Short term outcomes of extremely low birth weight infants from a multicenter cohort study in Guangdong of China.

With the increase in extremely low birth weight (ELBW) infants, their outcome attracted worldwide attention. However, in China, the related studies are rare. The hospitalized records of ELBW infants discharged from twenty-six neonatal intensive care units in Guangdong Province of China during 2008-2017 were analyzed. A total of 2575 ELBW infants were enrolled and the overall survival rate was 55.11%. From 2008 to 2017, the number of ELBW infants increased rapidly from 91 to 466, and the survival rate improved steadily from 41.76% to 62.02%. Increased survival is closely related to birth weight (BW), regional economic development, and specialized hospital. The incidence of complications was neonatal respiratory distress syndrome (85.2%), oxygen dependency at 28 days (63.7%), retinopathy of prematurity (39.3%), intraventricular hemorrhage (29.4%), necrotizing enterocolitis (12.0%), and periventricular leukomalacia (8.0%). Among the 1156 nonsurvivors, 90.0% of infants died during the neonatal period (≤ 28 days). A total of 768 ELBW infants died after treatment withdrawal, for reasons of economic and/or poor outcome. The number of ELBW infants is increasing in Guangdong Province of China, and the overall survival rate is improving steadily.

Contributions and achievements on schistosomiasis control and elimination in China by NIPD-CTDR.

Being a zoonotic parasitic disease, schistosomiasis was widely spread in 12 provinces of Southern China in the 1950s, severly harming human health and hindering economic development. The National Institute of Parasitic Diseases at the Chinese Center for Diseases Control and Prevention, and Chinese Center for Tropical Diseases Research (NIPD-CTDR), as the only professional institution focussing on parasitic diseases at the national level, has played an important role in schistosomiasis control in the country. In this article, we look back at the changes of schistosomiasis endemicity and the contribution of NIPD-CTDR to the national schistosomiasis control programme. We review NIPD-CTDR's activities, including field investigations, design of control strategies and measures, development of diagnostics and drugs, surveillance-response of endemic situation, and monitoring & evaluation of the programme. The NIPD-CTDR has mastered the transmission status of schistosomiasis, mapped the snail distribution, and explored strategies and measures suitable for different types of endemic areas in China. With a good understanding of the life cycle of Schistosoma japonicum and transmission patterns of the disease, advanced research carried out in the NIPD-CTDR based on genomics and modern technology has made it possible to explore highly efficient and soft therapeutic drugs and molluscicides, making it possible to develop new diagnostic tools and produce vaccine candidates. In the field, epidemiological studies, updated strategies and targeted intervention measures developed by scientists from the NIPD-CTDR have contributed significantly to the national schistosomiasis control programme. This all adds up to a strong foundation for eliminating schistosomiasis in China in the near future, and recommendations have been put forward how to reach this goal.

[Accumulation Characteristics and Health Risk Assessment of Heavy Metals in Wild Fish Species from Diaojiang River, Guangxi].

To explore the accumulation characteristics and health risk assessment of heavy metals in wild fish species, the concentrations of heavy metals (Pb, Cd, Cr, As and Hg) in the muscle samples of eight wild fish species collected from Diaojiang River, Guangxi were analyzed. The degree of pollution, food safety and health risk of heavy metals in wild fish species were evaluated using the average pollution index and the target hazard quotient methods. The results showed that the concentrations of Pb, Cd, Cr, As and Hg in wild fish species ranged from 0.041 to 1.160, 0.0001 to 0.066, 0.173 to 0.789, 0.010 to 2.420 and 0.0007 to 0.077mg·kg-1, respectively. The concentrations of Pb and As in wild fish species exceeded the limit values of the Maximum Levels of Contaminants in Foods (GB 2762-2012), and the over-standard rates were 5.06% and 64.56% respectively. The concentrations of Cd, Cr and Hg did not exceed the standard. The average pollution index results showed that Acheilognathus tonkinensis and Acheilognathus barbatus were seriously polluted by heavy metals. The Oreochromis niloticus were moderately polluted. The Siniperca kneri Garman, Carassius auratus, Pseudohemiculter dispar, Ctenopharyngodon idellus, Hemiculter leucisculus were slightly polluted. Higher bioaccumulation factors of Pb, Cr and Hg were found in wild fish species from Diaojiang River. The concentrations of heavy metals in carnivorous fish and omnivorous fish were higher than those in herbivorous fish. Potential health risk assessment showed that the total target hazard quotients (TTHQ) of Acheilognathus tonkinensis and Acheilognathus barbatus were higher than 1. It indicated that the local residents posed higher human health risk due to the long-term consumption of Acheilognathus tonkinensis and Acheilognathus barbatus. Among all the TTHQ in wild fish species (except Pseudohemiculter dispar and Hemiculter leucisculus), the contribution rate of As was the highest, and the average contribution rate reached 76.63%, which indicated that As was the main risk factor.

Oral Contrast-Enhanced Gastric Ultrasonography in the Assessment of Gastric Lesions: A Large-Scale Multicenter Study.

OBJECTIVE: To determine the diagnostic efficiency of oral contrast-enhanced gastric ultrasonography in the evaluation of gastric lesions, based on large-scale multicenter study. METHODS: The study enrolled 383,945 patients with suspect gastric lesions who underwent complete oral contrast-enhanced gastric ultrasonography and endoscopic evaluation. Two operators, unaware of the results of other diagnostic procedures, performed each examination independently. The accuracies of conventional ultrasonography, oral contrast-enhanced gastric ultrasonography, and upper gastrointestinal endoscopy were determined. RESULTS: After oral contrast, the anatomy of the stomach and morphologic features of gastric lesions were clearly visualized. The sensitivities, specificities, positive predictive values, negative predictive values and accuracies of oral contrast-enhanced ultrasonography in detecting the sites, sizes, numbers, and the extent of gastric lesions,were similar to those of upper gastrointestinal endoscopy (P > .05) and far greater than those of conventional ultrasonography (P < .01). Moreover, oral contrast-enhanced ultrasonography was far better than upper gastrointestinal endoscopy (P < .01) and was better than conventional ultrasonography (P < .05) in detecting the submucosal abnormalities (<5mm) and the adjacent structures abnormalities identified in surgical pathology. However, oral contrast-enhanced ultrasonography was a bit poorer than upper gastrointestinal endoscopy (P < .05) and far better than conventional ultrasonography (P < .01) in detecting the minor mucosal abnormalities (<5mm). CONCLUSION: Oral contrast-enhanced gastric ultrasonography is superior to conventional gastric ultrasonography in defining the anatomic location and extension of gastric lesions. Its diagnostic performance is not worse than upper gastrointestinal endoscopy and it can be used as a useful supplement to upper gastrointestinal endoscopy.

[Risk Assessment of Schistosomiasis Transmission by Catalytic Models Based on Antibody Positive Rates].

Objective: To evaluate the transmission risk and features of schistosomiasis by analyzing the data concerning positive rates of anti-schistosome antibody using catalytic models. Methods: Cross-sectional survey was conducted in seven villages with different endemicity of schistosomiasis in Jiangxi (Caohui, Xinhua, Jingtou villages), Anhui (Yuye, Tieguai, Longshang villages) and Hubei (Hebei village) Provinces in 2008. Serum samples were collected and indirect hemagglutination assay was performed to detect anti-schistosome antibodies in serum. Antibody positive rate was calculated and differences among villages and age groups as well as between genders were analyzed. Data of antibody positive rate based on age strata for each village were analyzed by two-stage catalytic model and reversible and two-stage compound catalytic model. Parameters of each model were estimated through the maximum likelihood method. Seroconversion rate and sero-negative conversion rate were estimated in the two-stage catalytic model. Seroconversion rate, seroreversion rate and sero-negative conversion rate were estimated in reversible and two-stage compound catalytic model. The fitting effect was evaluated through correlation analysis and chi-square tests. The best fitted models and parameters were used to analyze the transmission risk and characteristics of schistosomiasis. Results: A total of 6 428 individuals were examined with an average schistosomiasis antibody positive rate of 39.80%（2 485/6 428）. In terms of age, the peak of antibody positive rate in Caohui, Xinhua, Jingtou, Yuye, Tieguai, Longshang, and Hebei villages occurred in the age group of 46-50 （82.86%, 58/70）, 31-35 （60.78%, 31/51）, 31-35 （68.42%, 26/38）, 41-45（55.04%, 71/129）, 51-55 （62.38%, 63/101）, 56-60 （31.43%, 33/105）, and 16-20 （21.88%, 7/32） years old, respectively. In general, the antibody positive rate showed a trend of increase followed by a decrease with increasing age in each village. The best model for the data of Caohui, Xinhua and Jingtou and Yuye village was the two-stage catalytic model. The estimated seroconversion rate in these villages was 0.049 5, 0.044 0, 0.055 7, and 0.034 4 respectively, all higher than the corresponding sero-negative conversion rate of 0.005 9, 0.019 6, 0.015 5, and 0.017 8. The best model for the data of Longshang, Tieguai and Hebei villages was the reversible and two-stage compound model. The seroconversion rate in these villages was 0.062 9, 0.168 1, and 0.039 4 respectively, the seroreversion rate was 0.168 8, 0.121 1, and 0.152 2, and the sero-negative conversion rate was 0.001 7, 0.000 2, and 0.090 9. Conclusions: The catalytic model based on antibody positive rate by age strata could reflect the transmission rate and risk quantitatively and may provide guidance for making control strategies.

Integrated control programmes for schistosomiasis and other helminth infections in P.R. China.

The prevalence of human schistosomiasis and soil-transmitted helminthiasis (STH) has decreased significantly in the People's Republic of China (P.R. China), particularly after 2005 when the national control programmes were reinforced by forming of integrated control strategies. Furthermore, social-economic development also contributed to the decrease of schistosome and soil-transmitted helminth infections. The prevalence of the zoonotic helminthiasis, including clonorchiasis and echinococcosis, on the other hand, is either underestimated or has in fact increased due to changes in social and environmental factors. In comparison with the control strategies in force and their effects on those four kinds of helminthiasis, the challenges and control priorities for the potential transfer from control to elimination of each disease is reviewed, to provide evidence for policy-makers to act upon.

[Assessment on the effect of joint effort for schistosomiasis control in Hubei Province].

OBJECTIVE: To analyze the progress of implementation of integrated strategy with emphasis on the control of infectious sources and effectiveness for joint-project of schistosomiasis control in Hubei province. METHODS: Data on the endemic status and implementation of each integrated intervention in 6 collaborated counties including Gongan, Hanchuan, Honghu, Jiangling, Xiantao and Yangxin during 2009-2013 were collected and analyzed. 18 administrative villages with a history of endemic schistosomisis from 6 counties were selected for field survey. Individuals aged 6-65 years received screening test by IHA, and feces of antibody positive inhabitants were collected and tested by miracidia hatching technique. Hatching technique was conducted to determine the infection rate of schistosomiasis in cattle if there was any cattle existed. RESULTS: Various interventions were conducted with adaption to the local situation by the Departments of Agriculture, Water Conservancy, Forestry, and Health. The total number of cattle decreased from 75 388 at the beginning of 2009 to 1 805 at the end of 2013 in 6 counties with a reduction rate of 97.5%, while the prevalence in cattle reduced to 0-0.3% in 2013. Snail-infested areas were stable but areas with infected snails decreased significantly, and no infected snails were found in 2012-2013. Meanwhile, the infection rate of human beings on county level were less than 1%. No infected snails and cattle were found in 18 selected villages and the prevalence in inhabitants was in the range of 0-0.8%. CONCLUSION: Cooperation between provincial government and the Ministries of Health and Agruiculture accelerates the process to reach the criteria of transmission control of schistosomiasis in Hubei Province. However, sustainable effort in needed as the current endemic situation of schistosomiasis is stillunstable.

[Establishment and application of rapid assessment system of environment with high transmission risk of schistosomiasis in marshland and lake regions. I. Establishment of an index system with Delphi method].

OBJECTIVE: To establish an index system for rapid assessment of environment with high transmission risk of schistosomiasis in marshland and lake regions. METHODS: The alternative indices were established preliminarily by the documentary method, and then the Delphi method was used two rounds to select the indices and establish the index system. The degree of familiar and authority of the experts as well as the weights of all indices were assessed. RESULTS: A total of 3 primary indices namely morbidity in domestic animals, morbidity in humans and Oncomelania snail status were established, among which the weight of morbidity in domestic animals (0.68) was the highest. Totally 16 secondary indices were established, among which the combinative weights of the positive rate of wild feces (0.09), the infection rate of livestock (0.09), the infection rate of humans (0.07), the number of cases with acute schistosomiasis (0.07), the area with infected snails (0.07), and the density of infected snails (0.07) were the highest. The coefficients of familiar degree and authority degree of the experts of the primary indices were 0.79-0.85 and 0.88-0.91, and those of the secondary indices were 0.68-0.86 and 0.77-0.91, respectively. CONCLUSIONS: The index system for rapid assessment of environment with high transmission risk of schistosomiasis in marshland and lake regions is established preliminarily. Using this system, we can assess the key endemic indices of humans, domestic animals and snails to understand the endemic situation in the investigated sites.

[Distribution and potential ecological risk assessment of heavy metals in sediments of Zhalong Wetland].

This study investigated the concentrations of heavy metals in the sediments of the Zhalong Wetland using ICP-MS, analyzed their spatial distributions, evaluated the potential ecological risk, and explored the pollution sources and environmental influencing factors. The results can be summarized as the followings: (1) The concentrations of Hg, Cd, As, Cu, Pb, Zn and Cr were 0.065, 0.155, 10.26, 18.20, 21.35, 52.08 and 46.47 mg x kg(-1), respectively, which were all above the soil background values of the Songnen Plain. Their spatial distributions were distinctly different. The concentration of heavy metals in the north was higher than that in the south, and the east was higher than the west. Particularly in the eastern region, the concentrations of Hg and Cd were 20.8 and 32.4 times the minimum values of the whole area. And in the core zone, the concentration was relatively low. (2) The sequence of the potential ecological risk posed by the metals was Hg > Cd > As > Pb > Cu > Cr > Zn. The average potential ecological risk index (RI) of the Zhalong Wetland was 171.9 (ranged from 76.9-473.5), suggesting a moderate ecological risk. However, the potential ecological risk was extremely high in the east which should be treated as the major heavy metal pollution prevention site in the future. (3) Except for Hg and Pb, the concentrations of all heavy metals were significantly correlated to each other, indicating that those heavy metals had homology. (4) Organic matter was the major environmental influencing factor. However, the trend of land salinization in the Zhalong Wetland has been intensified, indicating a higher risk of heavy metal releasing from the sediments, to which the local authorities should pay enough attention.

[Assessment of effect and quality control for parasitological tests in national schistosomiasis surveillance sites].

OBJECTIVE: To understand the ability of pathogenic diagnosis for schistosomiasis japonica in the national surveillance sites and evaluate the effect of stool hatching method in the field, so as to provide the evidence for establishing a quality control system of pathogenic diagnosis of schistosomiasis in the surveillance sites. METHODS: The data pertaining to the parasitological diagnosis of the residents with positive serological tests were collected in 81 national surveillance sites of 12 provinces in 2011, and the effects of the Kato-Katz technique and stool hatching method were evaluated and compared. The incubation quality control samples made by the national schistosomiasis diagnosis reference laboratory were detected by both Kato-Katz technique and stool hatching method using the single-blind method, and the results were analyzed and compared for the coincidence rate, misdiagnosis rate and missing diagnosis rate in all the county laboratories in 2012. RESULTS: A total of 3 780 sero-positive residents were tested by using the Kato-Katz technique and stool hatching method in the 81 national surveillance sites in 2011, 127 persons were double egg-positive, 3 513 persons were double egg-negative, and the total coincidence rate was 96.30%. Totally 173 infected people were diagnosed by using the Kato-Katz technique and the positive detection rate was 4.58%; 221 infected people were diagnosed by using the stool hatching method and the positive detection rate was 5.85%. A total of 267 positive people were diagnosed by the Kato-Katz technique or the stool hatching method or both and the total positive detection rate was 7.06%, which was higher by 54.15% than that by using the single Kato-Katz technique (chi2 = 21.32, P < 0.01). In 2012, of 240 standard incubation quality control samples (160 positives, 80 negatives) detected by the technicians from the 80 surveillance sites, 105 samples were positive and 67 samples were negative, with a total coincidence rate of 71.67% (172/240) and a total missing diagnosis rate of 34.38% (55/160). Among them, the missing rate of the strong positive samples was 32.50% (26/80), the missing rate of the weakly positive samples was 36.25% (29/80), and the misdiagnosis rate of the negative samples was 16.25% (13/80). The detection rates of the incubation quality control samples were 61.11%, 80.00%, 77.08%, 90.48%, 58.33% and 59.26% in the surveillance sites of six provinces, including Anhui, Hubei, Hunan, Jiangsu, Jiangxi and Sichuan provinces, respectively, and a significant difference was found (chi2 = 14.27, P < 0.05). CONCLUSIONS: The detection efficiency of the stool hatching method is superior to that of the Kato-Katz technique in the field. However, the levels of the technical personnel for the stool hatching method are relatively low in most of the surveillance sites. Therefore, the technical training should be strengthened.

Assessment of hormonal activities and genotoxicity of industrial effluents using in vitro bioassays combined with chemical analysis.

Wastewaters from various industries are a main source of the contaminants in aquatic environments. The authors evaluated the hormonal activities (estrogenic/anti-estrogenic activities, androgenic/anti-androgenic activities) and genotoxicity of various effluents from textile and dyeing plants, electronic and electroplate factories, pulp and paper mills, fine chemical factories, and municipal wastewater treatment plants in the Pearl River Delta region by using in vitro bioassays (yeast estrogen screen [YES]; yeast androgen screen [YAS]; and genotoxicity assay [umu/SOS]) combined with chemical analysis. The results demonstrated the presence of estrogenic, anti-estrogenic, and anti-androgenic activity in most industrial effluents, whereas no androgenic activities were detected in all of the effluents. The measured estrogenic activities expressed as estradiol equivalent concentrations (EEQs) ranged from below detection (3 of 26 samples) to 40.7 ng/L, with a mean of 7.33 ng/L in all effluents. A good linear relationship was found between the EEQs measured by YES bioassay and the EEQs calculated from chemical concentrations. These detected estrogenic compounds, such as 4-nonylphenol and estrone, were responsible for the estrogenic activities in the effluents. The genotoxic effects expressed as benzo[a]pyrene equivalent concentrations (BaP EQs) varied between below detection and 88.2 µg/L, with a mean of 8.76 µg/L in all effluents. The target polycyclic aromatic hydrocarbons were minor contributors to the genotoxicity in the effluents, and some nontarget compounds in the effluents were responsible for the measured genotoxicity. In terms of estrogenic activities and genotoxicity, discharge of these effluents could pose high risks to aquatic organisms in the receiving environments.

[Retrospective investigation on national endemic situation of schistosomiasis I analysis of changes of endemic situation in transmission-interrupted counties].

OBJECTIVE: To analyze the changing rules of schistosomiasis endemic situation in the area of transmission that has been interrupted before and after they reach the criteria of transmission interruption, so as to offer the basis of amending to the criteria of schistosomiasis transmission interruption and a more scientific, standardized assessment and evaluation of the effects of schistosomiasis control in the future. METHODS: Nineteen counties of transmission that has been interrupted in 9 provinces nationwide were selected and investigated with the retrospective research method to collect and record the endemic detailed data 10 years before they reach the criteria of transmission interruption and several years later (ended in 2008 or 2009) and then a database was established. The changing rules of various disease indices in different endemic areas before and after reaching the criteria of transmission interruption were analyzed and compared. RESULTS: The average time from the transmission control to the transmission interruption was 17 years in the 17 counties. After reaching the criteria of transmission interruption, the infection rates of people turned down to a minimum level in various endemic areas, the infection rates in a few numbers of lake endemic areas and hilly endemic areas increased slightly after the transmission interruption 4-9 years later, but all of them were below 1%. The densities of living Oncomelania snails in lake endemic areas and water-network endemic areas were high and the changes were great each year, and the densities of living snails were much lower in hilly endemic areas than in the above two types of areas and they came to the lowest 4 years before and after the transmission interruption. The infected snails appeared occasionally in lake endemic areas, and they recurred 6 years and 10 years after the transmission interruption in water-network endemic areas and hilly endemic areas, respectively. The continued time without infected snails found before reaching transmission interruption was 2.71 +/- 1.10 years averagely in transmission-interrupted counties with endemic stable, and was 3. 80 +/- 1.43 years in lake endemic areas. CONCLUSIONS: It is possible to maintain a low level of population schistosome infection, and the endemic rebound is shown as snail rebound after the endemic areas reach the criteria of transmission interruption, The infected snails could be the comprehensive index reflecting the control achievement and the risk of schistosomiasis transmission. So the persistent control of infected snails is the fundament of schistosomiasis transmission interruption. It is suggested that in our current social and economic development and science and technology capacity conditions, the status of no infected snails found continuously for 5 years would be one of the criteria of schistosomiasis transmission interruption.

[Assessment of the application of variable-number tandem repeat loci of Salmonella Enteritidis in subtyping multiple-locus variable-number tandem repeat analysis].

OBJECTIVE: To evaluate the feasibility of the application of variable-number tandem repeat (VNTR) loci of Salmonella Enteritidis (S. enteritidis) in subtyping mutiple-locus variable-number tandem repeat analysis (MLVA). METHODS: A total of 16 isolates of S.enteritidis from different place and time in China were preliminarily assessed by choosing 11 reported VNTR loci, the loci with single amplified bands were picked to subtype all 104 S. enteritidis isolates. The isolates were also analyzed by pulse field gel electrophoresis (PFGE) to compare the superiority or inferiority of MLVA method and PFGE method. RESULTS: Seven VNTR loci were selected from the preliminary screening to expand the analysis, and the 7 VNTR loci had grouped 104 of S.enteritidis isolates into either 16 MLVA subtypes or 22 PFGE subtypes, with the D value at 0.7222 and 0.7974, respectively. Comparing with the isolates in MLVA subtypes, the isolates in PFGE showed a stronger resolving power. Meanwhile the results in PFGE showed a more disperse frequency distribution than those in MLVA. CONCLUSION: These results indicate that some VNTR locus which have shown a good polymorphism internationally, may fail to show polymorphism in China, thereby, more VNTR loci should be included in MLVA and the wide screening may benefit the unity of global laboratorial methods.

[A study of the effectiveness and cost of de-escalation therapy for severe lower airway infection in a respiratory intensive care unit].

OBJECTIVE: To evaluate the effectiveness of de-escalation therapy (DET) in patients with severe lower airway infection in the respiratory care unit. METHODS: Sixty-seven cases of severe lower airway infection (SLAI) were divided into two groups: a DET group (n = 29), and a non-DET group (NDET, n = 38). Samples of lower airway secretions were collected by blinded protected specimen brush for culture and Gram stain. The clinical data were compared between the DET group and the NDET group, including the time of mechanical ventilation, time of stay in hospital, APACHE-II score, treatment responses and outcome, cost of antibiotics and total cost in the hospital. RESULTS: There were significant differences in time in hospital (14 +/- 8; 19 +/- 12), the time of mechanical ventilation (22 +/- 16; 32 +/- 16) and the total cost in-hospital (52 871 +/- 54 457; 82 913 +/- 49 564. t = 2.195, 2.449, 2.354, all P < 0.05), while there was no significant difference in the cost on antibiotics between the DET group (7896 +/- 4718) and the NDET group (8490 +/- 5786. t = 0.449, P > 0.05). The mortality and inappropriate antibiotic therapy rate of the DET group (13.8%, 27.6%) were lower than those of the NDET group (36.8%, 60.5%; chi(2) = 4.45, 7.18, all P < 0.05). CONCLUSION: The mortality of SLAI was significantly decreased by DET. DET also led to shorter time of mechanical ventilation, shorter course of therapy and less total cost of therapy.