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Abstract Background An outbreak of Plasmodium malariae infection among forest goers in Sanya City of Hainan Island, China was reported in 2015. In response to this outbreak, an innovative three-layer strategy (TLS) targeted forest goers was adapted based on the 1-3-7 approach. Main text Key elements of TLS are: (i) The village with five malaria cases and adjacent villages were set as the first layer. All residents including forest goers were taken as the high-risk population (HRP). Active case detection (ACD) by blood smear microscopy and PCR was selected as the primary measure, and passive case detection (PCD) as complementary measure. One case was identified under TLS implementation. (ii) The township with cases (Gaofeng Town) and the nearby towns were chosen as the second layer. Only forest goers were screened by ACD, while PCD as a routine screening method. 7831 blood smears collected by ACD and PCD and tested with negative results. (iii) The city with cases (Sanya City) and others 12 counties/county-level cities were selected as the third layer. Malaria cases were monitored passively. A total of 77,555 blood slides were screened by PCD with zero positive sample. For each layer, the malaria vector mosquitoes were monitored using light traps, cattle-baited/human-bait traps. Anopheles minimus (dominant species), An. sinensis and An. dirus were captured. Vector control measures mainly include insecticide residual spraying and long-lasting insecticide nets. The capacity of clinicians, public health practitioners and laboratory technicians has been improved through training. During 2016‒2018, TLS and chemoprophylaxis were implemented in the same areas. In the first layer, all residents were monitored by ACD, and malaria chemoprophylaxis were distributed, 89.5% of forest goers were using chemoprophylaxis against malaria. The blood smears (3126 by ACD plus 1516 by PCD) were with zero positive results. Chemoprophylaxis and ACD were offered to forest goers once a year, and PCD in residents as a complementary measure in the second and third layer, 77.8% and 95.1% of forest goers received chemoprophylaxis. In each layer, vector surveillance and control of malaria and trainings for medical staff were still in place. Conclusions TLS was effective in blocking the outbreak by P. malariae among forest goers in Hainan in malaria elimination stage. However, whether it could prevent the malaria resurgence in the post-elimination phase needs to be further assessed. Graphical Abstract

Foot-and-mouth disease (FMD) is an acute and highly contagious animal disease caused by foot-and-mouth disease virus (FMDV). The outbreaks of FMD have brought huge economic losses and the disease has been considered as one of the most harmful infectious diseases to animal husbandry. The invasion of FMDV can be recognized by host immune system and the activated immune responses are responsible for suppression of viral infection and clearance of the virus. In order to maintain fitness and host adaptation, various viruses have evolved multiple elegant strategies to antagonize host immune response. In this review, we elaborated the molecular mechanisms of regulating host immunity by FMDV. We hope this will provide insights for FMD vaccine design, and help prevent and control FMD.

Backgrounds: Emerging evidence suggests that stress hyperglycemia ratio (SHR), an index of relative stress hyperglycemia, is of great prognostic value in acute myocardial infarction (AMI), but current evidence is limited in elderly patients. In this study, we aimed to assess whether SHR is associated with in-hospital outcomes in elderly patients with AMI.Methods: In this retrospective study, patients who were aged over 75 years and diagnosed with AMI were consecutively enrolled from 2015, January 1st to 2019, December 31th. Admission blood glucose and glycosylated hemoglobin (HbA1C) during the index hospitalization were used to calculate SHR. Restricted quadratic splines, receiver-operating curves, and logistic regression were performed to evaluate the association between SHR and in-hospital outcomes, including in-hospital all-cause death and in-hospital major adverse cardiac and cerebrovascular events (MACCEs) defined as a composite of all-cause death, cardiogenic shock, reinfarction, mechanical complications of MI, stroke, and major bleeding.Results: A total of 341 subjects were included in this study. Higher SHR levels were observed in patients who had MACCEs (n = 69) or death (n = 44) during hospitalization. Compared with a SHR value below 1.25, a high SHR was independently associated with in-hospital MACCEs (odds ratio [OR]: 2.945, 95% confidence interval [CI]: 1.626–5.334, P < 0.001) and all-cause death (OR: 2.871 95% CI: 1.428–5.772, P = 0.003) in univariate and multivariate logisitic analysis. This relationship increased with SHR levels based on a non-linear dose-response curve. In contrast, admission glucose was only associated with clinical outcomes in univariate analysis. In subgroup analysis, high SHR was significantly predictive of worse in-hospital clinical outcomes in non-diabetic patients (MACCEs: 2.716 [1.281–5.762], P = 0.009; all-cause death: 2.394 [1.040–5.507], P = 0.040), but the association was not significant in diabetic patients.Conclusion: SHR might serve as a simple and independent indicator of adverse in-hospital outcomes in elderly patients with AMI, especially in non-diabetic population.

Background: Frailty interferes both the management and the prognosis of atrial fibrillation (AF) in elderly patients. Catheter ablation (CA) is an important treatment for AF, but its safety for AF treatment among the elderly patients with frailty remains poorly studied. We thus aimed to investigate the prevalence of frailty among the elderly AF patients undergoing CA and to explore the association of frailty with adverse outcomes following CA. Methods: A total of 1,134 elderly patients (aged ≥ 65 years) who underwent CA for AF in Guangdong Provincial People's Hospital fromJanuary 2015 to December 2019were included. Subjectswere divided into non-frail and frail groups according to the Canadian Study of Health and Aging Clinical Frailty Scale (CSHA-CFS) at admission. The in-hospital outcomes and their clinical data were analyzed. Results: Frailty occurred in 19.3% of the included participants and the prevalence increased rapidly from 7.8% in 2015 to 34.0% in 2019. None of the patients had all-cause mortality in the hospital after CA. Compared with the non-frail group (n = 915), the frail group (n = 219) had significantly higher incidence of post-operative infection (5.5% vs. 1.9%, p = 0.002). Frailty was still significantly associated with an increased risk for post-operative infection in multivariate-adjusted regression analysis (OR = 2.72, 95% CI = 1.12-6.62, p = 0.027). There was no significantly statistical difference in other outcomes including procedure-related complications and length of stay. Conclusions: Among the elderly patients with AF, frailty was associated with a higher rate of post-operative infection following CA treatment. However, frailty did not confer a higher mortality risk or more major complications. [ABSTRACT FROM AUTHOR]

Leak detection has significant implications for the long-term stable operation of water distribution networks (WDNs). This study presented a novel leak detection method by calculating the angular variance between a pressure vector and other vectors in the database, to evaluate the presence of an anomaly in a network. The top priority for this method was to establish a reliable dataset collected from the pressure sensors, which is generated by EPANET 2.2. Numerous node water demand data in normal conditions were generated by the Monte Carlo method, and leak conditions with various leak flows were simulated by creating leak holes in the pipes. Through learning the composite normal and abnormal data in a certain proportion, the angle-based outlier detection model was employed to identify abnormal events. This angle-based method was applied in an actual WDN and the identification performance for anomalies was compared with that of previous detection methods. The results indicated that the novel method proposed in this study could significantly improve the accuracy and efficiency of leak detection compared to the threshold-based and distance-based detection methods. HIGHLIGHTS The proposed method for leak detection in the WDN combines the hydraulic model with outlier detection.; Numerous normal and leak scenarios are simulated by the hydraulic model to calculate residuals.; A clustering algorithm is used to determine the optimal locations of pressure sensors.; The performance of the proposed method is compared with the distance-based method in the literature.;

BackgroundLung cancer is the deadliest and most diagnosed type of cancer worldwide. The 5-year survival rate of lung adenocarcinoma (LUAD) dropped significantly when tumor stages advanced. Patients who received surgically resecting at the pre-invasive stage had a 5-year survival rate of nearly 100%. However, the study on the differences in gene expression profiles and immune microenvironment among pre-invasive LUAD patients is still lacking.MethodsIn this study, the gene expression profiles of three pre-invasive LUAD stages were compared using the RNA-sequencing data of 10 adenocarcinoma in situ (AIS) samples, 12 minimally invasive adenocarcinoma (MIA) samples, and 10 invasive adenocarcinoma (IAC) samples.ResultsThe high expression levels of PTGFRN (Hazard Ratio [HR] = 1.45; 95% Confidence Interval [CI]: 1.08-1.94; log-rank P = 0.013) and SPP1 (HR = 1.44; 95% CI: 1.07-1.93; log-rank P = 0.015) were identified to be associated with LUAD prognosis. Moreover, the early LUAD invasion was accompanied by the enhancement of antigen presentation ability, reflected by the increase of myeloid dendritic cells infiltration rate (Cuzick test P < 0.01) and the upregulation of seven important genes participating in the antigen presentation, including HLA-A (Cuzick test P = 0.03), MICA (Cuzick test P = 0.01), MICB (Cuzick test P = 0.01), HLA-DPA1 (Cuzick test P = 0.04), HLA-DQA2 (Cuzick test P < 0.01), HLA-DQB1 (Cuzick test P = 0.03), and HLA-DQB2 (Cuzick test P < 0.01). However, the tumor-killing ability of the immune system was inhibited during this process, as there were no rising cytotoxic T cell activity (Cuzick test P = 0.20) and no increasing expression in genes encoding cytotoxic proteins. ConclusionIn all, our research elucidated the changes in the immune microenvironment during early-stage LUAD evolution and may provide a theoretical basis for developing novel early-stage lung cancer therapeutic targets.

Hainan Province is in a tropical area of China and previously experienced serious P. falciparum and P. vivax malaria epidemics. After nearly 70 consecutive years of malaria prevention and control, malaria in Hainan has gradually been eliminated. To achieve the elimination of malaria, Hainan enacted six stages: investigative research and pilot prevention and control, large-scale antimalaria measures, adjustment of strategies for prevention and control, joint prevention and control measures, global funding of routine malaria control, and malaria elimination. Different strategies for malaria control were adopted at different stages. Malaria was most prevalent in the mountainous areas of central and southern Hainan, which contain a high-risk population (the forest goers) and two highly effective malaria vectors (An. dirus and An. minimus). Forest goers have been a high-risk population for malaria in Hainan since their identification in the 1990s. This paper summarizes malaria monitoring in forest goers and the response of forest goers to malaria control and elimination, distilling specific malaria control and elimination measures via case studies in Hainan Province. Two case studies in the malaria control stage demonstrated different measures for outbreaks and sporadic cases in forest goers. In view of the malaria outbreak in Sanya during the elimination stage, three-layered strategies (TLSs) were implemented to control outbreaks and improve control measures. Moreover, this paper also illustrates specific management measures to prevent malaria retransmission from sporadic imported malaria cases during the elimination phase. Hainan finally eliminated malaria in 2020. However, the risk of malaria retransmission is still high due to the prevalence of effective malaria vectors in Hainan, and forest goers are still a high-risk population for malaria retransmission. [ABSTRACT FROM AUTHOR]