Rule of changes in serum GGT levels and GGT/ALT and AST/ALT ratios in primary hepatic carcinoma patients with different AFP levels.

OBJECTIVE: This study aims to explore the rule of changes in serum GGT activity, as well as GGT/ALT and AST/ALT ratios, in primary hepatic carcinoma (PHC) patients with different alpha-fetal protein (AFP) levels. METHODS: GGT, AST and ALT were detected in 370 PHC patients with positive HBs-Ag using a automatic biochemical analyzer, and AFP was detected using a Roche E170 modular analytics immunoassay analyzer. GGT level, as well as AST/ALT and GGT/ALT, ratios were compared among PHC patients with different AFP levels. RESULTS: As shown in Table 1, GGT levels were 109.59 ± 111.06, 151.13 ± 190.43, 135.86 ± 107.62, 151.36 ± 176.59 and 172.58 ± 188.84, respectively, in the groups of primary PHC patients with AFP levels of ⩽ 10, 10-100, 100-200, 200-400 and ⩾ 400 ng/ml; and the differences among these groups were not statistically significant (P> 0.05). AST/ALT ratios were 1.55 ± 1.02, 1.30 ± 0.81, 2.02 ± 1.89, 2.12 ± 1.11 and 1.73 ± 1.25, respectively; and the differences among these groups were not statistically significant (P> 0.05). GGT/ALT ratios were 3.43 ± 3.12, 3.57 ± 5.70, 3.57 ± 2.94, 3.89 ± 4.58 and 3.43 ± 3.61, respectively; and the differences among these groups were not statistically significant (P> 0.05). CONCLUSION: For patients with chronic hepatitis B and cirrhosis after hepatitis B, no matter how AFP level is, when liver function report reveals increased GGT, AST/ALT > 1 and GGT/ALT > 1 (that is, AST > ALT and GGT > ALT), even if AFP is negative, we should also be alert to the existence of PHC.

DNA detection of Schistosoma japonicum: diagnostic validity of a LAMP assay for low-intensity infection and effects of chemotherapy in humans.

BACKGROUND: Schistosomiasis has decreased significantly in prevalence and intensity of infection in China, thus more accurate and sensitive methods are desperately needed for the further control of schistosomiasis. The present work aimed to assess the utility of the loop-mediated isothermal amplification (LAMP) for detection of light intensity infection or false-negative patients and patients post-treatment, targeting the highly repetitive retrotransposon SjR2 of Schistosoma japonicum. METHODOLOGY/ PRINCIPAL FINDINGS: LAMP was first assessed in rabbits with low intensity infection (EPG<10). Then 110 patient sera from Hunan Province, China, and 47 sera after treatment by praziquantel were used to evaluate the diagnostic validity of LAMP. Meanwhile, 42 sera from healthy individuals in a non-endemic area, and 60 sera from "healthy" residents who were identified as being negative for feces examination and immuno-methods in an endemic area were also examined. The results showed that LAMP could detect S. japonicum DNA in sera from rabbits at 3rd day post-infection. Following administration of praziquantel, the S. japonicum DNA in rabbit sera became negative at 10 weeks post-treatment. Of 110 sera from patients, LAMP showed 95.5% sensitivity, and even for 41 patients with less than 10 EPG, the sensitivity of LAMP still reached to 95.1%. For 47 patients after treatment, the negative conversion rate of S. japonicum DNA in patient sera increased from 23.4%, 61.7% to 83.0% at 3 months, 6 months and 9 months post-treatment, respectively. No false-positive result was obtained for 42 human sera from non-endemic area, while for the 60 "healthy" individuals from endemic area, 10 (16.7%) individuals were positive by LAMP, which suggested that these individuals might be false-negative patients. CONCLUSIONS/ SIGNIFICANCE: The present study demonstrated that the LAMP assay is sensitive, specific, and affordable, which would help reduce schistosomiasis transmission through targeted treatment of individuals, particularly for those with negative stool examinations who may yet remain infected. The LAMP assay may provide a potential tool to support schistosomiasis control and elimination strategies.

Development of an educational cartoon to prevent worm infections in Chinese schoolchildren.

BACKGROUND: With more than two billion people infected worldwide, soil-transmitted helminths (STH) are the most widespread infections. To date, STH control efforts rely predominantly on recurrent mass drug administration (MDA), which does not prevent reinfection. Additional public health measures including novel health educational tools are required for more sustained integrated control of STH. We describe the development of an educational cartoon video (The Magic Glasses) targeting STH infections in Chinese schoolchildren and its pilot testing in China.We applied an extensive community-based mixed methods approach involving input from the target group of 9-10 year old schoolchildren and key informants, such as teachers, doctors and parents, in order to identify potential STH infection risks in the study area and to formulate key messages for the cartoon. The development of the educational cartoon included three major steps: formative research, production, and pilot testing and revision. RESULTS: We found that most adults and approximately 50% of the schoolchildren were aware of roundworm (Ascaris) infection, but knowledge of transmission, prevention and treatment of STH was poor. Observations in the study area showed that unhygienic food practices, such as eating raw and unwashed fruit or playing in vegetable gardens previously fertilised with human faeces, posed major STH infection risks. CONCLUSIONS: It was crucial to assess the intellectual, emotional, social and cultural background of the target population prior to video production in order to integrate the key messages of the cartoon into everyday situations. Overall, our strategy for the development of the cartoon and its incorporation into a health education package proved successful, and we provide a summary of recommendations for the development of future educational videos based on our experiences in China.

[Monitoring the prevalence of schistosomiasis in Erlang Village, Yueyang County from 2005 to 2012].

OBJECTIVE: To understand the dynamics of schistosomiasis situation so as to provide the evidence for formulating the prevention and control scheme in Erlang Village, Yueyang County, Hunan Province. METHODS: The schistosomiasis prevalence and Oncomelania snail status were investigated from 2005 to 2012. RESULTS: The schistosome infection rates of the residents decreased from 2.76% in 2005 to 0.54% in 2012 and the decline rate was 80.43%; the infection rates of the livestock decreased from 8.70% in 2005 to 0 in 2012. No snails were found in the inner embankment over the eight-year period. The density of the infected snails was 0.0005 per 0.1 m(2) in 2005, but no positive snails were found from 2009 to 2012 outside the embankment. CONCLUSION: The schistosome infections of people and livestock and the status of the intermediate host snails have achieved the criteria of schistosomiasis transmission control.

[Influence factors of Schistosoma japonicum infection among fishermen in eastern Dongting Lake Region].

OBJECTIVE: To investigate schistosome infection among the professional fishermen in Yueyang County, East Dongting Lake Region and its influence factors. METHODS: A total of 275 fishermen from two fisherman villages in Yueyang County were selected in 2009. They were investigated by fecal examination and questionnairing. The stool-egg positive individuals were detected by B ultrasound. The multivariate unconditional Logistic regression analysis was used to explore the related factors of schistosome infection and liver in fishermen. RESULTS: The total infection rate in fishermen was 40.4% (111/275), and the geometric mean of EPG was 17.4 +/- 4.4. B ultrasound data showed among 111 egg positive individuals, 39 (35.1%) cases manifested as hepatomegaly, 22 (19.8%) had splenomegaly, 11 (9.9%) had portal vein expansion and 65 (58.6%) had hepatic fibrosis. Multivariate unconditional Logistic regression analysis showed that age groups (OR = 0.630), fishing working years (OR = 2.470), chemotherapy frequency (OR = 0.425) and chemotherapy in 2008 (OR = 0.290) were the influence factors on schistosome infection (P < 0.01). CONCLUSION: Schistosome infection rate is high, Schistosoma japonicum-induced liver and spleen injuries are still severe in fisherman of Eastern Dongting Lake Region.

[Recommendation of a new clinical classification of advanced schistosomiasis].

OBJECTIVE: To recommend a new clinical classification of advanced schistosomiasis for improving the diagnosis and evaluation of therapeutic effect of advanced schistosomiasis. METHODS: The medical records of 11 092 cases of advanced schistosomiasis from the Xiang-Yue Hospital from January 1990 to January 2010 and the medical aid centre for advance schistosomiasis in Hunan Province from January 2004 to January 2010 were collected and classified with the current and new clinical classification methods and the results were statistically analyzed and compared. RESULTS: Based on the current classification method, there were huge splenomegaly (5 710 cases), ascites (2 993 cases), colon proliferative (834 cases), and dwarf (54 cases). However, 1 501 cases were excluded from the current classification. Based on the new classification method, there were 8 types: huge splenomegaly (2 870 cases), ascites (1 885 cases), colon proliferative (425 cases), dwarf (38 cases), universal (1 281 cases), bleeding (1 857 cases), hepatic coma (553 cases), and miscellaneous (1 759 cases). Totally 424 cases were classified into chronic schistosomiasis. CONCLUSION: The new classification method can present a more comprehensive picture for clinical features, severe complications and prognosis of advanced schistosomiasis, and is useful for the diagnosis and treatment of advanced schistosomiasis.

[Infectivity difference between mice challenged by the laboratory-cultivated and field collected Schistosoma japonicum-infected Oncomelania hupensis].

OBJECTIVE: To explore the infectivity difference between the mice challenged by laboratory-cultivated and field collected Schistosomajaponicum-infected Oncomelania hupensis snails. METHODS: A total of 120 Kunming mice were randomly divided into two groups. S. japonicum-infected O. hupensis releasing cercariae was according to routine cercaria shedding method. Each mouse was challenged by 40 cercariae. The worm-load, the development rate, EPG of liver and EPG of feces in the mice were calculated. RESULTS: The mean worm-load, adult worm development rate, EPG of liver and EPG of feces in the group of mice infected by field collected S. japonicum-infected snails were 27.43 +/- 3.78, 68.53 +/- 9.44, 19 800.97 +/- 6 752.59 and 196.37 +/- 11.56, respectively, which were significantly higher than those in the group challenged by cercariae from laboratory-cultivated S. japonicum-infected snails (23.93 +/- 4.93, 59.83 +/- 12.32, 5 803.69 +/-1 560.49 and 107.73 +/- 10.32) (P < 0.05). The mean worm-load, adult worm development rate and EPG of liver in the male mouse group were higher than those in the female mouse group (P < 0.05). CONCLUSION: The cercariae released from field collected S. japonicum-infected snails have more aggressive infection ability, compared with the cercariae released from the laboratory-cultivated S. japonicum-infected snails and the results also show male mice are more susceptibility to the schistosome infection than female mice.

[Selection of government instruments in schistosomiasis control services].

From the perspective of public administration and epidemiology, on the combination of the governance cases in the central and local government of China, the author explores ten modes of the provision of public goods and services in schistosomiasis control services, discusses seven main government instruments, and points out its pluralism, complexity and the slight changes of government' s preference. This paper also explores the approach to help the relevant government make schistosomiasis control work more practicable in field.

[Retrospective survey of 184 patients infected with Schistosoma haematobium from African countries].

OBJECTIVE: To understand the status of persons of export of labor services infected with Schistosoma haematobium. METHODS: A total of 184 suspected hospitalized patients infected with S. haematobium were investigated retrospectively. RESULTS: Among the patients, 111 used to work in Angola (60.3%) and 57 in Mozambique (31.0%). Pathogenic examinations were done in 13 cases, and S. haematobium eggs were found in 6 subjects. Totally 96.7% of patients showed antibody positive by the tests of IHA and ELISA. A total of 112 subjects (60.9%) had urinary tract symptoms, and 52 had fatigue. However, 72 subjects (39.1%) did not have any signs and symptoms. CONCLUSIONS: There are some persons of export of labor services who are infected with S. haematobium. Therefore, we suggest that the authority should establish a program for prevention and treatment of schistosomiasis haematobia and schistosomiasis mansoni in persons of export of labor services.

[Study on risk factors of early complications after surgery for schistosomal portal hypertension].

OBJECTIVE: To explore the related factors of early complications after surgery for schistosomal portal hypertension, so as to provide a scientific basis for prevention of postoperative complications and development of perioperative prevention programe. METHODS: Case data of patients with schistosomal portal hypertension in Xiangyue Hospital affiliated to Hunan Institute of Parasitic Diseases from January, 2000 to September, 2009 were collected. With single factor analysis and relevant professional knowledge, related factors were analysed with logistic regression analysis. RESULTS: A total of 52 related factors from the data of 323 cases were analysed with univariate analysis, indicating that 17 factors, including sex, history of bleeding, history of smoking, history of ascites, preoperative length of stay, diameter of portal vein, A/G ratio, albumin, total bilirubin, blood ammonia, total bile acid, operative mode, blood loss, blood transfusion, size of the right liver, postoperative analgesia, time of indwelling gastric tube, were related to the incidence of postoperative complications (all P values < 0.05). Logistic regression results showed the portal vein diameter, A/G ratio, bleeding history, blood loss, time of indwelling gastric tube were risk factors of postoperative complications within 30 days. Postoperative analgesia was considered as the protection factor. CONCLUSIONS: The patients with larger portal vein diameter, lower of A/G ratio, history of bleeding, more loss of blood, longer retention with gastric tube have greater risk of postoperative complication. Loss of blood in operation was the greatest risk, but postoperative analgesia was the protection factor.

[Exploratory thinking on the control technologies of Schistosomiasis japonica].

In this paper, the authors elaborated the difficulties of schistosomiasis control and analyzed shortages and problems of the skills currently used. In order to consolidate the progress in schistosomiasis control and reach the transmission-blocking target, research priorities on the disease control technologies are proposed.

A randomized, double-blind, placebo-controlled trial of safety and efficacy of combined praziquantel and artemether treatment for acute schistosomiasis japonica in China.

OBJECTIVE: To evaluate the safety and efficacy of combining artemether (AM) and praziquantel (PZQ) in different regimens for treating acute schistosomiasis japonica. METHODS: We undertook a randomized, double-blind, placebo-controlled trial within four specialized schistosomiasis hospitals in the Dongting Lake region, Hunan province, China, between May 2003 and December 2005. Study participants were randomized into one of four treatment regimes: group A received 60 mg/kg PZQ + 6 mg/kg AM; group B received 60 mg/kg PZQ + AM placebo; group C received 120 mg/kg PZQ + 6 mg/kg AM; and group D received 120 mg/kg PZQ + AM placebo. All participants were followed up over a 45-day period. The primary endpoint of the trial was human infection status (determined by positive stool examination). Secondary endpoints involved clinical observations and blood biochemistry, including monitoring haemoglobin and alanine aminotransferase levels over time. FINDINGS: Treatment efficacies of the four different treatment regimens were 98.0%, 96.4%, 97.7% and 95.7% for group A, B, C, and D respectively (P > 0.05). The group B had a greater treatment efficacy (96.4%) than the group D (95.7%) (P > 0.05). Group A treatment was better for clearance of fever (P < 0.05) and resulted in a shorter hospitalization time (P < 0.05). CONCLUSION: This is the first report of a randomized, double-blind, placebo-controlled trial for evaluating combined chemotherapy with AM and two different dosages (60 mg/kg and 120 mg/kg) of PZQ in the treatment of acute schistosomiasis japonica in China. The combination of AM and PZQ chemotherapy did not improve treatment efficacy compared with PZQ alone. PZQ given as a dosage of 60 mg/kg (1 day, 3 x 20 mg/kg doses at 4-5 hour intervals) may be as effective as a dosage of 120 mg/kg (6 days, 20 mg/kg for each day split into 3 doses at 4-5 hour intervals).

Large water management projects and schistosomiasis control, Dongting Lake region, China.

Construction of the Three Gorges Dam across the Yangtze River will substantially change the ecology of the Dongting Lake in southern China. In addition, the Chinese Central and Hunan Provinces' governmental authorities have instigated a Return Land to Lake Program that will extend the Dongting Lake surface area from the current 2,681 km2 to 4,350 km2. The previous construction of embankments and the large silt deposits made by the Yangtze River and other connecting rivers have contributed to frequent disastrous flooding. As a consequence of the 2 water projects, > 2 million persons and their domestic animals are being resettled. This article provides an overview of the historical background of these 2 large water management projects, the associated population movement, and their impact on future transmission and control of schistosomiasis in the Dongting Lake area. The dam will likely substantially extend the range of the snail habitats and increase schistosome transmission and schistosomiasis cases.

[Study on the relationship between the degree of periportal fibrosis, hepatic parenchymatous fibrosis and diameter of portal vein in Schistosoma japonicum infection].

The degree of periportal fibrosis, hepatic parenchymatous fibrosis and the diameter of portal vein in fishermen from highly endemic area of schistosomiasis japonica in Dongting Lake region were measured. The results showed a significant correlation between the degree of periportal fibrosis and parenchymatous fibrosis and the portal venous diameter with a correlation coefficient of 0.375 and 0.332 respectively. The authors consider that the diameter of the portal vein can be used to assess the hepatic morbidity of patients.

[Protective effects of co-immunization with SjCTPI-Hsp70 and interleukin-12 DNA vaccines against Schistosoma japonicum challenge infection in water buffalo].

OBJECTIVE: To induce protective effect of co-immunization with S. japonicum triose-phosphate isomerase fused to heat shock protein 70 (SjCTPI-Hsp70) plasmid and interleukin-12 (IL-12) DNA vaccines against Schistosoma japonicum (Chinese strain) infection in water buffalo. METHODS: Forty-five 8-10 months-old water buffalo from a nonendemic area were divided into three treatment groups each with fifteen buffalo: experimental group A (SjCTPI-Hsp70+IL-12, 300 microg), experimental group B (SjCTPI+IL-12, 300 microg), and control group C (pVAX+IL-12, 300 microg). All buffalo were immunized with a series of 3 intramuscular injections administered once every four weeks. Twenty-eight days postvaccination, water buffalo were percutaneously challenged with 1000 S. japonicum cercariae. Fecal examinations were conducted two days prior, one day prior, and on perfusion day, and the number of hatching miracidia and eggs per gram feces were recorded. Fifty-six days post-infection, the buffalo were sacrificed and perfused via the descending aorta. The recovered adult worms and eggs in liver tissue were counted. RESULTS: Groups A and B showed a worm reduction rate of 51.2% and 41.5% (chi2=1.89, P>0.05)), female worm reduction of 48.9% and 44.7% (chi2=0.35,P>0.05), fecal egg reduction of 52.1% and 38.3% (chi2=3.84,P<0.05), a reduction of miracidia-hatching rate by 52.1% and 33.2% (chi2=7.30, P<0.01), and liver egg reduction of 61.5% and 42.0% (chi2=7.61 , P<0.01), respectively. CONCLUSION: Co-immunization with SjCTPI-Hsp70 and IL-12 DNA vaccines induces protective immunity against S. japonicum in water buffalo.

[Study on the relationship of immune status with severity of schistosomiasis japonica in fishermen in the Dongting Lake].

OBJECTIVE: To investigate the relationship of the immune status and the intensity of infection or the severity of the hepatosplenic pathology among fishermen with schistosomiasis japonica in the Dongting Lake region. METHODS: Inquiring and physical examination (IPE), stool examination, B-ultrasonography of the liver and spleen, flow cytometry, turbidimetry and ELISA were undertaken to acquire or determine the intensity of infection (EPG in stool), pathological change in the liver and spleen and the level of cellular and humoral immunity. Data were analyzed with SPSS 10.0 statistics software. RESULTS: Compared with subjects from non-endemic area, the CD4+ T cells and the CD4+/CD8+ ratio in fishing population in the endemic area significantly decreased. The decrease of the CD4+/CD8+ ratio was more significant among population with positive stool exam and with the increase of EPG and/or severity of pathological change in the liver and spleen. Contrarily, the level of the total IgM and the anti-SEA IgG in serum from fishing population in the endemic area was significantly higher than those from non-endemic area. High level serum antibodies in those stool positives were remarkable with the increase of EPG and/or the severity of hepatosplenic pathological change. The total IgA increased considerably in the subjects with significant pathological change of the liver and spleen. A high total IgG was only detected in those stool positives. CONCLUSION: The immune status in fishermen with schistosomiasis in the Dongting Lake showed a suppressed cellular immunity and a hyper functioning humoral immune response. The imbalance of the immunity was related to the increase of the intensity of infection and the progress of the hepatosplenic pathology.

LC-DAD-APCI-MS-based screening and analysis of the absorption and metabolite components in plasma from a rabbit administered an oral solution of danggui.

A valid chromatographic fingerprint method using liquid chromatography-diode array detection-atmospheric pressure chemical ionization mass spectrometry in negative mode (LC-DAD-APCI-MS) is proposed for studying the absorption and metabolites of a traditional Chinese medicine (TCM) Angelica sinensis (danggui) in rabbit plasma, after the rabbit is administered with danggui oral solution (DOS). More than thirty-two common components were detected in both DOS and rabbit plasma, which shows that the components in the DOS were absorbed into the body of the rabbit. Of these, senkyunolide I, senkyunolide H, Z-6,7-epoxyligustilide, 3-butylidene-7-hydroxyphthalide, Z-ligustilide, Z-butylidenephthalide, Diels-Alder dimers of ligustilide, linolenic acid, linoleic acid and falcarindiol were tentatively identified from their MS, UV spectra and retention behavior by comparing the results with the published literature. At least ten components were found in rabbit plasma but not in DOS, indicating that these components must be metabolites of some of the components in the original extract. The results prove that the proposed method can be used to rapidly analyze multiple constituents in TCMs, and to screen for bioactive compounds by comparing and contrasting the chromatographic fingerprints of DOS and plasma samples.

[Analysis on morbidity and chemotherapy effects of Schistosoma japonicum infection in fishermen on Dongting Lake].

OBJECTIVE: To clarify and evaluate the morbidity of schistosome infection and the effectiveness of chemotherapy among fishermen on East Dongting Lake. METHODS: Information on water-contact, history of infection and of praziquantel (PZQ) treatment among fishermen was collected. Kato-Katz method and miracidium hatching test were applied to detect the pathogens in stool specimen. Serum antibodies against soluble egg antigen (SEA) were detected with ELISA and IHA. B-ultrasonic examination was used to determine the pathological changes of liver and spleen. Chemotherapy [PZQ 40 mg/(kg x d)] was given to the fishermen followed by a re-examination after a transmission season. RESULTS: The first investigation (six months before chemotherapy) showed that among 268 people inquired, 90.7% were frequently or intermittently contacting water, 24.0% were treated with PZQ each year, 39.4% had never been treated in the recent five years. Stool positive rate was 68.1% (111/163) and the geometric mean eggs per gram feces (EPG) were 48.77. Males had a higher infection rate (76.0%) and intensity (62.97 EPG) compared with that of females (58.7% infection rate and 30.42 EPG). The highest positive rate (83.3%) was in the age group of 11 to 20 years old. The prevalence of those who frequently or intermittently contacted water and were never treated before was 76.3% (106/139) and 79.7% (51/64), respectively. Serological positive rate was 88.0% (IHA) or 78.7% (ELISA). B-ultrasound revealed 77.4% (82/106) of the fishermen showing pathological changes in liver and/or spleen due to schistosomiasis. 37.7% of the patients showed II-III stage liver fibrosis (male: 53.0%, female: 15%), 58.5% hepatomegaly and 19.8% splenomegaly. The second investigation (six months after chemotherapy with PZQ) showed a stool positive rate of 35.4% and an average EPG 36.13 in the treatment group which were considerably lower than 56.5% infection rate and 68.47 EPG in the group without treatment. In 39 patients treated, the reversion rate from egg positive to negative was 48.7%, pathological change in liver and spleen declined by 40.6%. CONCLUSION: The prevalence and morbidity of schistosomiasis in fishermen on Dongting Lake were high due to frequent exposure to the affected water, and chemotherapy can effectively reduce the prevalence, the intensity of infection and morbidity of the fishermen.