[Construction of a risk assessment indicator system for re-establishment of imported malaria].

OBJECTIVE: To create a risk assessment indicator system for re-establishment of imported malaria. METHODS: The risk assessment indicator system for re-establishment of imported malaria was preliminarily constructed through literature review and thematic discussions. A total of 26 malaria control experts were selected to carry out a two-round Delphi consultation of the indicator system. The active coefficient, authority coefficient and coordination coefficient of the experts and the coefficient of variation on each indicator were calculated for indicator screening and the weight of each indicator was calculated. The reliability of the indicator system was evaluated using Cronbach's coefficient α, and the content validity of the indicator system was evaluated using the authority coefficient of the expert, while the structural validity of the indicator system was evaluated using Kaiser-Meyer-Olkin (KMO) test and factor analysis. RESULTS: Two rounds of Delphi expert consultations were completed by 23 malaria control experts, and a risk assessment indicator system for re-establishment of imported malaria was constructed, including 3 primary indicators, 7 secondary indicators, and 21 tertiary indicators. The active coefficient (100.00% vs. 88.46%; P < 0.01) and coordination coefficient of the expert (0.372 vs. 0.286; P < 0.01) were significantly greater in the second round of the Delphi expert consultation than in the first round. After the second round of the Delphi expert consultation, the authority coefficient of the experts ranged from 0.757 to 0.930 on each indicator, and the coefficients of variation were 0.098 to 0.136, 0.112 to 0.276 and 0.139 to 0.335 for the primary, secondary and tertiary indicators, respectively. The overall Cronbach's coefficient α of the indicator system was 0.941, and there were significant differences in the KMO values for primary (KMO value = 0.523; χ2 = 18.192, P < 0.05), secondary (KMO value = 0.694, χ2 = 51.499, P < 0.01) and tertiary indicators (KMO value = 0.519; χ2 = 477.638, P < 0.01), while the cumulative contribution rate of six principal components in the tertiary indicators was 84.23%. The normalized weights of three primary indicators of the source of infection, transmission condition and control capability were 0.337, 0.333 and 0.329, and the three secondary indicators with the greatest normalized weights included the number of imported cases and malaria parasite species (0.160), introduction of imported cases in China and medical care seeking (0.152), vector species and density (0.152), while the five tertiary indicators with the greatest normalized weights included the malaria parasite species of imported cases (0.065), vector populations (0.064), and the time interval from onset to medical care seeking (0.059), number of imported cases (0.056), and the time interval from medical care seeking to definitive diagnosis (0.055). CONCLUSIONS: A risk assessment indicator system for re-establishment of imported malaria is successfully created, which provides insights into the assessment of the risk of re-establishment of imported malaria and management of key high-risk factors in malaria-eliminated areas.

[Surveillance of malaria vector Anopheles in Guizhou Province from 2005 to 2019].

OBJECTIVE: To understand the density, populations and habitats of malaria vector Anopheles in Guizhou Province from 2005 to 2019, so as to provide the evidence for formulating the countermeasures to tackle the risk of local transmission of imported malaria in the province. METHODS: The malaria vector Anopheles density and populations were monitored using human bait trapping and light trapping techniques in Guizhou Province from 2005 to 2019, and all captured Anopheles was morphologically identified and counted. In addition, the distribution of Anopheles habitats was investigated. RESULTS: During the period from 2005 through 2019, the malaria vector Anopheles density increased from early June in Guizhou Province, peaked on early July and then declined, which appeared a single peak. The greatest Anopheles density was seen on early August, 2018 [57.34 mosquitoes/(person-night)], and the lowest density was found on late October, 2009 [1.29 mosquitoes/(person-night)]. The annual mean Anopheles density slowly reduced from 17.91 mosquitoes/(person-night) in 2005 to 12.34 mosquitoes/(person-night) in 2012, with a 38.02% reduction (χ2trend = 115.04, P < 0.01), while the annual mean Anopheles density showed a tendency towards a rise from 2017 to 2019 (χ2trend = 420.00, P < 0.01). The malaria vector Anopheles was captured during the period between 19 : 00 and 7 : 00 of the next day in Guizhou Province from 2017 to 2019, with the overall density appearing a tendency towards a rise followed by a decline, and the Anopheles activity was highly frequent during the period between 19 : 00 and 21 : 00. The malaria vector Anopheles was monitored for 938 times using the light trapping method in Guizhou Province from 2005 to 2019, and a total of 52 781 Anopheles mosquitoes were captured, including 49 705 An. sinensis, 804 An. minimus, 238 An. anthropophagus, and 2 034 other Anopheles mosquitoes, with a significant difference seen in the Anopheles composition (χ2 = 165.68, P < 0.01). From 2017 to 2019, a total of 24 557 Anopheles mosquitoes were captured in human housings, outdoors and livestock housings in Guizhou Province, with 67.65% captured in livestock housings and 12.01% in human housings, and there was a significant difference in the number of Anopheles mosquitoes captured from the three types of habitats (χ2 = 55.04, P < 0.01). An. sinensis, An. minimus and An. anthropophagus were captured form all three types of habitats, in which 98.07% was An. sinensis, and 0.09% was An. anthropophagus. CONCLUSIONS: The population structure of malaria vector Anopheles has changed in historically malaria-endemic areas of Guizhou Province, and An. sinensis has replaced An. minimus and An. anthropophagus to become the predominant malaria vector. The malaria vector Anopheles density has shown a tendency towards a rise in Guizhou Province during the recent years, and there have been a rise in the type and number of Anopheles mosquitoes, leading to a potential risk of local transmission of imported malaria. Long-term, persistent and extensive surveillance of malaria vectors is recommended in Guizhou Province.

A survey of physicians who care for older persons in Southwest China.

OBJECTIVE: The aim of this survey is to determine the main barriers of geriatric health care from the physicians' point of view and compare the improvement before and after the Continue Medical Education (CME) provided by International Association of Gerontology and Geriatrics (IAGG). DESIGN: Cross-sectional survey. SETTING AND PARTICIPANTS: Five hundred samples were generated using systematic random sampling from the address lists of physicians in Southwest China who had received the IAGG CME or been trained in Sichuan Association of Geriatrics (SAG) CME. MEASUREMENTS: The interview instrument examined demographics and information on geriatric education. RESULTS: Of the 500 physician sampled, 461(92.2 percent) responded. 34.3 percent of the respondents reported that over 70 percent of their patients were older persons. 76.8 percent of the respondents felt that they lacked geriatric knowledge. Only 15.6 percent of the respondents had geriatric curriculum before graduation, and 26.0 percent received geriatric trainings after graduation. Most physicians felt that "Language barrier" and "Insufficient geriatric education in undergraduate medical school and postgraduate education" were the main challenges in practicing geriatric medicine. Geriatric training and knowledge are inadequate due to the lack of geriatric curriculums in medical schools and CME for physicians who practice geriatrics. With the help of IAGG, CME in Southwest China provided more workshops on geriatric progress in year 2011 than in year 2007-2010. Eighty percent of the physicians acknowledged that the IAGG CME was helpful for their clinical practice. The physicians paid more attention to geriatric syndromes rather than age-related pathophysiology alone. CONCLUSION: CME provided by geriatric associations is helpful. Collaboration between different geriatric societies such as IAGG and SAG may be a good model for spreading geriatric knowledge and should be considered by medical educational administration.

Lymphocytic HLA-A mRNA is a reliable indicator of acute rejection in renal transplantation.

BACKGROUND: Rejection in renal transplantation is the most frequent event causing transplant failure. It is important to identify parameters to predict rejection, which are helpful in a timely fashion. METHODS: Fifty-nine renal transplant recipients were divided into two groups: group 1 (stable renal function) and group 2 (acute rejection episodes). The levels of HLA-A mRNA in peripheral blood lymphocytes (both pre- and posttransplantation) were measured by reverse transcriptase-polymerase chain reaction (RT-PCR) with glucose-6-phosphate dehydrogenase (G6PDH) as an internal reference. The TEST software was used to analyze the relative expressions of HLA-A mRNA. RESULTS: There was no statistical significance between features of the two groups pretransplant versus normal controls. Posttransplant, the HLA-A mRNA levels decreased significantly compared to those of pretransplant and normal control individuals. The levels of HLA-A mRNA among the 10 patients with acute rejection episodes were significantly increased. There was no significant change in the lymphocyte populations in the early stage of an acute rejection episode compared with the prerejection value. CONCLUSION: HLA-A mRNA expression was strongly correlated with immune status. The HLA-A mRNA levels may provide an effective and reliable indicator to predict acute rejection episodes in renal transplantation.

Genetic analysis of four porcine avian influenza viruses isolated from Shandong, China.

A Bayesian phylogenetic analysis of eight separate gene segments indicated A/Swine/Shandong/2/2003 (H5N1), A/Swine/Shandong/na/2003 (H9N2), A/Swine/Shandong/nb/2003 (H9N2) and A/Swine/Shandong/nc/2005 (H9N2) probably represent two multiple reassortant lineages, that had not been described before, with genes coming from H5N1, H9N2 and other lineages from poultry in Asia. Amino acid motifs within the haemagglutinin sequence of A/Swine/Shandong/nb/2003 suggested it may be able to infect people, whereas the sequences of the other three isolates suggested they would not have had that capability. Our analysis emphasizes the need for a comprehensive study of the interactions between H5N1 and H9N2 viruses in Asia that includes sequencing and phylogenetic investigation.

Sizing of bovine heart and kidney pyruvate dehydrogenase complex and dihydrolipoyl transacetylase core by quasielastic light scattering.

Quasielastic light scattering (QELS) measurements on several preparations of bovine heart and kidney pyruvate dehydrogenase complex yielded hydrodynamic radii (rH values) ranging from 25.7 to 30 nm. Gel filtration chromatography removed stable aggregates and generated preparations that gave essentially the same rH values of 24.3 +/- 0.6 nm for both complexes. The data were characteristic of a monodisperse system and agree with estimates using cryoelectron microscopy [Wagenknecht et al. (1991) J. Biol. Chem. 266, 24650-24656]. The equivalent hydrodynamic sizes for the heart and kidney complex indicate that the larger number of pyruvate dehydrogenase components in the heart complex (M(r) congruent to 9 x 10(6)) than the kidney complex (M(r) congruent to 7.5 x 10(6)) associate without radial expansion of the heart complex. That accommodation of additional mass is consistent with the space available since even in the more massive complex greater than 80% of the volume within the dimensions of the complex must be occupied by solvent. Preparations of the core of the complex are primarily composed of 60 dihydrolipoyl acetyltransferase (E2) subunits whose inner domains associate to form a pentagonal dodecahedron that is readily observed by electron microscopy (particle radius 10.7-11.3 nm). However, the bulk of E2's mass is present in an exterior multidomain structure. These mobile outer structures are very difficult to observe by standard electron microscopy techniques. Preparations of the core formed stable aggregates that were removed by gel filtration chromatography. QELS measurements gave an rH of 20.1 +/- 0.8 nm.(ABSTRACT TRUNCATED AT 250 WORDS)