Ergonomic Consideration in Pillow Height Determinants and Evaluation.

(1) Background: Sleep problems have become one of the current serious public health issues. Pillow height affects the alignment of the cervical spine and is closely related to the mechanical environment of the cervical spine. An appropriate pillow height can provide adequate support for the head and neck to reduce the stress in the cervical spine and relax the muscles of the neck and shoulder, thereby relieving pain and improving sleep quality. (2) Methods: We reviewed the current trends, research methodologies, and determinants of pillow height evaluation, summarizing the evidences published since 1997. In particular, we scrutinized articles dealing with the physiological and mechanical characteristics of the head-neck-shoulder complex. (3) Results: Through the investigation and analysis of these articles, we presented several quantitative and objective determinants for pillow height evaluation, including cervical spine alignment, body dimension, contact pressure, and muscle activity. The measurement methods and selection criteria for these parameters are described in detail. However, the suggested range for achieving optimal cervical spine alignment, appropriate pressure distribution, and minimal muscle activity during sleep cannot yet be identified considering the lack of sufficient evidence. Moreover, there remain no firm conclusions about the optimal pillow height for the supine and lateral positions. (4) Conclusions: A comprehensive evaluation combining the above determinants provides a unique solution for ergonomic pillow design and proper pillow height selection, which can effectively promote the public sleep health. Therefore, it is necessary to develop a reasonable algorithm to weigh multiple determinants.

Identification of the high-risk area for schistosomiasis transmission in China based on information value and machine learning: a newly data-driven modeling attempt.

BACKGROUND: Schistosomiasis control is striving forward to transmission interruption and even elimination, evidence-lead control is of vital importance to eliminate the hidden dangers of schistosomiasis. This study attempts to identify high risk areas of schistosomiasis in China by using information value and machine learning. METHODS: The local case distribution from schistosomiasis surveillance data in China between 2005 and 2019 was assessed based on 19 variables including climate, geography, and social economy. Seven models were built in three categories including information value (IV), three machine learning models [logistic regression (LR), random forest (RF), generalized boosted model (GBM)], and three coupled models (IV + LR, IV + RF, IV + GBM). Accuracy, area under the curve (AUC), and F1-score were used to evaluate the prediction performance of the models. The optimal model was selected to predict the risk distribution for schistosomiasis. RESULTS: There is a more prone to schistosomiasis epidemic provided that paddy fields, grasslands, less than 2.5 km from the waterway, annual average temperature of 11.5-19.0 °C, annual average rainfall of 1000-1550 mm. IV + GBM had the highest prediction effect (accuracy = 0.878, AUC = 0.902, F1 = 0.920) compared with the other six models. The results of IV + GBM showed that the risk areas are mainly distributed in the coastal regions of the middle and lower reaches of the Yangtze River, the Poyang Lake region, and the Dongting Lake region. High-risk areas are primarily distributed in eastern Changde, western Yueyang, northeastern Yiyang, middle Changsha of Hunan province; southern Jiujiang, northern Nanchang, northeastern Shangrao, eastern Yichun in Jiangxi province; southern Jingzhou, southern Xiantao, middle Wuhan in Hubei province; southern Anqing, northwestern Guichi, eastern Wuhu in Anhui province; middle Meishan, northern Leshan, and the middle of Liangshan in Sichuan province. CONCLUSIONS: The risk of schistosomiasis transmission in China still exists, with high-risk areas relatively concentrated in the coastal regions of the middle and lower reaches of the Yangtze River. Coupled models of IV and machine learning provide for effective analysis and prediction, forming a scientific basis for evidence-lead surveillance and control.

A framework for assessing local transmission risk of imported malaria cases.

BACKGROUND: A key issue in achieving and sustaining malaria elimination is the need to prevent local transmission arising from imported cases of malaria. The likelihood of this occurring depends on a range of local factors, and these can be used to allocate resources to contain transmission. Therefore, a risk assessment and management strategy is required to identify risk indexes for malaria transmission when imported cases occur. These risks also need to be quantified and combined to give a weighted risk index score. This can then be used to allocate the resources to each administrative region to prevent transmission according to the degree of risk. METHODS: A list of potential risk indexes were generated from a literature review, expert consultation and panel discussion. These were initially classified into 4 first-level indexes including infection source, transmitting conditions, population vulnerability and control capacity. Each of these was then expanded into more detailed second-level indexes. The Delphi method was then used to obtain expert opinion to review and revise these risk indexes over two consecutive rounds to quantify agreement among experts as to their level of importance. Risk indexes were included in the final Transmission Risk Framework if they achieved a weighted importance score ≥ 4. The Analytic Hierarchy Process was then used to calculate the weight allocated to each of the final risk indexes. This was then used to create an assessment framework that can be used to evaluate local transmission risk in different areas. RESULTS: Two rounds of Delphi consultation were conducted. Twenty-three experts were used at each round with 100% recovery rate of participant questionnaires. The coordination coefficients (W) for the two rounds of Delphi consultation were 0.341 and 0.423, respectively (P < 0.05). Three first-level indexes and 13 second-level indexes were identified. The Analytic Hierarchy Process was performed to calculate the weight of the indexes. For the first-level indexes, infection source, transmitting conditions, and control capacity, the index weight was 0.5396, 0.2970 and 0.1634 respectively. For the three top second-level indexes, number of imported malaria cases, Anopheles species, and awareness of timely medical visit of patient, the index weight was 0.3382, 0.2475, and 0.1509 respectively. CONCLUSIONS: An indexed system of transmission risk assessment for imported malaria was established using the Delphi method and the Analytic Hierarchy Process. This was assessed to be an objective and practical tool for assessing transmission risk from imported cases of malaria into China.

[A retrospective analysis on the diagnosis and reporting of imported malaria in Jiangxi Province during 2012-2015].

Objective: To provide scientific basis for malaria surveillance in the elimination phase by retrospectively analyzing the diagnosis and reporting of imported malaria in Jiangxi Province. Methods: Data on malaria endemic situation and individual cases during 2012-2015 were collected through the National Information Management System for Infectious Diseases and the Report and Information Management System for Parasitic Diseases Control and Prevention. Detailed information on primary medical units, laboratory testing units, reporting units, diagnostic methods, time from onset to first medical visit, time from first medical visit to reporting, and time from onset to reporting was analyzed with the descriptive analysis method. Results: A total of 207 malaria cases were reported during 2012-2015 in Jiangxi, all were imported cases and 96.62%(200/207) were diagnosed with laboratory tests. The main primary medical units were found to be county-level (29.95%, 62/207) and prefecture-level (25.60%, 53/207) medical institutions, while the main laboratory testing units were prefecture-level medical institutions(35.27%,73/207) and county-level CDCs (20.29%, 42/207). There was a significant difference in the proportion of different laboratory testing units among the years(P < 0.05). The median time from onset to first medical visit was 1 d (0-149 d), from first medical visit to reporting was 3 d (0-144 d), and from onset to reporting was 5 d (0-149 d). Conclusions: The first visit and the laboratory testing of malaria cases mainly occur in the prefecture-level and county-level medical institutions.

[Research Progress on Risk Assessment of Secondary Transmission of Imported Malaria].

In 2015, WHO issued the Global Technical Strategy for Malaria 2016-2030, which sets the target of reducing global malaria incidence and mortality rates by at least 90% by 2030. Although many countries have successfully achieved malaria elimination, they are facing the risk of imported malaria. In China, despite the acceleration of malaria elimination, imported malaria has become a potential threat to achieving complete malaria elimination. This paper reviews the worldwide research progress on risk assessment of secondary transmission of imported malaria, in the aim of providing reference for risk assessment of imported malaria and preventing secondary transmission in China.

[Cellular immunity induced by H.pylori vaccine with chitosan as adjuvant].

AIM: To study the cellular immunity induced by H.pylori vaccine with chitosan as adjuvant and the mechanism of immunological protection. METHODS: BALB/c mice were randomly divided into nine groups and immunized by (1)PBS alone, (2)chitosan solution alone, (3)chitosan particles alone, (4)H.pylori antigen alone, (5)H.pylori antigen plus chitosan solution, (6)H.pylori antigen plus chitosan particles, (7)H.pylori antigen plus cholera toxin (CT), (8)H.pylori antigen plus chitosan solution and CT, (9)H.pylori antigen plus chitosan particles and CT orally respectively once a week for four weeks. At 4 weeks after the last immunization, mice were challenged by alive H.pylori (1x10(9) CFU/mL) twice at two days intervals. Before and after the challenge, mice were killed in batches and the H.pylori-infection in gastric mucosa was detected by H.pylori culture and Giemsa stain. ELISA and HE stain were used to detect IL-2, IL-4, IL-10 levels and pathologic change in gastric mucosa. RESULTS: (1)In the groups with chitosan as an adjuvant, 60% mice could achieve immunological protection, which was consistent with using CT as an adjuvant (58.33%), and was more than that when using H.pylori antigen alone or without H.pylori antigen. (2)After challenge, the IL-2 levels in gastric mucosa in the groups with adjuvants were significantly higher than those in the control group (P<0.001-0.05). Moreover, IL-2 levels in the groups with adjuvants after challenge were significantly higher than those before challenge (P<0.05). Before challenge, the IL-10 and IL-4 levels in gastric mucosa were significantly higher in the groups with chitosan as adjuvant than those in non-adjuvant groups (P<0.05). After challenge, IL-10 levels were significantly higher in the groups with chitosan particles as adjuvant than those in other groups (P<0.05); IL-4 levels were significantly higher in the groups with chitosan particles as an adjuvant than those in the group with CT as an adjuvant, and those in the group with chitosan solution as an adjuvant were significantly higher than those in control group, non-adjuvant group and the groups with CT (P<0.05). IL-10 and IL-4 in the groups with adjuvants after challenge were significantly lower than those before challenge (P<0.05). (3)The degree of inflammation in gastric mucosa was significantly lower in the groups with chitosan and chitosan particles as adjuvant than those with CT as adjuvant(P<0.05). CONCLUSION: (1)H.pylori vaccine with chitosan as an adjuvant has the immune protective effect against H.pylori infection. (2)H.pylori vaccine with chitosan as an adjuvant could reverse the inhibition of Th2 induced by H.pylori infection and recover the Th1/Th2 imbalance, which might contribute to the immune protection against H.pylori. (3)The rate of gastritis induced by H.pylori vaccine with chitosan as adjuvant was significantly lower than those with CT as adjuvant.

[Anti-Helicobacter pylori effect and regulation of T helper response of chitosan].

OBJECTIVE: To study the anti-Helicobacter pylori (Hp) effect and the regulation of T helper (Th) response of chitosan. METHODS: Hp infected grade one female BALB/c mice model was established by inoculating Hp Sydney strain 1 and the mice were randomly divided into eight groups and administrated with (1) Arabia glue solution (control group), (2) omeprazole, (3) amoxicillin, (4) amoxicillin plus omeprazole, (5) chitosan, (6) chitosan plus omeprazole, (7) chitosan plus amoxicillin, (8) chitosan plus amoxicillin plus omeprazole respectively twice daily for 14 consecutive days. Four weeks after the last administration, these mice were all killed and samples of gastric mucosa were embedded in paraffin, sectioned and assayed with Giemsa stain. The remaining gastric mucosa was used to quantitatively culture Hp. An quantitative ELISA was used to detect IL-2, IFNgamma, IL-12, IL-4, IL-10 content in gastric mucosa. RESULTS: The eradication rate of Hp was 0, 0, 41.7%, 58.3%, 58.3%, 66.7%, 83.3% and 91.7% respectively among these eight groups (P < 0.01). The Hp colony density in the (1) group and (2) group was significantly higher than that in the other six groups (P < 0.05). The Hp colony density in (3) group was significantly higher than that in (6) group, (7) group and (8) group (P < 0.05) and that in (4) group was significantly higher than that in (8) group (P < 0.05). There was no difference in the content of IL-2 in the gastric mucosa among these eight groups (P > 0.05). The content of IFNgamma, IL-12, IL-4 and IL-10 in the gastric mucosa in groups with chitosan was significantly higher than that in groups without chitosan (P < 0.05). CONCLUSIONS: Chitosan has anti-Hp effect and synergism with amoxicillin in vivo. Chitosan can up-regulate Th1 and Th2 response.

Th immune response induced by H pylori vaccine with chitosan as adjuvant and its relation to immune protection.

AIM: To study the immunological protective effect of H pylori vaccine with chitosan as an adjuvant and its mechanism. METHODS: Female BALB/c mice were randomly divided into seven groups and orally immunized respectively with PBS, chitosan solution, chitosan particles, H pylori antigen, H pylori antigen plus cholera toxin (CT), H pylori antigen plus chitosan solution, H pylori antigen plus chitosan particles once a week for four weeks. Four weeks after the last immunization, the mice were challenged twice by alive H pylori (1 x 10(9) CFU/mL) and sacrificed. Part of the gastric mucosa was embedded in paraffin, cut into sections and assayed with Giemsa staining. Part of the gastric mucosa was used to quantitatively culture H pylori. ELISA was used to detect cytokine level in gastric mucosa and anti- H pylori IgG1, IgG2a levels in serum. RESULTS: In the groups with chitosan as an adjuvant, immunological protection was achieved in 60% mice, which was significantly higher than in groups with H pylori antigen alone and without H pylori antigen (P < 0.05 or 0.001). Before challenge, the level of IFN and IL-12 in gastric mucosa was significantly higher in the groups with chitosan as an adjuvant than in the control group and the group without adjuvant (P < 0.05 or 0.005). After challenge, the level of IFN and IL-12 was significantly higher in the groups with adjuvant than in the groups without adjuvant and antigen (P < 0.05 or 0.001). Before challenge, the level of IL-2 in gastric mucosa was not different among different groups. After challenge the level of IL-2 was significantly higher in the groups with adjuvant than in the control group (P < 0.05 or 0.001). Before challenge, the level of IL-10 in gastric mucosa was significantly higher in the groups with chitosan as an adjuvant than in other groups without adjuvant (P < 0.05 or 0.01). After challenge, the level of IL-10 was not different among different groups. Before challenge, the level of IL-4 in gastric mucosa was significantly higher in the groups with chitosan as an adjuvant than in other groups without adjuvant (P < 0.05). After challenge, the level of IL-4 was significantly higher in the groups with chitosan particles as an adjuvant than in the group with CT as an adjuvant (P < 0.05), and in the group with chitosan solution as an adjuvant, the level of IL-4 was significantly higher than that in control group, non-adjuvant group and the groups with CT (P < 0.05 or 0.001). The ratio of anti- H pylori IgG2a/IgG1 in serum was significantly lower in the groups with chitosan as an adjuvant than in the groups with CT as an adjuvant or without adjuvant (P < 0.01). CONCLUSION: H pylori vaccine with chitosan as an adjuvant can protect against H pylori infection and induce both Th1 and Th2 type immune response.

[Epidemiological surveillance after filariasis transmission interrupted in Jiangxi Province].

In 10 years after the interruption of filariasis transmission, the surveillance covered 29.5% of the townships and 3.7% of the population in the endemic areas, and 25.8% and 2.5% respectively after 10 years. No case with microfilaremia was found. 8248 floating people were also blood-examined with negative result. No filarial larva was detected in 103 261 Culex quinquefasciatus dissected. Out of 70,3498 people investigated in 708 villages of 249 townships, 667 chronic filariasis patients were found. Among 2928 people formerly with microfilaremia, no positive was found. The results indicate that Jiangxi Province has met the criteria of filariasis elimination set by the Ministry of Health.

[The role of local immune response in gastric mucosa in the protection induced by Helicobacter pylori vaccine with chitosan as adjuvant].

OBJECTIVE: To study the immunological protection of Helicobacter pylori (H. pylori) vaccine with chitosan as adjuvant and it's mechanism. METHODS: One-grade female BALB/c mice were randomly divided into nine groups and immunized by (1) PBS alone, (2) chitosan solution alone, (3) chitosan particles alone, (4) H. pylori antigen alone, (5) H. pylori antigen plus chitosan solution, (6) H. pylori antigen plus chitosan particles, (7) H. pylori antigen plus CT, (8) H. pylori antigen plus chitosan solution and cholera toxin (CT), (9) H. pylori antigen plus chitosan particles and CT orally respectively once a week for four weeks. At 4 weeks after the last immunization, these mice were challenged by alive H. pylori (1 x 10(9)/ml) twice at two days intervals. At 4 weeks after the last challenge, these mice were all killed and Gastric mucosa were embedded in paraffin, sectioned and assayed with Giemsa stain. The other gastric mucosa were used to quantitatively culture H. pylori. An ELISA was used to detect anti-H. pylori IgA in saliva and gastric mucosa and a quantitative ELISA was used to detect IL-2, IL-4, IL-10 content in gastric mucosa, and SP immunohistochemical method was used to detect secretory immunoglobulin A (sIgA) in gastric mucosa. RESULTS: (1) In the groups with chitosan as adjuvant, 60% mice could achieve immunological protection, which was according to that with CT as adjuvant (58.33%), and was significantly higher than H. pylori antigen alone and other groups without H. pylori antigen (P < 0.01 or P < 0.05). While the rates of protection in the groups with chitosan plus CT as adjuvant were 84.62%, 85.71% and the H. pylori colonization score in it was significantly lower than that in the groups with CT as adjuvant and without adjuvants (P < 0.01 or P < 0.05). (2) the labeling index for sIgA-positive lumen of glands and special anti-H. pylori IgA levels in gastric mucosa in the groups with chitosan as an adjuvant had no difference with those in the group with CT as an adjuvant (P > 0.05) and were significantly higher than those in non-adjuvant groups, while those in the groups with chitosan plus CT were significantly higher than those in the group with CT as an adjuvant (P < 0.01 or P < 0.05). (3) Before challenge, the content of IL-2 in gastric mucosa were no different among different groups (P > 0.05). After challenge the content of IL-2 were significantly higher in the groups with adjuvant than those in the control group (P < 0.01 or P < 0.05), Moreover, those in the groups with antigen after challenge were significantly higher than those before challenge (P < 0.05). (4) Before challenge, the content of IL-10 in gastric mucosa were significantly higher in the groups with chitosan as adjuvant than those in the control group and the group without adjuvant (P < 0.01 or P < 0.05). After challenge, the content of IL-10 were no different among different groups (P > 0.05). Moreover, those in the groups with adjuvant after challenge were significantly lower than those before challenge (P < 0.01). (5) Before challenge, the content of IL-4 in gastric mucosa were significantly higher in the groups with chitosan as adjuvant than those in the control group and the group without adjuvant (P < 0.05), After challenge, the content of IL-4 were significantly higher in the groups with chitosan particles as an adjuvant than those in the group with CT as an adjuvant (P < 0.05), and those in the group with chitosan solution as an adjuvant were significantly higher than those in control group, non-adjuvant group and the groups with CT (P < 0.01 or P < 0.05), Moreover, those in the groups with adjuvant after challenge were significantly lower than those before challenge (P < 0.01 or P < 0.05). CONCLUSIONS: (1) H. pylori vaccine with chitosan as adjuvant could protect against H. pylori infection, this suggested that chitosan could be a mucosa adjuvant of H. pylori vaccine, and it could effectively elicit special humoral immune response of systemic and local mucosa, which might be one of its protective mechanism. (2) H. pylori vaccine with chitosan as adjuvant may induce both Th1 and Th2 type immune response, and after challenge it could reverse the inhibition of Th2 induced by H. pylori infection and recover the Th1/Th2 imbalance. which might contribute to the immune protection against H. pylori.