[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.

[Decoding the evolution of preventive chemotherapy schemes for schistosomiasis in China to improve the precise implementation of the WHO guideline on control and elimination of human schistosomiasis].

Preventive chemotherapy is one of the pivotal interventions for the control and elimination of schistosomiasis, which is effective to reduce the morbidity and prevalence of schistosomiasis. In order to promote the United Nations' sustainable development goals and the targets set for schistosomiasis control in the Ending the neglect to attain the Sustainable Development Goals: a road map for neglected tropical diseases 2021-2030, WHO released the guideline on control and elimination of human schistosomiasis in 2022, with major evidence-based updates of the current preventive chemotherapy strategy for schistosomiasis. In China where great success has been achieved in schistosomiasis control, the preventive chemotherapy strategy for schistosomiasis has been updated several times during the past seven decades. This article reviews the evolution of the WHO guidelines on preventive chemotherapy and Chinese national preventive chemotherapy schemes, compares the current Chinese national preventive chemotherapy scheme and the recommendations for preventive chemotherapy proposed in the 2022 WHO guideline on control and elimination of human schistosomiasis, and proposes recommendations for preventive chemotherapy during the future implementation of the 2022 WHO guideline, so as to provide insights into schistosomiasis control among public health professionals engaging in healthcare foreign aid.

[Sharing the WHO guideline on control and elimination of human schistosomiasis to achieve the goal of schistosomiasis elimination in China].

Currently, the national schistosomiasis control program of China is moving from transmission interruption to elimination, and there are multiple challenges during the stage moving towards the progression of schistosomiasis elimination, including a high difficulty in shrinking snail-infested areas, unstable achievements for infectious source control, imperfect surveillance system and a reduction in schistosomiasis control and administration. Based on the core suggestions proposed in the 2022 WHO guideline on control and elimination of human schistosomiasis, recommendations on schistosomiasis surveillance system building, development of novel diagnostics, adjustment of the schistosomiasis control strategy and maintaining and improvements of the schistosomiasis control capability are proposed for the national schistosomiasis control program of China in the new era according to the actual status of schistosomiasis control in China. Formulation of the national schistosomiasis control strategy and goal from One Health perspective, verification of transmission interruption and elimination of schistosomiasis, precision implementation of schistosomiasis control interventions with adaptations to local circumstances, development and application of highly sensitive and specific diagnostics are recommended for elimination of schistosomiasis in China. In addition, the implementation of the 2022 WHO guideline on control and elimination of human schistosomiasis may guide the elimination of schistosomiasis in China.

Quantification of peak blood flow velocity at the cardiac valve and great thoracic vessels by four-dimensional flow and two-dimensional phase-contrast MRI compared with echocardiography: a systematic review and meta-analysis.

AIM: To objectively examine the agreement and correlation between four-dimensional (4D) flow magnetic resonance imaging (MRI) and traditional two-dimensional (2D) phase-contrast (PC) MRI with the reference standard of Doppler echocardiography for measuring peak blood velocity at the cardiac valve and great arteries, and to assess if 4D flow MRI offers an advantage over the traditional 2D method. MATERIALS AND METHODS: The literature was searched systematically for studies that evaluate the degree of correlation and agreement between 4D flow MRI or 2D PC MRI and Doppler retrieved from PubMed, EMBASE, and the Cochrane Library. A meta-analysis was conducted to determine the peak velocity pooled bias with 95% limits of agreement (LoA) and correlation coefficient (r) for 4D flow MRI and 2D PC MRI compared with Doppler. RESULTS: Ten studies that compared 4D flow MRI with Doppler and 12 studies that compared 2D PC MRI with Doppler were included. 4D flow MRI showed an underestimation with bias and 95% LoA of -0.09 (-0.41, 0.24) m/s (p=0.079) while 2D PC MRI showed a poorer agreement with a bias and 95% LoA of -0.25 (-0.53, 0.03), p=0.596. 4D flow MRI and 2D PC MRI showed a strong correlation with R=0.80 (95% CI 0.75, 0.84; p<0.001) and R=0.83 (95% CI 0.79, 0.87; p<0.001), respectively. CONCLUSION: In this meta-analysis, 4D flow MRI provides improved assessment of peak velocity when compared with traditional 2D PC MRI. 4D flow MRI can be considered an important complement or substitute to Doppler echocardiography for peak velocity assessment.

[Endemic situation of schistosomiasis in national surveillance sites of Zhejiang Province from 2015 to 2019].

OBJECTIVE: To analyze the endemic situation of schistosomiasis in national surveillance sites of Zhejiang Province, so as to provide the scientific evidence for formulating the new schistosomiasis surveillance program and consolidating schistosomiasis elimination achievements. METHODS: A total of 54 to 55 national surveillance sites and 6 risk monitoring sites were assigned in historical endemic regions of Zhejiang Province from 2015 to 2019, where the Schistosoma japonicum infections in humans, livestock, snails and wild feces were monitored. All data pertaining to the surveillance results were descriptively analyzed. RESULTS: There were 34 530 person-time local residents receiving serological screening for S. japonicum infections in national surveillance sites of Zhejiang Province from 2015 to 2019, and the seroprevalance of S. japonicum infections were 0.29% to 0.68%; however, no egg-positives were detected. During the period from 2015 to 2019, there were 62 086 person-time mobile populations receiving serological screening for S. japonicum infections in national surveillance sites of Zhejiang Province, and the seroprevalance of S. japonicum infections were 0.32% to 0.56%; additionally, there were 27 egg-positives identified, including 3 imported cases with schistosomiasis haematobia and one case with acute schistosomiasis japonica, indicating that the adjusted prevalence of Schistosoma infections were 0.01% to 0.07% among mobile populations. A total of 829 livestock were examined for S. japonicum infections, with no positives detected. There were 10.55 hm2 and 2.89 hm2 snail habitats found in national surveillance sites and risk monitoring sites of Zhejiang Province during the 5-year period, respectively; however, no S. japonicum infections were identified in snails. Moreover, a total of 305 wild feces were tested for S. japonicum infections, and no egg-positives were identified. CONCLUSIONS: The schistosomiasis elimination achievement have been consolidated in Zhejiang Province; however, the risk factors of re-emerging schistosomiasis have not been completely eliminated, such as residual snails and imported schistosomiasis cases. Further surveillance and control activities of snails and the source of S. japonicum infections should be reinforced.

[Expert consensus on the strategy and measures to interrupt the transmission of schistosomiasis in China].

Since 2015 when the transmission of schistosomiasis was controlled in China, the country has been moving towards elimination of schistosomiasis, with the surveillance-response as the main interventions for schistosomiasis control. During the period of the 13th Five-Year Plan, the transmission of schistosomiasis had been interrupted in four provinces of Sichuan, Jiangsu, Yunnan and Hubei and the prevalence of schistosomiasis has been at the historically lowest level in China. As a consequence, the goal set in The 13th Five-Year National Schistosomiasis Control Program in China is almost achieved. However, there are multiple challenges during the stage moving towards elimination of schistosomiasis in China, including the widespread distribution of intermediate host snails and complicated snail habitats, many types of sources of Schistosoma japonicum infections and difficulty in management of bovines and sheep, unmet requirements for the current schistosomiasis control program with the currently available tools, and vulnerable control achievements. During the 14th Five-Year period, it is crucial to consolidate the schistosomiasis control achievements and gradually solve the above difficulties, and critical to provide the basis for achieving the ultimate goal of elimination of schistosomiasis in China. Based on the past experiences from the national schistosomiasis control program and the challenges for schistosomiasis elimination in China, an expert consensus has been reached pertaining to the objectives, control strategy and measures for The 14th Five-Year National Schistosomiasis Control Program in China, so as to provide insights in to the development of The 14th Five-Year National Schistosomiasis Control Program in China.

[Surveillance and control strategy of imported schistosomiasis mansoni: an expert consensus].

In 1980s, Biomphalaria straminea, an intermediate host of Schistosoma mansoni, was found in Shenzhen City, Guangdong Province, China, and currently, this snail has colonized in Shenzhen City and spread to peripheral cities involving of Dongguan and Huizhou. Since imported cases infected with S. mamoni have been reported from time to time in China, Mainland China is facing the potential risk of transmission of schistosomiasis mansoni. With the deepening of the opening-up policy, notably the implementation of the Belt and Road Initiative, there is an increase in the risk of transmission of schistosomiasis mansoni in Mainland China. Increasing the understanding on schistosomiasis mansoni, improving the awareness toward schistosomiasis mansoni prevention and control, and identifying, reporting and managing imported cases with S. mansoni infection or pathogen carriers, are of particular importance to prevent the development of entire life cycle of S. mansoni and the resultant schistosomiasis mansoni transmission in China. To protect public health, a consensus has been reached pertaining to the surveillance and control strategy of imported schistosomiasis mansoni by Chinese infectious disease experts and parasitologists, with aims to improve the awareness and capability for the diagnosis, treatment and control of imported schistosomiasis mansoni among Chinese disease control and prevention institutions and medical institutions, and decrease and even eliminate the risk of schistosomiasis mansoni transmission in China.

Effect of branched chain amino acids on perioperative temperature, glucose level and fat metabolism in patients with gastrointestinal tumors.

This study aimed to investigate the effect of branched chain amino acids (BCCAs) on perioperative temperature, glucose and fat metabolism in patients with gastrointestinal tumors. Fifty-six patients undergoing gastrointestinal tumor surgery were included in the study and randomly divided into two groups of 28 patients each: an experimental and a control group. During surgery, the experimental group received 5.64mL·Kg-1·h-1(4KJ·Kg-1·h-1) of BCCAs intravenously, through an infusion pump, and the control group received an equal volume of NaCl 0.9%. Vital signs were continuously monitored during the operation. Nasopharynx temperature levels of glucose, insulin, free fatty acid and ketone bodies in the blood were determined 30 min before anesthesia (t 0), after anesthesia and before surgery (t 1), 30 min after the start of surgery (t 2), 2 h after start of surgery (t 3) and 1 h after the end of surgery (T4). Patients’ shivering intensity (Wrench grading) and pain degree [Visual analogue scale (VAS)]) were estimated 1 h after the endotracheal tube was removed. Nasopharynx temperature was decreased (p less than 0.05) in both groups after anesthesia induction, while 1 h after the tube was removed it was higher in the experimental group than the control group (p less than 0.05); compared with pre-surgery values, blood glucose levels were increased during surgery in both groups, but the experimental group had a lower increasing trend compared to the control group, though without statistical significance (p>0.05). Insulin levels were significantly different between the two groups at all time-points during surgery (p less than 0.05). However, the rising trend of the experimental group was more dramatic during the period from t 0 to t 3. One hour after surgery (t 4), the insulin levels varied, but still at higher levels than pre-surgery, with a significant difference (p less than 0.05); levels of free fatty acids had a downward trend in both groups, and levels in the experimental group continued to decline until 1 h after surgery. Patients who received branched chain amino acids had less temperature decrease during surgery. Moreover, blood glucose levels were not increased, which limits fat mobilization and leads to production of ketone bodies, reduces the shivering and its intensity after surgery.

Effect of dexmedetomidine on stress reactions and cellular immune function of patients in perioperative period following radial resection for rectal carcinoma.

The study aimed to assess the effects and the further mechanism of action of dexmedetomidine with regard to stress reactions and cellular immune function of patients during the perioperative period following radical resection for rectal carcinoma. A total of 36 patients with rectal carcinoma were selected for radical resection under general anesthesia. The patients were divided into two groups, namely an experimental and a control group. In the experimental group (dexmedetomidine group) 1 µg/ kg/bw dexmedetomidine was injected intravenously 10 min prior to the induction of general anesthesia, and then infusion was carried out at a rate of 0.2 µg·kg-1·h-1 for 30 min prior to the end of surgery. With regard to the control group, the same amount of normal saline (NS) was infused with the same method as the experimental group. Controlled intravenous analgesia was conducted following surgery to all of the patients. Regarding the effect of dexmedetomidine on the reaction of stress, a decrease of VAS scores was noted in the experimental group following extubation compared with the control group (P less than 0.05). Furthermore, a significant decrease in the consumption of morphine in the first 24 h was observed that was accompanied by a decrease of plasma cortisol levels at 6 and 24 h following surgery compared with the control group. The levels of IFN-γ/IL-10 in the experimental group were lower than those of the control group (P less than 0.05). The percentages of CD8+ and CD4+/CD8+ cells in the experimental group were increased compared with those of the control group (P less than 0.05). By infusing dexmedetomidine continuously, stress reactions during the perioperative period were significantly decreased, whereas the analgesic effects of opioid were increased.

Effect of diurnal temperature range on the outpatient visits for acute bronchitis in children: a time-series study in Hefei, China.

OBJECTIVES: To determine the relationship between diurnal temperature range (DTR) and outpatient visits for childhood acute bronchitis (AB) in Hefei, China, to analyze whether DTR effect was delayed, and to explore the susceptible populations. STUDY DESIGN: An ecological study. METHODS: A Poisson generalized linear regression model combined with a distributed lag non-linear model was used to analyze the relationship between DTR and childhood AB from Hefei, China during 2010-2013, after adjusting for long-term trend and seasonality, mean temperature and relative humidity. RESULTS: An adverse effect of DTR on childhood AB was observed, and the impact of DTR was greatest at three days lag, with a 1.0% (95% confidence interval = 0.5-1.6%) increase of AB cases per 1 °C increment of DTR. Female children and children aged 0-4 years appeared to be more vulnerable to DTR effect than other children. CONCLUSIONS: Our study suggests that large DTR may increase the incidence of childhood AB in Hefei, particularly for those who are female and young. Caregivers and health practitioners should be made aware of the potential threat posed by large DTR.

Impacts of ambient temperature on the burden of bacillary dysentery in urban and rural Hefei, China.

Bacillary dysentery continues to be a major health issue in developing countries and ambient temperature is a possible environmental determinant. However, evidence about the risk of bacillary dysentery attributable to ambient temperature under climate change scenarios is scarce. We examined the attributable fraction (AF) of temperature-related bacillary dysentery in urban and rural Hefei, China during 2006-2012 and projected its shifting pattern under climate change scenarios using a distributed lag non-linear model. The risk of bacillary dysentery increased with the temperature rise above a threshold (18·4 °C), and the temperature effects appeared to be acute. The proportion of bacillary dysentery attributable to hot temperatures was 18·74% (95 empirical confidence interval (eCI): 8·36-27·44%). Apparent difference of AF was observed between urban and rural areas, with AF varying from 26·87% (95% eCI 16·21-36·68%) in urban area to -1·90% (95 eCI -25·03 to 16·05%) in rural area. Under the climate change scenarios alone (1-4 °C rise), the AF from extreme hot temperatures (>31·2 °C) would rise greatly accompanied by the relatively stable AF from moderate hot temperatures (18·4-31·2 °C). If climate change proceeds, urban area may be more likely to suffer from rapidly increasing burden of disease from extreme hot temperatures in the absence of effective mitigation and adaptation strategies.

The Establishment and Function of Schistosomiasis Surveillance System Towards Elimination in The People's Republic of China.

Schistosoma japonicum is the main schistosome species in The People's Republic of China, causing intestinal schistosomiasis, a debilitating disease of public health importance. The People's Republic of China used to be heavily endemic with schistosomiasis, but great progress has been made through the vigorous efforts of the national control programmes in the last six decades. Presently, efforts are geared towards eliminating schistosomiasis from The People's Republic of China by the end of 2025 through effective schistosomiasis surveillance, an important component in the drive towards schistosomiasis elimination. Therefore, this article explicitly outlines the development and progress made in schistosomiasis surveillance since 1990 with a special focus on the new surveillance system in use. Although the surveillance system has steadily improved over the years, it is faced with many challenges. Hence, more efforts are needed to establish an effective and sensitive evaluation system for the national schistosomiasis elimination programme in The People's Republic of China.

Biology and Control of Snail Intermediate Host of Schistosoma japonicum in The People's Republic of China.

Schistosomiasis caused by Schistosoma japonicum is a severe parasitic disease in The People's Republic of China and imposed considerable burden on human and domestic animal health and socioeconomic development. The significant achievement in schistosomiasis control has been made in last 60years. Oncomelania hupensis as the only intermediate host of S. japonicum plays a key role in disease transmission. The habitat complexity of the snails challenges to effective control. In this review we share the experiences in control and research of O. hupensis.

Development and Application of Diagnostics in the National Schistosomiasis Control Programme in The People's Republic of China.

Schistosomiasis, caused by Schistosoma japonicum infection to human, has a documented history of more than 2100years in The People's Republic of China. In spite of great progress in controlling the disease, it is still one of the most serious parasitic diseases in the country. The study and use of diagnostic techniques play an important role in the targeting of chemotherapy that has been continuously applied in the national schistosomiasis control programme for several decades. This paper reviews the development and application of parasitological, immunodiagnostic and molecular diagnostic technology for S. japonicum in The People's Republic of China with a brief mention of diagnostic imagery, such as ultrasound and radiology. When analysing the efficacy and performance characteristics of the main diagnostic techniques in current use, it becomes apparent that approaches that worked well in the past are less suitable now as successful control has shifted the endemic situation towards control and interruption of transmission. The conclusion is that a mutable approach must be adopted choosing the most appropriate diagnostic technique for each control stage (and area), thus modifying the methodology according to the prevailing diagnostic needs in terms of sensitivity and specificity.

Tuberculosis vs. chronic lymphocytic leukaemia in mediastinal lymph nodes using computed tomography.

BACKGROUND: The enlarged mediastinal lymph nodes caused by tuberculosis (TB) and chronic lymphocytic leukaemia (CLL) are similar, sometimes resulting in misdiagnosis of the two diseases. OBJECTIVE: To determine the differential characteristics of enlarged mediastinal lymph nodes caused by TB and CLL using multidetector-row computed tomography (MDCT). MATERIALS AND METHODS: We conducted a retrospective analysis for the anatomical distribution and enhancement patterns of mediastinal lymph nodes on MDCT in 67 consecutive patients with newly diagnosed untreated TB (58%) and CLL (42%). RESULTS: Concerning the main anatomic distribution of lymph nodes, TB involved the 4R (n = 32, 82%) and 10R (n = 27, 69%) regions more often than CLL (n = 16, 57%; n = 12, 43%, respectively). Contrast region 1 had a greater tendency to be affected in CLL (n = 16, 57%) than TB (n = 11, 28%). TB showed peripheral enhancement in 28 cases (72%), frequently with a multilocular appearance, compared to CLL, which showed no peripheral enhancement in these cases. Homogeneous enhancement was more commonly seen in CLL than in TB (82% vs. 10%, P < 0.01). CONCLUSION: The distribution and enhancement pattern of enlarged lymph nodes on MDCT was useful in differentiating TB and CLL.

Tuberculosis in the abdominal lymph nodes: evaluation with contrast-enhanced magnetic resonance imaging.

OBJECTIVE: To determine magnetic resonance imaging (MRI) characteristics of abdominal tuberculous lymphadenopathy. DESIGN: Twenty-six consecutive patients (20 men, 6 women; mean age 38 ± 14 years) with documented tuberculosis (TB) in the abdominal lymph nodes were recruited and retrospectively analysed for contour, size, enhancement patterns, signal intensity and anatomic distribution of enlarged lymph nodes, as well as extra-nodal lesions. RESULTS: The main anatomic distribution of lymph node involvement included the lesser omentum (80.8%, 21/26), anterior pararenal space (96.2%, 25/26), mesentery (34.6%, 9/26) and the upper para-aortic region (73.1%, 19/26), and, exceptionally, the lower para-aortic region (19.2%, 5/26). Contrast-enhanced T1-weighted images demonstrated predominantly peripheral enhancement in 24 cases (92.3%, 24/26), most of which (80.8%, 21/26) had enlarged lymph nodes with conglomerated multilocular appearance. In 24 peripheral enhancement cases, the contrast-to-noise ratio values were significantly higher for the marginal zones of the enlarged lymph nodes compared to the central zones in each contrast phase (all P < 0.05); the difference in signal-to-noise ratio between the central and marginal zones was found at the portal venous phase (P = 0.04). CONCLUSION: The particular anatomic distribution and peripheral enhancement patterns of contrast-enhanced MRI with quantitative analysis might be useful in the diagnosis of abdominal tuberculous lymphadenopathy.

Differentiation of tuberculosis from lymphomas in neck lymph nodes with multidetector-row computed tomography.

BACKGROUND: Tuberculosis (TB) of the cervical lymph nodes may mimic lymphoma. OBJECTIVE: To evaluate multidetector-row computed tomographic (MDCT) imaging criteria for differentiating between the two diseases. MATERIALS AND METHODS: We retrospectively reviewed the anatomical distribution and CT enhancement patterns of the nodes in 81 patients, 27 (33%) with untreated TB and 54 (67%) with untreated lymphomas involving cervical lymph nodes. Of the patients with lymphomas, 19 (35%) had Hodgkin's disease and 35 (65%) had non-Hodgkin's lymphoma. RESULTS: TB predominantly involved the upper cervical nodes. The supraclavicula fossa nodes on MDCT were involved more often in Hodgkin's disease (n = 15, 79%) and non-Hodgkin's lymphoma (n = 25, 71%) than in TB (n = 3, 11%). Tuberculous lymphadenopathy commonly showed peripheral enhancement, frequently with a multilocular appearance. Peripheral enhancement was significantly more frequent in TB (n = 19, 70%) than in Hodgkin's disease (n = 1, 5%) and non-Hodgkin's lymphoma (n = 1, 3%), but homogeneous enhancement was less common in the TB group. CONCLUSION: Our findings indicate that a specific enhancement pattern of lymphadenopathy seen on MDCT was useful in differentiating between untreated TB and lymphomas of the cervical lymph nodes.

Differentiation between tuberculosis and lymphoma in mediastinal lymph nodes: Evaluation with contrast-enhanced MDCT.

AIM: To determine the specific imaging criteria on contrast-enhanced multidetector computed tomography (MDCT) for differentiating between tuberculosis and lymphoma in mediastinal lymph nodes. MATERIALS AND METHODS: The anatomical distribution and enhancement patterns of mediastinal lymph nodes on contrast-enhanced MDCT were reviewed in 37 patients with tuberculosis and 54 patients with lymphoma. Of the patients with lymphoma, 18 had Hodgkin's disease and 36 had non-Hodgkin's lymphoma. RESULTS: Region 10R was involved more often in tuberculosis than in Hodgkin's disease and non-Hodgkin's lymphoma. Region 6 had a higher tendency to be affected in Hodgkin's disease and non-Hodgkin's lymphoma compared with tuberculosis. Tuberculosis showed peripheral enhancement in 78% of cases, frequently with a multilocular appearance, compared to Hodgkin's disease and non-Hodgkin's lymphoma, which showed peripheral enhancement in only 6 and 3% of cases, respectively. Homogeneous enhancement was more commonly seen in lymphoma (83% for Hodgkin's disease, and 83% for non-Hodgkin's lymphoma) than in tuberculosis (8%). In the determination of tuberculosis, results showed that when a peripheral enhancement pattern was seen, sensitivity was 78%, specificity was 96%, and accuracy was 89%. In the determination of lymphoma, results showed that when a homogeneous enhancement pattern was seen, sensitivity was 83%, specificity was 92%, and accuracy was 87%. CONCLUSION: The findings of the present study indicate that specific anatomical distribution and enhancement patterns of lymphadenopathy shown on contrast-enhanced MDCT can be useful in differentiating tuberculosis from lymphoma of mediastinal lymph nodes.