥5%. Hypertension, diabetes and hypercholesterolaemia were only controlled in 58.2%, 46.6% and 38.5% of participants, respectively. Only 30.3% of physicians with a 10-year risk of CHD ≥10% were using aspirin.

CONCLUSIONS

The results show suboptimal awareness in physicians of their own cardiovascular risks, and low use of prophylactic agents. Improvement of physicians' risk factors in will improve their ability to act as role models in the promotion of primary and secondary prevention initiatives.

Generalized negative binomial distribution: a promising statistical distribution for Oncomelania hupensis in the lake- and marsh-land regions of China

A new generalization of the negative binomial distribution (GNBD) is introduced and fitted to counts of Oncomelania hupensis, the intermediate host of Schistosoma japonicum, made, in areas of Chinese lakeland and marshland, early in the winter of 2005 and late in the spring of 2006. The GNBD was found to fit the snail data better than the standard negative binomial distribution (NBD) that has previously been widely used to model the distribution of O. hupensis. With two more parameters than the NBD, the GNBD can integrate many discrete distributions and is more flexible than the NBD in modelling O. hupensis. It also provides a better theoretical distribution for the quantitative study of O. hupensis, especially in building an accurate prediction model of snail density. The justification for adopting the GNBD is discussed. The GNBD allows researchers to broaden the field in the quantitative study not only of O. hupensis and schistosomiasis japonica but also of other environment-related helminthiases and family-clustered diseases that have, traditionally, been modelled using the NBD.

Polymorphisms of 5,10-methylenetetralydrofolate reductase (MTHFR), fruit and vegetable intake, and the risk of stomach cancer

Stomach cancer is a serious public health problem in China. 5,10-Methylenetetralydrofolate reductase (MTHFR) may be involved in both DNA methylation and DNA synthesis. Folate deficiency is associated with cancer risk that may be modulated by a genetic variation in the MTHFR gene in folate metabolism. The main goal of this study was to evaluate the association between polymorphisms of the MTHFR gene and the risk of stomach cancer. This study also explored the modification effects of fruit and vegetable intake (one of the main constituents is folate) on the risk of this disease. A population-based case-control study was conducted in Taixing, China, consisting of 206 newly diagnosed cases with primary stomach cancer and 415 healthy population controls. Polymorphisms of MTHFR C677T and A1298C were assayed by polymerase chain reaction-restricted fragment length polymorphism (PCR-RFLP) techniques. The data were analysed using the logistic regression model. No obvious association between the MTHFR A1298C polymorphism and the risk of stomach cancer was observed in this study. The frequencies of 677 C/C, C/T, and T/T were 34.5, 50.9, and 14.6%, respectively, in controls. The frequency of the MTHFR 677 wild homozygotic genotype was 25.8% in cases, which was lower than that in controls (34.5%). The adjusted odds ratio (OR) for the MTHFR 677 any T genotype was 2.05 (95% confidence interval (CI), 1.26-3.34) when compared with the C/C genotype. In the low fruit and vegetable intake group an increasing trend was observed with the T allele exposure, p = 0.0056. The adjusted ORs were 1.68 (95% CI = 0.86-3.29) for the C/T genotype and 3.58 (95% CI = 1.46-8.75) for the T/T genotype, respectively. The MTHFR 677 any T genotype was associated with an increased risk of primary stomach cancer among the Chinese population. Folate deficiency might modify the MTHFR gene polymorphism and influence the risk of stomach cancer.

Pathways from first health care seeking to diagnosis: obstacles to tuberculosis care in rural China

OBJECTIVE

To examine health care seeking pathways for patients with tuberculosis (TB) and barriers related to these pathways in counties under the National TB Control Programme in rural China.

METHODS

A cross-sectional study was conducted in two counties of east China in 2004-2005. A total of 557 TB patients were recruited and interviewed by physicians at the time of TB diagnosis.

RESULTS

Of 557 participants, 13.3% had presented to a specialised county TB dispensary (CTD) directly after onset of symptoms, 31.4% had first sought care at a village health station and 51.2% had visited a township or county hospital first. The proportion of referral by a first health care provider to a CTD was highest in county level hospitals (73.5%) and lowest in village health stations (21.7%). The most prompt pathway from first health care seeking to TB diagnosis was to visit a CTD directly, with a median provider's delay of only one day. There was an increase in provider's delay when more health facilities were involved.

CONCLUSION

To improve direct referral from general health care providers, especially village health care workers, to TB specialists would significantly shorten the delays in TB diagnosis in rural China.

Comparison of the Kato-Katz technique, hatching test and indirect hemagglutination assay (IHA) for the diagnosis of Schistosoma japonicum infection in China

The Kato-Katz technique (duplicate 41.7 mg fecal smears), hatching test and indirect hemagglutination assay (IHA) were compared for their ability to detect human Schistosoma japonicum infection in two endemic villages (Zhonjiang and Zhuxi) in rural China. The hatching test (using a nylon bag, and based on about 30 g of feces) and IHA are conventional Chinese diagnostic methods. In both villages, the trends of prevalences with age and sex were comparable for the different methods. In Zhuxi, Kato-Katz examinations of stools from 7 different days and hatching were available, which could be used as a reliable gold standard. This resulted for IHA in a sensitivity of 80% and a specificity of 48%. The sensitivity of the Kato-Katz technique using one stool specimen was 68%, twice that of hatching (33%). In Zhonjiang, however, hatching resulted in more positive cases than Kato-Katz (prevalence 31% vs. 24%). Apparently, the result of the hatching test depends on environmental factors such as temperature and water quality. Although imperfect, Kato-Katz is recommended out of the three evaluated techniques as the method of choice for large-scale screening of S. japonicum. Hatching is much more tedious, provides inconsistent and only qualitative results, and is not much more sensitive than Kato-Katz. Its poor specificity makes IHA unsuitable for individual screening, but it may be more effective for community diagnosis.

Diagnostic delays in access to tuberculosis care in counties with or without the National Tuberculosis Control Programme in rural China

SETTING

A county covered by the National Tuberculosis Control Programme (NTP) (Jianhu) and a nonprogramme county (Funing) in Jiangsu Province, China.

OBJECTIVE

To compare diagnostic delays among tuberculosis (TB) patients between counties with and without the NTP, and to study the impact of demographic, socioeconomic and policy factors on the delays.

DESIGN

A cohort study of 493 newly diagnosed TB patients registered in the study sites during 2002 was conducted using a structured questionnaire interview.

RESULT

The median total diagnostic delay was longer in Jianhu County, 31 (14-68) days, compared to Funing County, 19 (12-34) days, with a shorter patient's delay (10 vs. 16 days, P < 0.05) but a longer doctor's delay (6 vs. 0 days, P < 0.01) in Jianhu than in Funing. Smear-positive TB accounted for 86% of patients in Jianhu, compared to 37% in Funing. Less educated and uninsured patients had longer patient's or doctor's delays in Jianhu, while in Funing poor patients and farmers had both longer patient's and doctor's delays.

CONCLUSION

The subsidised NTP leads to a shorter patient's delay, but a longer doctor's delay, with a substantially higher proportion of smear-positive TB diagnosis. Education, medical insurance, poverty and the system of TB control can influence patients' access to TB care.

Perceptions and experiences of health care seeking and access to TB care--a qualitative study in rural Jiangsu Province, China

This study aims to obtain an in-depth understanding of factors that influence the health seeking behavior of TB patients, and access to tuberculosis (TB) care in counties with or without National TB Control Program (NTP) in rural China. Sixteen focus group discussions (FGDs) composed of TB patients and health care providers were held. Content analysis showed perceptions that financial difficulties influence health care-seeking behavior of TB patients in both program and non-program counties. Female and elderly patients were perceived to be more reluctant to seek health care and to seek care for cough from village health stations rather than general hospitals. Many TB patients said they could not afford the cost of TB care, even where services were subsidized. Fee-for-service incentives of health care providers and their ability to make a correct TB diagnosis were also perceived to influence patient access to TB care. Inappropriate treatment of cough patients was perceived to increase the risk of missing smear-positive diagnoses.

[Studies on risk factors for liver fibrosis of schistosomiasis japonica]

OBJECTIVE

To explore the risk factors for schistosomal liver fibrosis.

METHODS

192 hepatitis-negative patients with schistosomiasis were selected and divided into 3 groups according to the result of B ultrasound examination, that is, grade 2 and 3 fibrosis group(81 patients), grade 1 fibrosis group (61 patients) and control group (non-fibrosis, 50 patiets). The univariate and multivariate ordinal regression model was made to analyse the possibly harmful factors influencing the liver damages of these patients.

RESULTS

Four factors were found to be positively associated with schistosomal liver fibrosis. They were: number of treatments of schistosomiasis (OR = 1.75), interval of schistosomal infection(OR = 1.40), history of drinking wine (OR = 1.95) and familial history of advanced schistosomiasis (OR = 2.11).

CONCLUSION

Patients with repeated schistosome infection, long duration of schistosomal infection, long history of drinking and familial history of advanced schistosomiasis had higher risk for liver fibrosis than schistosomiasis patients without these factors.

Comparison of the therapeutic efficacy and side effects of a single dose of levo-praziquantel with mixed isomer praziquantel in 278 cases of schistosomiasis japonica

A randomized double-blind study comparing the therapeutic efficacy of single dose of levo-praziquantel and mixed isomer praziquantel was carried out on 139 matched pairs of patients with schistosomiasis japonica. A single dose of either levo-praziquantel (20 mg/kg) or praziquantel (40 mg/kg) was given to each patient. Four and six months after treatment, the stool ova negative conversion rates were 94.85% and 96.27% for the levo-praziquantel group, and 97.06% and 94.03% for the praziquantel group, respectively; there was no statistically significant difference between the two treatments (P greater than 0.05). For lightly and moderately infected patients, a single 20 mg/kg dose of levo-praziquantel was as efficacious as 40 mg/kg of praziquantel. Moreover, levo-praziquantel produced fewer side effects than praziquantel. These results suggest that levo-praziquantel is the component of the mixed isomer preparation that is antihelminthic. Levo-praziquantel could be used therapeutically at half the current dose of the mixed isomer drug.