Assessment on the Effects of Hepatitis B Prevention and Control Measures in Western China: A Comparison of Three Population-based Serosurveys / 生物医学与环境科学（英文）

Objective@#Despite the remarkable progress in efforts to control disease spread, the nationwide elimination of hepatitis B in China is still hindered by the persistently high rate of hepatitis B virus (HBV) infection in Western China. This study aimed to evaluate the strategy of hepatitis B prevention and control in Western China and identify potential areas and strategies for improvement.@*Methods@#Susceptible population vaccination, health education, professional training of doctors, and other prevention and control measures have been implemented in Wuwei city since 2010. Data were obtained from three representative cross-sectional serosurveys conducted in 2010, 2013, and 2015. The serum samples were subjected to enzyme-linked immunosorbent assays to detect the following seromarkers: HBV surface antigen (HBsAg), antibody against hepatitis B surface antigen (anti-HBs), and antibody against hepatitis B core antigen (anti-HBc). Estimates of variance were determined using Taylor series linearization methods.@*Results@#The three serosurveys revealed decreases in the prevalence of HBsAg (7.19% in 2010 @*Conclusion@#Although vaccine-based prevention and control measures reduced the rate of HBV infection in Wuwei City over time, the hepatitis B infection rate in children younger than 10 years was still higher than the national average level. Therefore, the prevention and control of mother-to-child transmission and the management of the infected should be the focus of future prevention and control work.

Study on the quality of life and its related factors on patients with multiple myeloma / 中华流行病学杂志

<p><b>OBJECTIVE</b>To evaluate the quality of life and influencing factors on patients with multiple myeloma (MM).</p><p><b>METHODS</b>227 MM cases were selected at 5 hospitals in Xi'an from August, 2010 to March, 2013. QLQ-C30 was used to evaluate the quality of life of MM patients, and their norms were as control. Factors which influencing the quality of life were investigated and analyzed with SPSS 17.0 software.</p><p><b>RESULTS</b>The total score of quality of life in MM patients was 49.0±21.7 which was lower than the norms (60.7±23.4). The scores on fatigue, nausea, vomiting, pain, short of breath, disturbance on sleeping, losing appetite, constipation, other symptoms and financial difficulty were significantly higher than data of the norms (P < 0.05). Factors as being elderly (especially those older than 70), under higher proportion of medical costs on their own expense or financial difficulty etc., had major influences on the quality of life (P < 0.05) of MM patients who in particular having worse quality of life when in worsening clinical ISS stage (P < 0.05). Low level of hemoglobin, high level of serum calcium and globulin all significantly reduced the quality of life of the MM patients (P < 0.05).</p><p><b>CONCLUSION</b>The quality of life of MM patients was significantly lower than the normal people or patients with other tumors. Fatigue, pain, and financial difficulty were main influencing factors on the quality of life of MM patients. The assessment on the effects of treatment should relate to the improvement of hemoglobin, serum calcium and globulin, which could all improve the quality of life of MM patients.</p>

The mechanism of HBV infection of human trophoblast cell / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To observe the changes of human trophoblast cells after infected with hepatitis B virus.</p><p><b>METHODS</b>HBV positive serum was used to infect human trophoblast cells in vitro. HBsAg in cell culture medium were detected by ELISA method and HBV DNA in cell culture medium and cells were detected by PCR method. HBV fluorescence polymerase chain reaction diagnose kit were used to detect the HBV DNA concentration. Ultra structure of trophoblast cells were observed with transmission electron microscopy (TEM).</p><p><b>RESULTS</b>HBsAg could be detected in infection group by ELISA. Infection group cell culture medium and infection group cells were HBV DNA positive. HBV DNA concentrations in HBV infection cell culture medium in 0, 12, 36, 60, 84 h after extensively PBS washed were < 10(3), 3 x 10(4), 6 x 10(5), 5 x 10(5), 3 x 10(5) copies/mL. HBV infected trophoblast cells were found many forms of endosomes, some of which contents virus like particle.</p><p><b>CONCLUSION</b>HBV might take advantage of clathrin-mediated endocytosis to enter trophoblast cell, which might lead to cell infection or across the cell bar by transcytosis.</p>

A follow-up study on the efficacy of hepatitis B immunoglobulin combining hepatitis B vaccine in infants born to HBsAg positive mothers / 中华流行病学杂志

<p><b>OBJECTIVE</b>To study the efficacy of hepatitis B immunoglobulin (HBIG) combining hepatitis B vaccine in high risk infants born to HBsAg positive mothers through a follow-up study program.</p><p><b>METHODS</b>184 infants (4 twin pairs) born to HBsAg carrier mothers who were consecutively recruited from December 2002 to August 2004 were followed. Major HBV serologic markers in all infants were detected by enzyme-linked immunosorbent assay (ELISA) when they were at birth, at 7th, at 24th and at 36th months.</p><p><b>RESULTS</b>7 of the 184 infants were HBsAg positive at birth, making the transplacental intrauterine infection rate of HBV as 3.80% (7/184). 125 infants were followed up at 7th months and 108 infants were followed up at 24th and 36th months. Only 2 of the 7 infants born to HBsAg-positive and HBeAg-positive mothers were persistently sera positive for HBsAg, making the chronic infection rate of HBV as 28.57%. The other 140 infants were HBsAg negative during t he follow-up period. The rate o f detectable anti-HBs i ninfants was 7.02% at birth. After infants were immunized by HBIG combining hepatitis B vaccine, the anti-HBs-positive rate reached 92% at 7th months, and gradually descended thereafter. 72.04% of the infants at 24th and 60% at 36th months showed detectable levels of anti-HBs. There was significant correlation between the produce of anti-HBs in infants and HBsAg-positive at birth while HBsAg-positive and HBeAg-positive in mothers did not relate to the produce of anti-HBs in their infants. Of 39 infants born to HBsAg-positive and HBeAg-positive mothers, 25 showed detectable levels of HBeAg. During the follow-up peirod, HBeAg was still detectable in 2 infants who were also HBsAg positive and the others all became HBeAg-negative but no infant became HBeAg-positive.</p><p><b>CONCLUSION</b>The efficacy of HBIG combining hepatitis B vaccine in high risk infants was fine.</p>

Evaluation on the indirect economic burden of stroke using combination of disability-adjusted life years and human capital method / 中华流行病学杂志

<p><b>OBJECTIVE</b>Using the indirect economic burden of stroke in a rural population to develop rational allocation of future health resources, in Hanzhong area.</p><p><b>METHODS</b>Cluster sampling which involved 53 natural villages with a total number of 75,000 people selected from the 'stroke monitoring base' of rural population was adopted in this study in the Hanzhong area. All of the 164 stroke cases were studied through a self-designed questionnaire. In calculating disability-adjusted life years (DALYs), fixed value was used in accordance with the value of GBD. The disability assessment was simplified in DALYs calculation and modified Barthel's ADL was used in disability assessment of stroke patients. In indirect economic burden analysis, the human capital method combined with DALYs was adopted with the formula as: indirect economic burden = GNP per capita x DALYs x productivity weight.</p><p><b>RESULTS</b>The total DALYs were 598.88, with an average DALY of stroke as 3.65 per case. The total indirect economic burden of stroke patients in rural areas was 1,993,977.8 RMB and the average of indirect economic burden of stroke was 12,158.4 RMB per case with the largest seen in the 45-59 age group, accounted for 74.4%.</p><p><b>CONCLUSION</b>In our study, the use of method in combining the human capital with DALYs was the first time being adopted in calculation of the indirect economic burden of stroke in rural population in China. The burden seemed to be much lower than literature cited from other countries. It was reasonable to evaluate indirect economic burden of stroke using method in integrating DALYs with human capital, but it was difficult to calculate the DALYs.</p>

A retrospective study on the survival rate and risk factors of mortality among 617 inpatients with ischemic stroke / 中华流行病学杂志

<p><b>OBJECTIVE</b>The purpose of this study was to describe survival status and risk factors of mortality on inpatients with ischemic stroke.</p><p><b>METHODS</b>617 patients with continuous ischemic stroke cases were collected from January 2002 to June 2005 retrospectively in the Department of Neurology, Xijing Hospital, Fourth Military Medical University. In order to perceive relevant information on survival and the cause of death. All patients were followed through phone calls or mailing. The follow-up program was completed in January 2006. Kaplan-Meier methods were used for survival description. Monovariant and multivariant Cox's proportional hazard regression model were used to analyze prognostic factors on mortality.</p><p><b>RESULTS</b>The longest time in the follow-up program was 47 months with 59 dropped-out cases, making the dropout rate as 9.5%. Of these patients, 80 cases died during the period of study(60 for ischemic stroke,3 for cerebral hemorrhage, 10 for cardiac disease, 7 for other cause). The median survival time was 42. 16 months. The survival rates of one-year, two-year and three-year period were 91.9%, 89.4% and 85.3%, respectively. Monovariant and multivariant Cox's proportional hazard regression model showed that the risk factors associated with mortality were old age (RR = 1.043, 95% CI: 1.013-1.074), lower Glasgow scores (RR = 0.855, 95% CI: 0.742-0.985) ,poor conscious levels(RR = 4.085, 95% CI: 2.128-7.844) and having complication (RR = 1.765, 95% CI: 1.108-2.812).</p><p><b>CONCLUSION</b>The results of this study suggested that the risk factors were old age, lower Glasgow scores, poor conscious levels and having complication on mortality of ischemic stroke.</p>

An 18-year follow-up study on the risk factors of deaths regarding chronic obstructive pulmonary disease in Xi'an, China / 中华流行病学杂志

<p><b>OBJECTIVE</b>To examine risk factors of chronic obstructive pulmonary disease (COPD) deaths in Chinese military elderly men.</p><p><b>METHODS</b>A cohort analytic study was carried out in Xi'an, China. A total of 1268 retired military males aged 55 or older were examined in 1987 and followed for 18 years. Main outcome measures were all causes and COPD deaths.</p><p><b>RESULTS</b>The total person-years of follow-up from 1987 until June 2005 was 18 766.28. The mean follow-up time was 14.35 years; A total of 491 had died, with 748 alive and 29 lost of follow-up. COPD was the second cause of death in all deaths (16.90%). Results Univariate analysis of Cox model showed that age, number of smoking cigarettes per day, duration of smoking, negative affairs and existing COPD were risk factors of COPD deaths and the relative risks [95% confidence intervals (CI)] were 1.13 (1.09-1.17), 1.04 (1.02-1.06), 1.03 (1.01-1.04), 1.81 (2.85-6.77) and 4.39 (2.85-6.77) respectively. Data from Multivariate analysis of Cox model showed that age, number of smoking cigarettes per day and existing COPD were risk factors of COPD death with relative risks [95% confidence intervals (CI)] as 1.10 (1.06-1.15), 1.03 (1.01-1.06) and 3.07 (1.90-4.98) respectively. The risks for deaths increased significantly with increasing amount and duration of smoking resulting from all causes and COPD. Compared with current smokers, former smokers had lower risks of total mortality(excess risk reduction of 66.67%).</p><p><b>CONCLUSION</b>COPD was the second cause among all deaths in this cohort. Age, number of smoking cigarettes per day and existing COPD were the risk factors of COPD deaths which called for further survey to examine the relationship between quitting smoking and COPD deaths in this cohort.</p>

Screening of cellular proteins binding to the core region of hepatitis C virus RNA by ultraviolet cross-linking assay / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To screen cellular proteins binding to the core region of hepatitis C virus (HCV) from human hepatoma cells.</p><p><b>METHODS</b>Unlabeled and labeled RNA transcripts were prepared by in vitro transcription. Cytoplasmic extracts were prepared from human hepatoma cells HepG2. Ultraviolet (UV) cross-linking was used to screen the cellular proteins that would bind to the core region of HCV. Competition experiment was performed to confirm the specificity of the binding in which excess unlabeled RNA of HCV core region and plasmid RNA were used as competitors.</p><p><b>RESULTS</b>Two cellular proteins of 6.6 x 10(4) and 5.5 x 10(4) were found binding to the core region of HCV RNA by UV cross-linking assay. The unlabeled core region of HCV RNA could compete out this binding whereas the unlabeled plasmid RNA could not.</p><p><b>CONCLUSION</b>The cellular proteins from HepG2 cells could bind to the core region of HCV RNA.</p>

Analysis on direct economic burden of stroke in the rural population of Hanzhong, Shaanxi Province / 中华流行病学杂志

<p><b>OBJECTIVE</b>To analyze the direct economic burden of stroke in rural areas of Hanzhong.</p><p><b>METHODS</b>Plan on primary interview was made after the purpose of the study had been informed to the managers of the 'surveillance field base', heads and members of the monitor assistants and detailed information was collected in the fields. Every single patient of stroke was then interviewed by the above said interviewers,using a self-designed questionnaire. 164 patients with stroke were interviewed in 53 villages with 75,000 persons lived there. The main items involved in the questionnaire would include: costs for inpatient or outpatient, reaching-out fees, fee for accommodation during treatment as outpatient, costs for treatment at home, long term medicine, caregivers and funerals as well as average income.</p><p><b>RESULTS</b>The median of annual direct economic burden was 3100 Yuan for each patient in Hanzhong rural area. There were no significant differences seen between males and females or among age groups (P > 0.05). The proportion of patients with medians of annual direct economic burden of: 1000 Yuan and below, 1001-5000 Yuan, 5001-10,000 Yuan, 10,001-20,000 Yuan and over 20,001 Yuan, were 29.2%, 36.0%, 18.3%, 9.8% and 6.0% respectively. The median of annual direct economic burden of first episode stroke was 5500 Yuan for each patient, and that of stroke was 1700 Yuan for each chronic patient. The direct economic burden of first episode was significantly higher than that of stroke (P < 0.01). The costs of hospitalization, accommodation of hospitalization and treatment at home of middle-aged patients were significant higher than that of old age patients (P < 0.05).</p><p><b>CONCLUSION</b>In this study, the direct economic burden of stroke was 2.9 times of the annual personal average income, which was contrary to the reports from other countries. However, the State Health Bureau bore 87.1% of the direct economic burden for urban patients, but patients in the rural areas had to pay from their own pockets. The direct economic burden of stroke was heavy in Hanzhong rural region, which called for measures to be made to decrease the direct economic burden of stroke in the region.</p>

In vitro infection of human hepatoma (Hep G2) cell line by hepatitis B virus positive serum / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To establish a culture system of HBV positive serum infected Hep G2 cells in vitro.</p><p><b>METHODS</b>Hep G2 cells were seeded into six-well cluster dishes, at 1 x 10(-6) cells per well and incubated with 3 ml 10% fetal calf serum/ Dulbecco's modified Eagle's medium (10% FCS/DMEM) at 37 degrees in 5% CO2 air. At 24 h after plating, infection group Hep G2 cells were cultured with 0.5 ml HBV positive serum, in control group HBV negative serum was used, 24 h later the inoculums was removed. The cells were then extensively washed with 0.01 mol/L phosphate-buffered saline (PBS). After washing with PBS, 4 ml 2% FCS/DMEM were added to each well and the medium was collected every 12 h. ELISA method was used to detect HBsAg in culture medium. HBV DNA in cells and culture medium was detected by PCR.</p><p><b>RESULTS</b>In infection group, HBsAg could be detected from cell culture medium from 12 h (after PBS washed) to 84 h. HBV DNA could be detected by PCR in culture medium and cells.</p><p><b>CONCLUSION</b>Infection of Hep G2 cells by HBV positive serum is feasible.</p>

The use of unsupervised classification of Landsat-5 TM images in analysing the types of vegetation in the areas of "breaking dikes or opening sluice for water store" / 中华流行病学杂志

<p><b>OBJECTIVE</b>To clarify the change of vegetation types and its relationship between the density of alive-snails in the areas of "breaking dikes or opening sluice for water store" in Jicheng.</p><p><b>METHODS</b>Synthesized false color images of Jicheng before and after 1998 (1994 and 2003) were classified without supervision and results were compared. Vegetation types were identified on the spot.</p><p><b>RESULTS</b>Normalized difference vegetation index (NDVI) of snail habitats before 1998 were between 126 and 183 in Jicheng, whose vegetation types were mainly paddy, cotton and cabbage. NDVI of snail habitats in Jicheng after 1998 were between 152 and 193 whose vegetation types were mainly poplar forest, bulrush and grass. Areas of snail habitats increased from 64.64% to 66.47%. Snail habitats were mostly composed of mixed vegetation types and mono-typed vegetation was hardly found. According to the density of alive-snails orders from high to low were poplar forest and bulrush, poplar forest and grass, bulrush.</p><p><b>CONCLUSION</b>Vegetation types would not be identified by unsupervised classification only. Poplar forest, bulrush and grass were closedly related to the density of alive-snails.</p>

A retrospective study on the association of sexual behavior during pregnancy with intrauterine infection of hepatitis B virus / 中华流行病学杂志

<p><b>OBJECTIVE</b>Case-control study was employed to explore the association of sexual behavior during pregnancy and hepatitis B virus (HBV) intrauterine infection.</p><p><b>METHODS</b>212 HBsAg positive pregnant women were consecutively collected and investigated as objects. Those neonates detected for HBsAg with S/N value > or = 5 by Abbott reagents in periphery sera were selected as cases, others as controls. Information on sexual behavior during pregnancy, maternal HBeAg status and other factors was collected, and were analyzed with univariate analysis, multivariate logistic regression analysis, etc, to explore the association of factors with HBV intrauterine infection.</p><p><b>RESULTS</b>Ten of the 214 neonates were validated as occurrence of HBV intrauterine infection. Sexual behavior in the second trimester during pregnancy, with odd ratios 9.15 (95% CI: 1.10 - 76.28), as well as maternal positivity for HBeAg and HBV DNA, was significantly associated with HBV intrauterine infection, and sequently affirmed by multiple logistic regression analysis. The strength of association increased with frequency of sexual behavior. Interaction analysis suggested that there was synergistic interaction between maternal positivity of HBeAg and sexual behavior in the second trimester.</p><p><b>CONCLUSION</b>Sexual behavior was a newly discovered risk factor for HBV intrauterine infection, which need to be estimated in future studies. Inhibition of virus replication and moderate control of sexual behavior would be helpful to prevent HBV intrauterine infection.</p>

Application of "time series analysis" in the prediction of schistosomiasis prevalence in areas of "breaking dikes or opening sluice for waterstore" in Dongting Lake areas, China / 中华流行病学杂志

<p><b>OBJECTIVE</b>To provide the fittest model for forecasting schistosomiasis prevalence in Haokou village of "breaking dikes or opening sluice for waterstore" in Dongting Lake areas by comparing the results of Moving Average, Exponential Smoothing, Autoregressive Model and Autoregressive integrated moving average model (ARIMA model) from 1990 to 2002.</p><p><b>METHODS</b>Error sum of square of four statistical methods was compared and the fittest model was chosen.</p><p><b>RESULTS</b>Error sum of square of predicted schistosomiasis prevalence rates in Haokou village from 1994 to 2002 were 39.40, 39.86, 26.63, 22.54 respectively.</p><p><b>CONCLUSION</b>ARIMA model seemed to be the fittest one in the prediction of schistosomiasis prevalence in Haokou village of "breaking dikes or opening sluice for waterstore" in Dongting Lake from 1990 to 2002.</p>