Genomic bacterial load associated with bacterial genotypes and clinical characteristics in patients with scrub typhus in Hainan Island, Southern China.

Scrub typhus, caused by mite-borne Orientia tsutsugamushi (O. tsutsugamushi), is a major febrile disease in the Asia-Pacific region. The DNA load of O. tsutsugamushi in the blood was previously found to be significantly higher in patients with fatal disease than those with non-fatal disease and correlated with the duration of illness, presence of eschar, and hepatic enzyme levels. In this prospective observation study, we analyzed the association of bacterial DNA load with clinical features, disease severity, and genotype using real-time PCR targeting the 56 kDa TSA gene of O. tsutsugamushi in the blood samples of 117 surviving patients with scrub typhus who had not received appropriate antibiotic treatment. The median O. tsutsugamushi DNA load was 3.11×103 copies/mL (range, 44 to 3.3×106 copies/mL). The severity of patients was categorized as mild, moderate, and severe based on the number of dysfunctional organs, and no significant difference in O. tsutsugamushi DNA load was found among these groups. Patients infected with the Karp group showed a significantly higher O. tsutsugamushi DNA load than those in the Gilliam (P < 0.05) and TA763 (P < 0.01) groups. Patients belonging to the Li ethnic group showed a significantly higher DNA load than those in the Han ethnic groups. The blood bacterial DNA load of patients showed no significant difference between groups divided by gender, age, with or without eschar, or the season of disease onset. The highest body temperature recorded during fever onset was positively correlated with O. tsutsugamushi DNA load (ρ = 0.272, P = 0.022). Correlation analyses indicated that the serum total bilirubin level was positively correlated with O. tsutsugamushi DNA load. In conclusion, the findings in this study demonstrated the association of DNA load of O. tsutsugamushi with the severity and genotype in patients with scrub typhus in Hainan, China.

Quantifying the spatiotemporal evolution characteristics of medical waste generation during the outbreak of public health emergencies.

Based on the medical waste quantity and patient data during the corona virus disease 2019 (COVID-19) outbreak in China, this study used scenario analysis to quantitatively analyze the temporal and spatial evolution of medical waste generation during the pandemics. First, the results show that the estimated medical waste per capita reached 15.4 kg/day if only patients were considered in Scenario 1, while the figures were reduced to 3.2 kg/day in Scenario 2 and 2.5 kg/day in Scenario 3 when the effects of both the patient type and the number of medical staffs were considered. The estimated results also demonstrated that the per capita medical waste related to the epidemic showed the characteristics of a U-shaped and trailing phenomenon over time. Then, the amount of medical waste related to the COVID-19 generated that generated due to COVID-19 was estimated in Hubei, Heilongjiang, Zhejiang, Henan and Hunan provinces under Scenario 2 and Scenario 3. The results indicated that the spatiotemporal evolution characteristics of five provinces show the significant differences, and the patient type has a remarkable influence on the generation of medical waste. Finally, a novel decomposition-ensemble approach was designed to make a better short-term forecasting effect for future medical waste generation in different provinces. Supplementary Information: The online version contains supplementary material available at 10.1007/s10163-022-01523-5.

Analysis of the pollution status of paralytic shellfish poisons in shellfish sold in Hainan Province, 2018-2021 / 中国热带医学

@#Abstract: Objective　To investigate the pollution of paralytic shellfish poisons (PSP) in shellfish sold in Hainan Province from 2018 to 2021. Methods　From 2018 to 2021, the content of 10 paralytic shellfish poisons including saxitoxin (STX), neosaxitoxin (neoSTX), gonyautoxins 1 (GTX1), gonyautoxins 2 (GTX2), gonyautoxins 3 (GTX3), gonyautoxins 4 (GTX4), gonyautoxins 5 (GTX5), decarbamoylsaxitoxin (dcSTX), decarbamoylgonyau toxins 2 (dcGTX2) and decarbamoylgonyau toxins 3 (dcGTX3) in 7 kinds of shellfish commonly sold in 13 cities and counties in Hainan province was analyzed. Results　The detection rate of PSP in 360 shellfish samples was 10.3%. Among them, the highest detection rate of STX was 5.83%, followed by GTX2 detection rate of 4.17%; the detection rate of neoSTX and GTX3 were both 1.67%; the detection rate of GTX1 was 1.39%. None of the five PSP, GTX4, GTX5, dcSTX, dcGTX2 and dcGTX3, were detected. Four types of PSP were detected in fanscallops, two were detected in oysters, mussels and Scapharca subcrenata, only one was detected in scallops, and no toxin contamination was detected in clams and razor clams. A single sample of fanscallops detected a maximum of 4 PSP, and a single sample of oysters, scallops, mussels and Scapharca subcrenata detected a maximum of 1 PSP. The equivalence of PSP in all samples was ND-155.6 μg/kg.The annual detection rate of PSP from high to low was: 20.0% in 2020, 15.6% in 2019, 5.3% in 2018, and 2.0% in 2021, and none of the samples tested exceeded the standard. Continuously detectable STX in 2018-2020, all PSP that could be detected in 2018 were STX. In 2019, in addition to STX detected in scallops and Scapharca subcrenata, neoSTX was also detected in oysters, mussels and Scapharca subcrenata. In 2020, PSP was only detected from scallops, and GTX2 could be detected in all positive specimens, while 5 STX, 5 GTX1 and 6 GTX3 were detected. Only GTX2 detected from scallops in 2021. STX was detected in shellfish sold in 12 cities and counties, GTX2 can be detected in 10 cities and counties, neoSTX can be detected in 5 cities and counties, GTX1 and GTX2 were detected in 4 cities and counties respectively. Shellfish sold in Wenchang and Lingshui markets can detect 5 types of PSP. Conclusion　Some types of shellfish on the market in Hainan are contaminated with some kind of PSP pollution risks, and it is necessary to strengthen the supervision of PSP in marketed shellfish.

Biosafety risks and mitigation strategies for mosquito infection in Arthropod Containment Level-2 laboratory / 中国热带医学

@#Arthropods of medical importance such as mosquitoes, ticks and sandflies are one of the key drivers of arthropod-borne diseases outbreak, posing a great threat to global public health security. For further understanding the transmission mechanisms of arthropod-borne diseases and establishing the prevention and control measures, a series of experiments of arthropods infection need to be carried out under laboratory conditions. Besides the regular biosafety requirements, some specific considerations need to be taken into account when performing arthropod infection and the infected arthropod rearing. Except for the physical containment composed of biosafety facilities, a comprehensive assessment of the biosafety risks during operations and corresponding preventive measures are also critical to eliminate or mitigate the biosafety risks. In this paper, we introduce our practice in handling mosquito infection with Risk Group 2 pathogens in Arthropod Containment Level-2 (ACL-2) laboratory, with an aim to provide a reference for researchers in related fields.

Adsorption performance and mechanisms of Pb(II), Cd(II), and Mn(II) removal by a ß-cyclodextrin derivative.

In this study, the novel adsorbent PVA-TA-ßCD was synthesized via thermal cross-linking between polyvinyl alcohol and ß-cyclodextrin. The characterization methods SEM-EDS, FTIR, and XPS were adopted to characterize the adsorbent. The effect of pH, contact time, initial concentrations, and temperature during the adsorption of Pb(II), Cd(II), and Mn(II) onto the PVA-TA-ßCD was also investigated. In a single-component system, the data fitted well to pseudo-second-order, and film diffusion and intra-particle diffusion both played important roles in the adsorption process. As for isotherm study, it showed a heterogeneous adsorption capacity of 199.11, 116.52, and 90.28 mg g-1 for the Pb(II), Cd(II), and Mn(II), respectively. Competition between the ions existed in a multi-component system; however, owing to the stronger affinity of the PVA-TA-ßCD for Pb(II) relative to Cd(II) and Mn(II), the Pb(II) adsorption onto the PVA-TA-ßCD was less affected by the addition of the other metals, which could be effectively explained by the hard and soft acid and base theory (HSAB). Furthermore, PVA-TA-ßCD showed good reusability throughout regeneration experiments.

Comparison of mercury and methylmercury bioaccumulation in earthworms (Bimastus parvus) native to landfill-leachate-contaminated forest soil.

Total mercury (THg) and methylmercury (MeHg) bioaccumulation was explored in the Bimastus parvus species of earthworm (B. parvus) native to the leachate-contaminated forest soils around a Hg-polluted traditional landfill in Japan. General soil properties and concentrations of THg and MeHg in forest soils and in B. parvus were determined. The results indicated that the average THg concentrations in B. parvus and in forest soils in the leachate-contaminated sites were 10.21 and 14.90 times higher than those in the reference sites, respectively, whereas similar average MeHg concentrations were observed in forest soils (< 0.01 mg kg-1) and in B. parvus (0.100-0.114 mg kg-1) across all sampled sites. The average bioaccumulation factors of THg in B. parvus (BAFTHg) in forest soil were similar between the leachate-contaminated sites and the reference sites. Cluster and regression analyses demonstrated that the B. parvus Hg (THg and MeHg) and soil THg were positively correlated with each other and with soil organic matter (SOM) and clays, but were negatively correlated with sand and hardly correlated with silts and pH in leachate-contaminated forest soils. From these results, it was proposed that Hg exposure to food chains is possible through B. parvus, because B. parvus showed a high ability to accumulate THg and MeHg in both leachate-contaminated and reference forest soils. Together, these findings indicated that the role of B. parvus in MeHg production is not clear, and it is possible that the MeHg in B. parvus was firstly formed within forest soils and then accumulated in their tissues.

Spatial distribution characteristics of mercury in the soils and native earthworms (Bimastos parvus) of the leachate-contaminated zone around a traditional landfill.

The contents and spatial distribution of mercury (Hg), including soil-Hg fractionation and Hg-containing native earthworm Bimastos parvus (B. parvus) species, were investigated in the leachate-contaminated zone of a large traditional landfill, Japan. Soil-Hg was fractionated into 5 categories: F1/water soluble Hg (Hg-w), F2/human stomach acid soluble Hg (Hg-h), F3/organic-chelated (Hg-o), F4/elemental Hg (Hg-e), and F5/mercuric sulfide (Hg-s). The total mercury (T-Hg) and methylmercury (MeHg) of native B. parvus, and the geochemical properties of soils were examined in this study. Soil T-Hg concentration ranged between 0.227 and 2.919 mg kg-1 dry weight (dw). The T-Hg and MeHg concentrations of B. parvus species ranged from 1.242 to 6.775 mg kg-1 dw and from 0.031 to 0.218 mg kg-1 dw, respectively. Percentages of soil-Hg fractions were in the order of F3/Hg-o > F4/ Hg-e > F5/Hg-s > F1/Hg-w > F2/Hg-h, and the fractions of Hg-o and Hg-e were 55.50% and 35.31%, respectively. Similar distributions and close correlations between the levels of B. parvus Hg and soil Hg-o, Hg-e, and Hg-s were observed in this study. The distribution of Hg in B. parvus was associated with soil organic matter (SOM) content and particle size (sand, clay); however, it was not correlated with Hg-w or Hg-h. The results indicated that easily bioavailable and soluble Hg fractions (Hg-w, Hg-h) of the soil were not appropriate to illustrate the distribution of Hg in native B. parvus. Instead, the stable soil-Hg fractions (Hg-o, Hg-e, and Hg-s) demonstrated good relationships of spatial distribution with B. parvus Hg in leachate-contaminated soil. It is advisable to preclude the evaluation of Hg biological distribution using soluble Hg fractions only. Stable Hg fractions in leachate-contaminated soil should also be included for assessing the biological distribution of Hg in leachate-contaminated soils.

Rapid removal of Pb2+ from aqueous solution by phosphate-modified baker's yeast.

Phosphate-modified baker's yeast (PMBY) was prepared, and used as a novel bio-sorbent for the adsorption of Pb2+ from aqueous solution. The influencing factors, absorption isotherms, kinetics, and mechanism were investigated. The scanning electron microscopy (SEM), Fourier-transform infrared spectroscopy (FTIR) characterization and elemental analysis of PMBY showed that phosphate groups were successfully grafted onto the surface of yeast. The kinetic studies suggested that the adsorption process followed a pseudo-second-order chemisorption. The adsorption process of Pb2+ using PMBY was spontaneous and endothermic. Furthermore, the adsorption of Pb2+ on PMBY can rapidly achieve adsorption equilibrium (in just 3 min), and the maximum adsorption capacity of Pb2+ on PMBY was found to be 92 mg g-1 at 30 °C, which was about 3 times that of the pristine baker's yeast. The suggested mechanism for Pb2+ adsorption on PMBY was based upon ion-exchange, electrostatic interaction and chelation between the phosphate groups and Pb2+. However, compared with the pristine baker's yeast, the higher capacity and rapid adsorption of PMBY for Pb2+ was mainly due to the chelation and electrostatic interactions between the phosphate groups and Pb2+. In addition, the regeneration experiments indicated that the PMBY was easily recovered through desorption in 0.01 M HCl, and that PMBY still exhibited 90.77% of the original adsorption capacity for Pb2+ after five regeneration cycles. These results showed the excellent regeneration capability of PMBY for Pb2+ adsorption. PMBY has shown significant potential for the removal of heavy metals from aqueous solution due to its rapid adsorption, high-capacity and facile preparation.

Characterization and adsorption properties of cross-linked yeast/ß-cyclodextrin polymers for Pb(ii) and Cd(ii) adsorption.

In this study, a crosslinked yeast/ß-cyclodextrin polymer (Y-ß-CDP), for use as an effective adsorbent for removal Pb(ii) and Cd(ii) ions from aqueous solution, has been innovatively prepared by grafting ß-cyclodextrin (ß-CD) onto the surface of baker's yeast (BY) and thiomalic acid as a crosslinker. Several characterization techniques, such as SEM equipped with an EDS analyzer, FTIR, XRD, and XPS were employed characterize the Y-ß-CDP. The impact of various operating parameters, such as pH, adsorbent dosage, initial concentration of metal ions, contact time and solution temperature, as well as adsorption kinetics, isotherms and thermodynamics were systematically investigated. The adsorption of Pb(ii) and Cd(ii) on Y-ß-CDP reached equilibrium in 25 min, and the kinetic process conforms to the pseudo-second order model. The Langmuir model was used to describe the adsorption isotherm data better than the Freundlich model. The predicted maximum adsorption capacity at 25 °C for Pb(ii) and Cd(ii) was 150.08 and 102.80 mg g-1, respectively, when the initial concentration of metal ions was 120 mg L-1. The thermodynamic analysis revealed that the adsorption procedure of Pb(ii) and Cd(ii) onto Y-ß-CDP was spontaneous and endothermic. Furthermore, regeneration experiments demonstrated that Y-ß-CDP had excellent recyclability. Together, all results suggested that Y-ß-CDP could potentially be a promising adsorbent in the purification of water contaminated with heavy metal ions.

Simultaneous removal of cadmium, zinc and manganese using electrocoagulation: Influence of operating parameters and electrolyte nature.

In the present study, the influence of operating parameters and electrolyte nature on the simultaneous removal of toxic metals (cadmium, zinc and manganese) from synthetic smelting wastewater by batch electrocoagulation was investigated. This wastewater contained high concentrations of anion-cation electrolytes. Results indicated that the efficiency of heavy metals removal can be enhanced by increasing the solution pH and current density. The Fe-Fe electrode combination is more effective than the other combinations (Al-Al, Al-Fe and Fe-Al). The interaction of heavy metal ions showed that the increase of initial Zn2+ concentration adversely affects on Cd2+ removal. In addition, the single chloride system exhibits the optimum removal efficiency on Mn2+. Single sulfate and binary anion systems exert a more positive effect on Cd2+ and Zn2+ removal because of the stronger charge neutralization and destabilization of iron hydroxide flocs. Increases of Ca2+ and Mg2+ ions exert a significant negative effect on metal removal. However, the addition of a small amount of sodium chloride into a high sulfate and hardness solution can accelerate the removal of heavy metals. Finally, the sludge samples generated from electrocoagulation were characterized by XRD and SEM-EDS analyses.

Extensive Resistance of Anopheles sinensis to Insecticides in Malaria-Endemic Areas of Hainan Province, China.

Anopheles sinensis is one of the major malaria vectors and among the dominant species in Hainan Province, China. The resistance of An. sinensis to insecticides is an important threat to malaria control. However, few reports on insecticide resistance of An. sinensis were reported in this area. Eight districts in Hainan Province were selected as the study areas. Insecticide susceptibility bioassays were tested on wild-caught female mosquitoes of An. sinensis to 4% dichlorodiphenyltrichloroethane (DDT), 0.05% deltamethrin, and 5% malathion by using the World Health Organization standard resistance tube assay procedure. All the tested An. sinensis mosquitoes demonstrated resistance to 4% DDT, with less than 72% mortality in the standard assay. The populations from Baisha and Qiongzhong demonstrated possible resistance to 0.05% deltamethrin, with 94-95% mortality, whereas the populations from other districts demonstrated resistance to 0.05% deltamethrin in the standard assay. The populations from Baisha, Qiongzhong, and Dongfang demonstrated susceptibility to 5% malathion, but the populations from other districts demonstrated resistance. These results facilitate the improvement of effective control strategies for malaria vector mosquitoes in Hainan.

A Cost-Effectiveness Analysis of Plasmodium falciparum Malaria Elimination in Hainan Province, 2002-2012.

In Hainan Province, China, great achievements in elimination of falciparum malaria have been made since 2010. There have been no locally acquired falciparum malaria cases since that time. The cost-effectiveness of elimination of falciparum malaria has been analyzed in Hainan Province. There were 4,422 falciparum malaria cases reported from 2002 to 2012, more cases occurred in males than in females. From 2002 to 2012, a total of 98.5 disability-adjusted life years (DALYs) were reported because of falciparum malaria. Populations in the age ranges of 15-25 and 30-44 years had higher incidences and DALYs than other age groups. From 2002 to 2012, malaria-related costs for salaries of staff, funds from the provincial government, national government, and the GFATM were US$3.02, US$2.24, US$1.44, and US$5.08 million, respectively. An estimated 9,504 falciparum malaria cases were averted during the period 2003-2012. The estimated cost per falciparum malaria case averted was US$116.5. The falciparum malaria elimination program in Hainan was highly effective and successful. However, funding for maintenance is still needed because of imported cases.

Genetic diversity of Plasmodium vivax population before elimination of malaria in Hainan Province, China.

BACKGROUND: Hainan Province is one of the most severe endemic regions with high transmission of Plasmodium falciparum and Plasmodium vivax in China. However, the incidence of P. falciparum and P. vivax has dropped dramatically since 2007 and a national elimination malaria programme (NEMP) was launched after 2010. To better understand the genetic information on P. vivax population before elimination of malaria in Hainan Province, the extent of genetic diversity of P. vivax isolates in Hainan Province was investigated using four polymorphic genetic markers, including P. vivax merozoite surface proteins 1, 3α, and 3ß (pvmsp-1, pvmsp-3α, and pvmsp-3ß) and circumsporozoite protein (pvcsp). METHODS: Isolates of P. vivax (n = 27) from Hainan Province were collected from 2009 to 2010 and pvmsp-1 and pvcsp were analysed by DNA sequencing, respectively. Using polymerase chain reaction-restriction fragment length polymorphism were analysed in pvmsp-3α, and pvmsp-3ß. RESULTS: The DNA sequencing analysis on pvmsp1 revealed that there were three allele types: Salvador-1 (Sal-1), Belem and recombinant (R) types. Among them, Sal-1 type was a dominant strain with eight variant subtypes (88.9%), whereas R- (3.7%) and Belem-type strains (7.4%) had one variant subtypes, respectively. All the isolates carried pvcsp with VK210 type accounting for 85.2% (23/27 isolates) and VK247 type accounting for 14.8% (4/27). Only type A and type B alleles were successfully amplified in pvmsp-3α gene, and a high level of polymorphism was observed in pvmsp-3α. Considering pvmsp-3ß gene, type A was the predominant type in 17 isolates (63%), whereas type B was dominant in only ten isolates (37%). CONCLUSION: The present data indicate that there was high degree of genetic diversity among P. vivax population in Hainan Province of China during the pre-elimination stage of malaria, with 26 unique haplotypes observed among 27 samples.

Sensitivity of Plasmodium falciparum to antimalarial drugs in Hainan Island, China.

Pyronaridine and artesunate have been shown to be effective in falciparum malaria treatment. However, pyronaridine is rarely used in Hainan Island clinically, and artesunate is not widely used as a therapeutic agent. Instead, conventional antimalarial drugs, chloroquine and piperaquine, are used, explaining the emergence of chloroquine-resistant Plasmodium falciparum. In this article, we investigated the sensitivity of P. falciparum to antimalarial drugs used in Hainan Island for rational drug therapy. We performed in vivo (28 days) and in vitro tests to determine the sensitivity of P. falciparum to antimalarial drugs. Total 46 patients with falciparum malaria were treated with dihydroartemisinin/piperaquine phosphate (DUO-COTECXIN) and followed up for 28 day. The cure rate was 97.8%. The mean fever clearance time (22.5 ± 10.6 hr) and the mean parasite clearance time (27.3 ± 12.2 hr) showed no statistical significance with different genders, ages, temperatures, or parasite density (P > 0.05). The resistance rates of chloroquine, piperaquine, pyronarididine, and artesunate detected in vitro were 71.9%, 40.6%, 12.5%, and 0%, respectively (P < 0.0001). The resistance intensities decreased as follows: chloroquine > piperaquine > pyronarididine > artesunate. The inhibitory dose 50 (IC50) was 3.77 × 10(-6) mol/L, 2.09 × 10(-6) mol/L, 0.09 × 10(-6) mol/L, and 0.05 × 10(-6) mol/L, and the mean concentrations for complete inhibition (CIMC) of schizont formation were 5.60 × 10(-6) mol/L, 9.26 × 10(-6) mol/L, 0.55 × 10(-6) mol/L, and 0.07 × 10(-6) mol/L, respectively. Dihydroartemisinin showed a strong therapeutic effect against falciparum malaria with a low toxicity.

Eliminating Plasmodium falciparum in Hainan, China: a study on the use of behavioural change communication intervention to promote malaria prevention in mountain worker populations.

BACKGROUND: In the island of Hainan, the great majority of malaria cases occur in mountain worker populations. Using the behavioral change communication (BCC) strategy, an interventional study was conducted to promote mountain worker malaria prevention at a test site. This study found the methods and measures that are suitable for malaria prevention among mountain worker populations. METHODS: During the Plasmodium falciparum elimination stage in Hainan, a representative sampling method was used to establish testing and control sites in areas of Hainan that were both affected by malaria and had a relatively high density of mountain workers. Two different methods were used: a BCC strategy and a conventional strategy as a control. Before and after the intervention, house visits, core group discussions, and structural surveys were utilized to collect qualitative and quantitative data regarding mountain worker populations (including knowledge, attitudes, and practices [KAPs]; infection status; and serological data), and these data from the testing and control areas were compared to evaluate the effectiveness of BCC strategies in the prevention of malaria. RESULTS: In the BCC malaria prevention strategy testing areas, the accuracy rates of malaria-related KAP were significantly improved among mountain worker populations. The accuracy rates in the 3 aspects of malaria-related KAP increased from 37.73%, 37.00%, and 43.04% to 89.01%, 91.53%, and 92.25%, respectively. The changes in all 3 aspects of KAP were statistically significant (p < 0.01). In the control sites, the changes in the indices were not as marked as in the testing areas, and the change was not statistically significant (p > 0.05). Furthermore, in the testing areas, both the percentage testing positive in the serum malaria indirect fluorescent antibody test (IFAT) and the number of people inflicted decreased more significantly than in the control sites (p < 0.01). CONCLUSION: The use of the BCC strategy significantly improved the ability of mountain workers in Hainan to avoid malarial infection. Educational and promotional materials and measures were developed and selected in the process, and hands-on experience was gained that will help achieve the goal of total malaria elimination in Hainan.

Pulmonary embolism with acute pancreatitis: a case report and literature review.

Acute pancreatitis is an inflammatory disease characterized by local tissue injury which can trigger a systemic inflammatory response. So vascular complications of pancreatitis are a major cause of morbidity and mortality. Pulmonary embolism in acute pancreatitis has been reported to be very rare. We reported a case of pulmonary embolism with acute pancreatitis. A 38-year-old woman broke out upper abdomen pain without definite inducement. She had no nausea and vomiting, fever, dyspnea, cough and expectoration, chest pain. The patient had been diagnosed with acute pancreatitis in local hospital. The patient was treated with antibiotics and proton pump inhibitors, and the abdomen pain was alleviated slightly. But the patient came forth cough and expectoration with a little blood, progressive dyspnea. A computed tomographic scan of the abdomen revealed pancreatitis. Subsequent computer tomography angiography of chest revealed pulmonary embolism (both down pulmonary arteries, left pulmonary artery and branch of right pulmonary artery). Dyspnea of the patient got well with thrombolytic treatment and anticoagulation therapy. Pulmonary embolism is a rare but potentially lethal complication of pancreatitis. Familiarity with this complication will aid in its early diagnosis, therapy and prevent pulmonary embolism, a rare but catastrophic phenomenon.

Epidemic status of Angiostrongylus cantonensis in Hainan island, China.

OBJECTIVE: To understand the current epidemiological status of Angiostrongylus cantonensis in Hainan island and provide the scientific evidences for prevention and control of the disease. METHODS: The investigation on nature infection condition of intermediate hosts and final hosts of Angiostrongylus cantonensis were carried out in five counties, Hainan Province, and enzyme linked immunosorbent assay (ELISA) was employed to detect antibodies of Angiostrongylus cantonensis in human hosts. RESULTS: A total of 1612 molluscs were examined, 21.3% of which harbored L3 of Angiostrongylus cantonensis. Among them, the infection rates of Pomacea canaliculata, Achatina fulica, Cepaea and Phlegm bilineatus were 12.36%(64/518), 22.66%(121/534), 20.93%(9/43), and 28.24%(146/517), respectively. Of the 118 rats trapped, 13 Rattus norvegicus were found to be infected with Angiostrongylus cantonensis. A total of 459 serum samples were collected and tested. 92 serum samples were Angiostrongylus cantonensis antibody-positive. CONCLUSIONS: The survey revealed a wide distribution of Angiostrongylus cantonensis in Hainan island. Pomacea canaliculata and Achatina fulica are main intermediate hosts of Angiostrongylus cantonensis. Rattus novegicus is a nature definitive host, indicating that a considerable number of people are at risk of angiostrongyliasis. Health education, rigorous food inspection and surveillance are all needed to prevent angiostrongyliasis outbreaks in future.

Decreased expression of KLF6 and its significance in gastric carcinoma.

To study the expression of the Krüppel-like transcription factor 6 (KLF6) in human gastric carcinoma and normal gastric mucosa tissues, and to explore the role of KLF6 in the carcinogenesis and tumor progression and its clinical significance. Expression of KLF6, P21WAF1 and PCNA was investigated by immunohistochemistry for 69 surgically resected gastric carcinoma tissues and corresponding normal gastric mucosa tissues, respectively. The correlations of KLF6 expression with clinicopathological characteristics, P21WAF1 and PCNA were examined. Positive-expression of KLF6 was 64 out of 69 cases (92.8%) in normal gastric mucosa and only 23 cases (33.3%) in gastric carcinoma. Expression of KLF6 in the gastric carcinoma was remarkably lower than normal gastric mucosa. Decreased expression of KLF6 in gastric carcinoma was significantly associated with histological differentiation (P<0.01), TNM stage (P<0.05), lymph node metastasis (P<0.01) and distant metastasis (P<0.05). There was no significant correlation between KLF6 expression and sex, age. Meanwhile, expression of KLF6 was associated with expression of P21WAF1 in both normal gastric mucosa and gastric carcinoma (P<0.05). In addition, decreased expression of KLF6 in gastric carcinoma was positively associated with PCNA level (r=0.719, P<0.01) by association analysis. Down-regulation of KLF6 might play an important role in the carcinogenesis and development of human gastric carcinoma and have significant clinical value.