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Agaricus is a species-rich genus with more than 600 species around the world. In this work, three new species, Agaricus cacainus, A. baiyunensis , and A. praeclarefibrillosus are described from the specimens collected at Baiyun Mountain, Guangzhou, China, a subtropical area with a monsoon maritime climate, based on phylogenetic analyses and morphological examinations of internal transcribed spacer (ITS1-5.8S-ITS2 = ITS), D1/D2 domains of the large subunit of ribosomal DNA (28S), and a part of translation elongation factor 1-alpha ( TEF1 ). Agaricus cacainus in A . sect. Amoeni is characterized by a parabolic to applanate, slightly depressed pileus covered with chocolate brown, appressed, triangular squamules against white background, a white, furfuraceous stipe, an unchanging context when cut, a fragile and evanescent annulus, usually 4- or 2-spored basidia, and mostly pyriform cheilocystidia. Agaricus baiyunensis in A . sect. Minores has a pileus with a slightly truncate top covered with light brown, downy-wooly fibrillose scales and a light yellowish stipe with membranous annulus. Agaricus praeclarefibrillosus in A . sect. Brunneopicti is characterized by a pileus surface with brownish, triangular, recurved scales and longitudinally splitting lines toward margin, a cottony stipe with white, tiny, recurved fibrils, a single annulus, and variously shaped cheilocystidia, with sparsely ornamented basidiospores. The detailed comparison of their morphological characteristics with closely related species is provided.

Long-term immunoreactivity to mycobacterial antigens in Bovis Calmette-Guérin (BCG)-vaccinated population is not well investigated. Herein, 361 volunteer healthy donors (HDs) with neonatal BCG vaccination from Shanghai region (China) were enrolled. They were subdivided into ESAT-6/CFP10 - (E6C10 - ) and ESAT-6/CFP10 + (E6C10 + ) groups based on gamma-interferon release assays (IGRAs). Three mycobacterial antigens, including Rv0934, Rv3006, and Rv3841, were subjected to the determination of immunoreactivity by ELISPOT assay. The immunoreactivities to three mycobacterial antigens were firstly compared among TB patients (N=39), E6C10 + HDs (N=78, 21.61% of HDs) and E6C10 - HDs (N=283, 78.39% of HDs). It was revealed that Rv3006 was dominant upon M.tb infection, while Rv3841 was likely to be more responsive upon latent TB infection. In E6C10 - population, the immunoreactivity to Rv3841 maintained along with aging, whereas those to Rv3006 and Rv0934 attenuated in E6C10 - HDs older than 45 years old. Our study implies the shift of dominant antigens at different infection statuses, providing the clues for the selection of mycobacterial antigens in vaccine development and precision revaccination in the future., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Yang, Zhang, Xiao, Liang, Ji, Wang, Wang and Chen.)

The present study validated the Chinese version of the Anticipatory and Consummatory Interpersonal Pleasure Scale (ACIPS) in a group of patients with mental disorders. The results replicated the four-factor structure of the ACIPS in a Chinese setting and showed good discrimination validity., (© 2020 The Institute of Psychology, Chinese Academy of Sciences and John Wiley & Sons Australia, Ltd.)

Schistosomiasis was once heavily endemic in Jiangsu Province. Following the control efforts for several decades, schistosomiasis was almost eradicated in all endemic counties in Jiangsu Province in 1980, and transmission control was achieved in the province in 2011. According to the principle of "implementing the control measures with adaptation to local circumstances and guiding the control programs with classified interventions", an integrated strategy with emphasis on the management of both infectious sources and snails has been recently employed for schitsosomiasis control in Jiangsu Province. In addition, a sensitive and highly effective surveillance system has been built and the application of novel techniques and information construction has been intensified to effectively interrupt the transmission of schistosomiasis in the Province. Transmission interruption of schistosomiasis was achieved in all endemic counties in Jiangsu Province. The paper summarizes the endemic situation of schistosomiasis, progress of schistosomiasis control, and major schistosomiasis control measures implemented during the stage of transmission interruption in Jiangsu Province.

The Questionnaire of Cognitive and Affective Empathy (QCAE) is a commonly used instrument in empathy research. However, this scale has not been validated in the Chinese context. We examined the psychometric properties and structure of the QCAE in a Chinese sample consisting of 1224 college students. The whole sample was split into two halves for exploratory factor analysis (EFA; n = 617) and confirmatory factor analysis (CFA; n = 607). A subsample (n = 351) completed the Chinese versions of the Interpersonal Reactivity Index (IRI) to examine convergent validity and the Revised Social Anhedonia Scale (RSAS) to examine the discriminate validity. Finally, 79 participants of the above subsample were retested after a 4-week interval. Results from EFA and CFA suggested a five-factor model, namely Perspective Taking, Online Simulation, Emotional Contagion, Proximal Responsivity, and Peripheral Responsivity. The internal consistency was .86 and test-retest reliability was .76. Scores on the QCAE positively correlated with scores on the IRI and negatively correlated with scores on the RSAS. The Chinese version of the QCAE exhibited good factor structure, reliability, and validity. Specific relationships between empathy and social anhedonia were also demonstrated., (© 2019 The Institute of Psychology, Chinese Academy of Sciences and John Wiley & Sons Australia, Ltd.)

Schistosomiasis remains one of the world's most significant neglected tropical diseases, second only to malaria in terms of socioeconomic impact. In 2014, China proposed the goal of schistosomiasis japonicum elimination by 2025. However, one major challenge is the widely distributed, and in certain cases potentially increasing, habitats of Oncomelania hupensis, the snail intermediate hosts of S. japonicum. Therefore, an understanding of population genetics of O. hupensis in new or re-emerged habitats, together with that of the established habitats with snail persistence, would be valuable in controlling and predicting the future transmission dynamics of schistosomiasis in China. Using nine microsatellite loci, we conducted population genetic analyses of snails sampled from one habitat where snails were detected for the first time, one (previously eliminated) habitat with re-emerged snails, and one habitat with established snail persistence. Results showed lower diversities, in terms of number of observed alleles per locus (Na), number of effective alleles per locus (NeA), observed (Ho) and expected heterozygosity (He), in snails from new or re-emerged snail habitats than from the habitat with snail persistence. The smallest effective population size was inferred in the re-emerged snail habitat, but the largest was in the new habitat rather than in the habitat with snail persistence. No bottleneck effects were detected in new or re-merged habitats. No or low sub-structure was inferred in new and persistent snail habitats. Snails from the three sites were clearly separated and low gene flow was estimated between sites. We propose that snails at the new habitat may have been introduced through immigration, whereas snails at the re-emerged habitat may be the consequence of those few snails remaining subsequently expanding through reproduction. We discuss our results in terms of their theoretical and applied implications., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Schistosomiasis japonica is a zoonotic parasitic disease. After nearly 70 years of control efforts in China, Schistosomiasis transmission has been reduced to a much lower level. The absence or near absence of infections in humans or livestock, based on traditional fecal and serological tests, has made the targets and priorities of future control efforts difficult to determine. However, detection of schistosome cercariae in waters using sentinel mice could be an alternative way of identifying remaining foci of infection, or even serve as a tool for evaluation of control efficacy. This method has been employed in China over last forty years. We therefore performed a meta-analysis of the relevant research to investigate if infections in sentinel mice mirror the ongoing trend of schistosomiasis transmission in China., Methods: We conducted a meta-analysis of studies reporting infection rates of S. japonicum in sentinel mice in China before Sep 1, 2018 in accordance with the PRISMA guidelines. We retrieved all relative studies based on five databases (CNKI, WanFang, VIP, PubMed and Web of Science) and the reference lists of resulting articles. For each individual study, the infection rate in sentinel mice is presented together with its 95% confidence interval (CI). Point estimates of the overall infection rates and their 95% CIs were calculated. Subgroup analyses were performed according to study periods, seasons or regions., Results: We identified 90 articles, including 290 studies covering eight endemic provinces. The overall rate in sentinel mice was 12.31% (95% CI: 10.14-14.65%) from 1980 to 2018. The value of 3.66% (95% CI: 2.62-4.85%) estimated in 2004 to 2018 was significantly lower than in 1980 to 2003 (22.96%, 95% CI: 19.25-26.89%). The estimate was significantly higher in the middle and lower reaches than in the upper reaches of the Yangtze River. The highest estimates were obtained in Hunan (30.11%, 95% CI: 25.64-34.77%) followed by Anhui (26.34%, 95% CI: 12.88-42.44%) and then Jiangxi (13.73%, 95% CI: 6.71-22.56%). Unlike the other provinces in the middle and lower reaches, no significant reduction was seen in Hubei after 2003. Even in Hubei two studies carried out after 2014 reported infections in sentinel mice, although no infected snails were reported across the province. Infections were most found in April (17.40%, 95% CI: 1.13-45.49%), July (24.98%, 95% CI: 15.64-35.62%) and October (17.08%, 95% CI 5.94-32.05%). High degrees of heterogeneity were observed., Conclusion: This meta-analysis provides a comprehensive analysis of schistosome infection in sentinel mice across China. The estimates largely mirror the ongoing trends of transmission in terms of periods and regions. Infections were most likely to occur in April, July and October. In areas where no infected snails were reported infections in sentinel mice were still observed. Due to the presence of snails and infected wildlife, detection of schistosomes in waters using such a highly sensitive method as the deployment of sentinel mice, remains of importance in schistosomiasis monitoring. We would suggest the current criteria for transmission interruption or elimination of schistosomiasis in China be adjusted by integrating the results of sentinel mice based surveys., Competing Interests: The authors have declared that no competing interests exist.

Objective: To develop a machine simultaneously integrating mechanized environmental cleaning and automatic mollusciciding and to evaluate its effectiveness of field application, so as to provide a novel Oncomelania hupensis snail control technique in the large-scale marshlands., Methods: The machine simultaneously integrating mechanized environmental cleaning and automatic mollusciciding, which was suitable for use in complex marshland areas, was developed according to the mechanization and automation principles, and was used for O. hupensis snail control in the marshland. The effect of the machine on environmental cleaning and plough was evaluated, and the distribution of living snails was observed at various soil layers following plough. The snail control effects of plough alone and plough followed by mollusciciding were compared., Results: The machine could simultaneously complete the procedures of getting vegetation down and cut vegetation into pieces, plough and snail control by spraying niclosamide. After plough, the constituent ratios of living snails were 36.31%, 25.60%, 22.62% and 15.48% in the soil layers at depths of 0-5, 6-10, 11-15 cm and 16-20 cm respectively, and 61.91% living snails were found in the 0-10 cm soil layers. Seven and fifteen days after the experiment, the mortality rates of snails were 9.38% and 8.29% in the plough alone group, and 63.04% and 80.70% in the plough + mollusciciding group respectively (χ²₇ d = 42.74, χ²₁₅ d = 155.56, both P values < 0.01). Thirty days after the experiment, the densities of snails were 3.02 snails/0.1 m² and 0.53 snails/ 0.1 m² in the soil surface of the plough alone group and the plough + mollusciciding group, which decreased by 64.92% and 93.60%, respectively, and the decrease rate of snail density was approximately 30% higher in the plough + mollusciciding group than that in the plough alone group., Conclusions: The machine simultaneously integrating mechanized environmental cleaning and automatic mollusciciding achieves the integration of mechanical environmental cleaning and automatic niclosamide spraying in the complex marshland areas, which provides a novel technique of field snail control in the large-scale setting in China.

Objective: To evaluate the effects of a novel molluscicide, the salt quinoid-2', 5-dichloro-4'-nitrosalicylanilide from niclosamide (LDS), with 10% wettable powder, in main schistosomiasis epidemic areas of China, including Hunan, Jiangxi, Hubei, Anhui, Jiangsu, Sichuan, Yunnan and Zhejiang Province., Methods: In the immersion test, 6 effective concentrations of 10% LDS were tested respectively: 0.1, 0.2, 0.4, 0.6, 0.8, 1.0 g/m3 in the field; at the same time, 50% wettable powder of niclosamide ethanolamine salt (WPN) with effective concentrations of 1.0 g/m was used as the molluscicide control, and the fresh water as the blank control, then the mortality rates of 0. hupensis snails were recorded at 24 h, 48 h and 72 h after the immersion. In the spraying test and powder-spraying test, 5 effective dosages of 10% LDS were tested respectively: 0.2, 0.4, 0.6, 0.8, 1.0 g/m2, while 50% WPN 1.0 g/m2 was used as the molluscicide control, and the fresh water as the blank control in the field for 1 d, 3 d and 7 d, then the mortality rates of O. hupensis snails were recorded at 1 d, 3 d and 7 d after the spraying and powder-spraying., Results: The snail mortality rates of LDS using the immersion test for 72 h were more than 95% in the field of eight provinces (0.1 g/m in Sichuan, Jiangxi, Jiangsu and Zhejiang provinces, 0.2 g/m3 in Yunnan, Hunan and Hubei provinces, and 0.4 g/min Anhui Province); the snail mortality rates of LDS using the spraying test for 7 d were more than 85% (0.2 g/m2 in Hunan, Hubei, Jiangxi and Zhejiang provinces, 0.4 g/m2 in Sichuan and Anhui provinces, 0.6 g/m2 in Yunnan and Jiangsu provinces). The snail mortality rates of LDS the powder-spraying test for 7 d were more than 85% (0.6 g/m2 in Yunnan, Sichuan, Hubei, Jiangxi, Anhui, Jiangsu and Zhejiang provinces). According to the standards of "Efficacy test methods and evaluation of molluscicide for pesticide registration (NY/T 1617-2008)", LDS is a qualified molluscicide., Conclusions: LDS has good molluscicidal effects through the immersion, spraying and powder-spraying test in the fields. It is suitable for a variety of environments to control O. hupensis snails of schistosomiasis endemic areas in China. The recommended dosages of LDS are 0.1-0.2 g/m3 by the immersion method, 0.2-0.4 g/m2 by the spraying method, and 0.4-0.6 g/m2 by the powder-spraying method in the fields.

Objective: To evaluate the field molluscicidal effect of 5% niclosamide ethanolamine granules, so as to provide a novel Oncomelania hupensis snail control approach for emergency treatment of high-risk settings., Methods: Snail control tests with spraying of 5% niclosamide ethanolamine granules were conducted in two settings of 2 counties, and the dose-, time- and setting-specific field molluscicidal effects were tested., Results: In the small-scale setting, spraying of 5% niclosamide ethanolamine granules at doses of 30, 40 and 50 g/m2 resulted in 54.55%, 68.41% and 73.45% 1-day snail mortality, 57.27%, 68.59% and 80.28% 3-day snail mortality, and 63.49%, 77.58% and 85.55% 7-day snail mortality, respectively, and no significant differences were detected in 1- and 3-day snail mortality caused by spraying of 5% niclosamide ethanolamine granules at doses of 30 and 40 g/m2 (all P > 0.05), while significant difference was found in the 7-day snail mortality (χ2 = 4.549, P < 0.05). In addition, spraying of 5% niclosamide ethanolamine granules at doses of 40 and 50 g/m2 resulted in comparable 1-, 3- and 7-day snail mortality (all P > 0.05). In the large-scale setting, spraying of 5% niclosamide ethanolamine granules at a dose of 40 g/m2 resulted in 85.29% and 87.70% 3-day snail mortality, 83.89% and 91.02% 7-day snail mortality, and 83.41% and 91.84% 15-day snail mortality in the environment-cleaning group and non-cleaning group, respectively. The overall snail mortality was 90.02% in the environment-cleaning group 3 to 15 days after spraying, which was significantly higher than that (84.28%) in the non-cleaning group (χ2 = 9.950, P < 0.05). After 15 days of spraying with 5% niclosamide ethanolamine granules at a dose of 40 g/m2, the densities of living snails reduced from 19.90 and 19.83 snails/0.1 m2 to 0.60 and 2.60 snails/0.1 m2 in the environment-cleaning group and non-cleaning group, with 96.98% and 86.89% reductions, respectively., Conclusion: The appropriate dose of 5% niclosamide ethanolamine granules is 40 g/m2 for snail control in the field, and environment cleaning of vegetation with a height of more than 50 cm may improve the molluscicidal efficacy.

Objective: To explore and integrate the key techniques used in the surveillance and forecast of schistosomiasis in the water regions along the Yangtze River, so as to provide technical support for identifying rapidly the risk of schistosomiasis transmission and implementing control measures targeting the risk., Methods: According to the distribution of water systems and water regions along the Yangtze River in Jiangsu Province, the demonstration sites for surveillance and forecast of schistosomiasis were set across the province, where the integration and demonstration of the techniques regarding monitoring of Schistosoma japonicum infection in sentinel mice, human and animal activities, release of forecast information, and emergency treatment of water regions at risk of infection were performed. The pattern of human and animal activities was compared with the S. japonicum infection in sentinel mice in the demonstration sites, and the operability of the release of information and emergency treatment of the risk of S. japonicum infection was evaluated., Results: A total of 50 demonstration sites for surveillance and forecast of schistosomiasis were set in fixed anchor points, opening of the navigation lock to the Yangtze River, freight terminal, agritainment places, ferry, large construction places, and places for guaranteeing the Youth Olympic Games in 23 counties (districts) of 5 cities, Jiangsu Province. During the period between May. and September, 2014, the infectivity of water body was monitored by using 5 batches of sentinel mice, with a 99.06% (4,954/5,001) gross recovery rate of mice. S. japonicum infection was detected in a demonstration site, and an infected mouse was found, with a 0.02% (1/4,933) gross positive rate of sentinel mice. The field survey showed 2 088 person-times contacting water, including 91.95% (1,920/2,088) contacting water due to the production such as capturing fish, harvesting and cultivating crops, and repairing and building boats, and 8.05% (168/2 088) contacting water due to the life activity, such as fishing, washing vegetables and playing with water. The people contacted water predominantly in August and September (49.57%). A total of 859 boats containing 1,877 boatmen were observed, 68.22% (586/859) of which were fishing boats containing 1,306 fishermen (69.58%). There were 32 sheep found in 4 demonstration sites, and 3 sheep were seen in the demonstration site with infected sentinel mouse. Four blue forecasts (emergence of water contact) and one orange forecast (S. japonicum-infected sentinel mouse detected) were released across the province, with one forecast map released which showed 5 sites with fishing and one site with sheep grazing, one emergency response system initiated, mollusciciding implemented in 10 hm2 high-risk regions, 120 sheep grazed in fence, and 35 fishermen given health-education materials, schistosomiasis examination and preventive therapy. In addition, no acute schistosomiasis occurred in the demonstration site with S. japonicum-infected sentinel mice., Conclusions: The integration and demonstration of the techniques regarding monitoring of S. japonicum infection in sentinel mice, human and animal activities, release of forecast information, and emergency treatment of water regions at risk of infection provides an effective approach for the large-scale surveillance and forecast of schistosomiasis.

As the currently only available molluscicide, niclosamide has been widely used for snail control for over 2 decades in China. There is therefore a concern about the emergence of niclosamide-resistant snail populations following repeated, extensive use of the chemical. The purpose of this study was to investigate the likelihood of niclosamide resistance in Oncomelania hupensis in China. Active adult O. hupensis snails derived from 20 counties of 10 schistosomiasis-endemic provinces of China, of 10 snails in each drug concentration, were immersed in solutions of 1, 0.5, 0.25, 0.125, 0.063, 0.032, 0.016 and 0.008 mg L-1 of a 50% wettable powder of niclosamide ethanolamine salt (WPN) for 24 and 48 h at 25 °C, and the median lethal concentration (LC50) was estimated. Then, the 24- and 48-h WPN LC50 values were compared with those determined in the same sampling sites in 2002. The results indicated that the 24- and 48-h WPN LC50 values for O. hupensis were not significantly different from those determined in 2002 (P = 0.202 and 0.796, respectively). It is concluded that the current sensitivity of O. hupensis to niclosamide has not changed after more than 2 decades of repeated, extensive application in the main endemic foci of China, and there is no evidence of resistance to niclosamide detected in O. hupensis.

Objective: To establish the surveillance and risk assessment system of schistosomiasis in Jiangsu Province, so as to provide technical support for timely understanding of the risk of schistosomiasis transmission and implementation of targeted control measures., Methods: The surveillance sites of schistosomiasis were assigned according to the epidemic status and endemic type of schistosomiasis as well as the characteristics of the water system, and the prevalence of Schistosoma japonicum in humans and domestic animals, and snail status were investigated. In addition, the quality control of serum detection of S. japonicum infections was performed. The prevalence of human and animal S. japonicum infections, snail status and missing diagnosis of serum detection were analyzed and compared among regions., Results: A total of 27 surveillance sites of schistosomiasis were set up in 26 counties of 10 cities, Jiangsu Province, including 14 sites in transmission-interrupted villages and 13 sites in transmission-controlled villages, and 15 sites in marshland and lake regions, 9 sites in plain regions with water network and 3 sites in mountainous region. In the 27 surveillance sites, a total of 16 617 residents were screened for S. japonicum infection by using dipstick dye immunoassay (DDIA), and 326 were sero-positive, with a sero-prevalence of 1.96% (2.17% for men and 1.8% for women). Of the 326 individuals undergoing parasitological examination, 2 positive cases were detected in the marshland and lake region, with a S. japonicum human prevalence of 0.01%. Of the 762 floating population detected, 10 were positive for blood test, with a sero-prevalence of 1.31%, and no egg-positive individuals were detected. No infection was found in the 476 domestic animals. Of the 746 settings surveyed, a total of 240.7 hm2 snail area was detected, with a mean snail density of 0.06 snails/0.1 m2, and no infected snails were found. There were 780 quality-control sera detected in 26 surveillance sites of schistosomiasis, and the gross coincidence rate was 95.13%, with misdiagnosis rate of 1.28% and missing diagnosis rate of 19.23%., Conclusion: The surveillance sites of schistosomiasis show reasonable distribution in Jiangsu Province, and the endemic situation of schistosomiasis appears a low level in the whole province.

Objective: To explore the enrichment technique of Schistosoma japonicum cercariae on the water surface, so as to establish a new method combined with the existing technology to detect the cercarial infested water body quickly and sensitively., Methods: Soybean oil, gasoline, kerosene and isophorone were screened as expanding agents. The cercariae were enriched by the thrust of the expanding agents when diffusing on the water surface, and PE adsorption film and C-6 film were applied to seize them so as to determine the infectivity of the water quickly. The relationship between the dose of expanding agents and diffusion radius were explored., Results: Gasoline, kerosene and isophorone were suitable expanding agents, and the diffusion effect of isophorone was the best. After the enrichment by the expanding agents, the detection rate of cercariae of the method seizing cercariae with the film significantly improved in the water., Conclusion: This new method could effectively improve the detection rate of the cercarial infested water and is suitable for the low-degree infested water.

Objective: To investigate the effect of environmental change in marshland after the implementation of the Three Gorges Reservoir Project on schistosomiasis in Jiangsu Province., Methods: The hydrologic data of Nanjing City in Jiangsu section of the Yangtze River, and the data regarding the marshlands, the snail status and schistosomiasis morbidity in areas adjacent to the Yangtze River in Jiangsu Province were collected, and field snail surveys were performed in typical marshlands., Results: Following the implementation of the Three Gorges Reservoir Project, the water level in Nanjing section of the Yangtze River appeared a year-dependent gradual decline tendency. The mean peak water level on January to March, 2012 (spring) increased by 0.41 m as compared to that before the construction of the project in 2002, while the peak water level on April to December, 2012 decreased by 0.32 m as compared to that before the construction of the project in 2002. The endemic situation of schistosomiasis showed a decline tendency in areas adjacent to the Yangtze River in Jiangsu Province. The area with infected snails along the Yangtze River was 0, the positive rates of serological tests and parasitological tests of the population were 0.73% and 0.004%, respectively in 2012., Conclusions: Both the schistosomiasis morbidity and snail status appear a decline tendency in areas adjacent to the Yangtze River along the lower reaches of the Yangtze River, Jiangsu Province after the implementation of the Three Gorges Reservoir Project.

The risk for Schistosoma japonicum infection in Jiangsu province, People's Republic of China, was investigated by a mouse bioassay. Various investigations were conducted in the period 2009-2011 with the presentation here representing the summary of the results from 45-50 sites in the marshlands along the Yangtze River's course through the province. Indices representing three aspects of the infection were collected to assess risk: (i) the proportion of sentinel points where at least one mouse infection was recorded; (ii) the proportion of infected mice at each of these sites; and (iii) the average worm burdens. Directional distribution analysis and scan statistics were used to explore the spatio-temporal risk pattern. The spatial distribution was oriented along the Yangtze River and the directional distributions for the proportion of infected mice and mean worm burdens were similar for the positive sentinel sites. Four statistically significant clusters were detected in 2009, but only one in 2010 and 2011, respectively. Temporal windows for infection risk were seen in June and September. The study illustrates the utility of spatio-temporal analysis in assessing the risk for schistosomiasis. This approach should be useful with respect to surveillance and response that can be expected to be increasingly applied when moving from morbidity control to transmission control.

Background: Medical professionalism is valued globally. However, Western frameworks of medical professionalism may not resonate with the cultural values of non-Western countries., Aims: This study aims to formulate a professionalism framework for healthcare providers at Peking Union Medical College (PUMC) in China., Methods: This study was conducted using nominal group technique (NGT) in a convenient sample of 97 participants at PUMC in November and December, 2011. Participants were sorted into 13 occupational groups, each discussing and ranking categories of medical professionalism. The authors compared the results of each group's ranked categories and analyzed meeting transcripts., Results: A pre-existing framework provided eight categories: clinical competence, communication, ethics, humanism, excellence, accountability, altruism, and integrity. Participants created four categories: teamwork, self-management, health promotion, and economic considerations. Clinical competence and communication ranked highly among most groups. Only hospital volunteers and resident physicians included self-management in their top-ranked items. Only public health experts prioritized health promotion. Standardized patients were unique in mentioning "economic considerations." Medical students and attending physicians both referenced Chinese traditional values., Conclusions: Our study was able to document effects of East Asian cultural influences and conflicts between Western ideologies and Asian traditions that led to divergent interpretations of medical professionalism.

Objective: To establish the measures of schistosomiasis field survey and evaluate the efficacy of their application according to the content of indexes of rapid assessment system to high transmission risks in schistosomiasis endemic areas of lake regions., Methods: In 2012, based on the analysis of Oncomelania hupensis snail situation, and schistosomiasis epidemic data of human and cattle from 2008-2010, 60 villages from Hunan, Hubei, Jiangxi and Anhui provinces were selected and investigated, and the content of the investigation included the field feces, snail status, and epidemic situation of human and cattle. The systemic sampling was applied for snail investigation; the feces collected from snail investigation field were examined by the hatching test (3 bottles for 1 sample). A cluster random sampling was carried out with more than 300 people in each village. By using the hatching test (3 bottles for 1 sample) , the human stool examination was carried out for the identification of the infected persons who were positive in the immunity test screening. The hatching test was applied for cattle of all the villages (3 bottles for 1 sample)., Results: A total of 65 field feces spots were surveyed in 60 villages, field feces were found in 78.46% (51/65) of spots, and the positive rate of field feces was 1.07% (9/842). There were 73.33% (44,160)of villages with cattle, and the largest amount cattle with 329 was found in Wufeng Village, Jiangxi Province. The cattle infection rate was 1.5 1% (4,913,242) in 3242 investigated cattle. The highest cattle infection rate was 4% in Tongxin Village, Jiangxi Province. The population of 47 099 was surveyed, the infection rate was 0.77% (364/47 099), and the highest was 4.37% in Xumuchang Village, Hunan Province. The infection rate was 0 in 43.33% (26/60) of villages. No acute schistosomiasis cases were reported in all the villages in 2011 and 2012. Totally, 77 snail spots in 60 villages were investigated, and 51 spots were marshland and 26 spots were ditches. The schistosome-infected snails were detected in 5.88% (3/51 )of the marshland spots and the living snails were found in 80.39%(41/51) of the spots. The highest density of living snails was 3.20/0.1 m2 in Xumuchang Village, Hunan Province. The average density of infected snails was 0.00045/0.1 m2 (4/8942). The infected snail spots were distributed in Liujiadi Village and Liuhe Village of Hubei Province, and Jiangkou Village of Anhui Province. No infected snails were detected in 26 ditches spots. The living snails were detected in 53.85% (14/26) of the ditches spots. The highest average density of living snails was 3.76/0.1 m2 in Huakou Village, Hubei Province., Conclusions: The measures of field survey for rapid assessment system of high transmission risks in schistosomiasis endemic areas of lake regions are established and applied with scientific, impersonal and rapid characteristics.

Objective: To understand the status of newly-developed advanced schistosomiasis patients in schistosome transmission-interrupted areas., Methods: The newly diagnosed advanced schistosomiasis patients confirmed by professionals at province and county levels according to the available standards were investigated. Their detailed epidemiology history and present signs/ symptoms were surveyed, and the relevant medical examinations were performed., Results: There were 75 patients including 22 males and 53 females. The average age was (70.0 +/- 7.0) years and they were all infected with schistosome previously. They received anti-schistosome therapy (mean 1.85 times) and stool examinations (mean 26.24 times) continuously from 1976 to 1985, and the results of stool examination were all negative. In majority of the patients' resident areas, the last time that Oncomelania hupensis snails were found was 1976, and the latest was 1983. During this period, no patients were up to the diagnostic criteria of advanced schistosomiasis after multiple examinations, and they were diagnosed as advanced cases between 2008 and 2011. The survey indicated that liver fibrosis was found in all the patients with 82.7% showing grad III pathological change, 90.7% of them had splenomegaly, 20.0% had ascites, and 22.7% had portal vein broadening. The mean value of enzyme indexes of liver function was 31.81 U/L (ALT), 53.19 U/L (AST) and 89.28 U/L (gamma-GT), and the positive rate was 21.3%, 49.3% and 57.3%, respectively. As for the fibrosis indexes, the positive rate of HA, LN, C VI and P III P was 73.3%, 13.3%, 17.3% and 9.3%, respectively, and the mean value of HA was 3 times higher than that of the upper limit of normal standard. Conclusions Newly-developed advanced schistosomiasis patients are those who were dignosed and cured parasitologically but progressed pathologically without any chance of re-infection. Anti-fibrosis therapy is necessary as the patients show considerable progressive liver fibrosis.

Objective: To evaluate the ability for serological screening of schistosomiasis among county-level personnel, so as to provide the evidence for establishing the quality control system of field detection of schistosomiasis., Methods: The standard serum panel was prepared for the quality assessment of schistosomiasis diagnostic capability, and detected by county-level personnel in the endemic field simultaneously using single-blind method. The rates of coincidence, misdiagnosis and missed diagnosis were calculated compared with the standard results., Results: Totally 780 samples of standard serum were detected in 26 counties, and showed 134 positive and 646 negative samples. The rates of coincidence, misdiagnosis and missed diagnosis were 95.13%, 1.28% and 19.23%, respectively, and there was a significant difference between the detection results and the standard results (chi2 = 11.6053, P = 0.0007). Among the 26 counties investigated, the misdiagnosis occurred in 5 counties (19.23%) and missed diagnosis occurred in 21 counties (80.77%). The misdiagnosis rate and missed diagnosis rate of serological screening of schistosomiasis were 0-2.08% and 16.67%-33.33% in beach, hilly, water net and marshland endemic areas, respectively, and no significant differences were found in the misdiagnosis rate and the missed diagnosis rate among various types of endemic areas (chi2 = 1.590 and 1.757, P = 0.6671 and 0.6244). The rates of misdiagnosis and the missed diagnosis were 1.14% and 1.39%, and 18.18% and 20.00% in the schistosomiasis transmission-controlled and the schistosomiasis transmission-interrupted areas, respectively, and no significant differences were found in the misdiagnosis rate and missed diagnosis rate between the schistosomiasis transmission-controlled and transmission-interrupted areas (chi2 = 0.008 and 0.001, P = 0.931 and 0.974)., Conclusions: The missed diagnosis is a major cause for the reduction of quality of schistosomiasis detection at the county level in Jiangsu Province, and the coincidental detection of schistosomiasis with standard serum in the field is one of effective approaches for the control of the quality of schistosomiasis detection.

Background: Human Schistosoma haematobium infection that causes urinary schistosomiasis occurs in Africa and the eastern Mediterranean, and China is only endemic for S. japonicum. In this report, we reported an imported case with S. haematobium infection returning from Angola to Shaanxi Province, northwestern China, where S. japonicum is not endemic., Findings: The case was misdiagnosed as ureteral calculus, invasive urothelial carcinoma and eosinophilic cystitis in several hospitals, and was finally diagnosed by means of serological assay followed by microscopic examination of the urine sediment. The patient was then treated with praziquantel, and a satisfactory outcome was obtained., Conclusions: As S. haematobium is not indigenous to China, most Chinese doctors and medical technicians are unfamiliar with this introduced parasitic disease, therefore, they need to increase the awareness of its existence when they encounter persons who have visited or resided in endemic areas, and the techniques for detection of the parasite, so as to reduce the misdiagnosis. In addition, health education should be given to those who will go to the endemic areas to improve their knowledge and awareness on prevention and control of schistosomiasis haematobia, thereby reducing the risk of exposure to the infested freshwater.

Schistosomiasis is a major disease of public health importance in humans occurring in 76 countries of the tropics and sub-tropics. In China, schistosomiasis japonica is one of the highest priorities in communicable disease control defined by the central government. Since 1970s, the habitats of Biomphalaria straminea, an intermediate host of Schistosoma mansoni in South America, have been identified in Hong Kong Special Administrative Region and Shenzhen city, Guangdong province of China. With the sharp growth in the China-aided projects in Africa and labor services export to Africa, a gradual rise in the cases infected with S. haematobium or S. mansoni is reported in those returning from Africa to China. The existence of intermediate snail hosts and import of infectious source of schistosomiasis results in concern about the transmission of African schistosomiasis in mainland China in the context of global climate change. This paper evaluates the risk of transmission of African schistosomiasis in China, and proposes countermeasures and research priorities to tackle the risk.

The habitats of Biomphalaria straminea, the intermediate host of Schistosoma mansoni, have been found in Hong Kong Special Administrative Region and Shenzhen City of People's Republic of China. Currently, there is a sharp increase in the number of Africa-aid projects and workers moving to Africa, and more and more cases infected with S. mansoni or S. haematobium returning from African countries have been detected in China. The possibility of transmission of African schistosomiasis in Chinese mainland, in the context of global climate warming, has received much attention. This paper illustrates the risk of transmission of African schistosomiasis in China based on biological and epidemiological features, and proposes interventions to tackle the risk.

Background: With the successful implementation of integrated measures for schistosomiasis japonica control, Jiangsu province has reached low-endemicity status. However, infected Oncomelania hupensis snails could still be found in certain locations along the Yangtze river until 2009, and there is concern that they might spread again, resulting in the possible re-emergence of infections among people and domestic animals alike. In order to establish a robust surveillance system that is able to detect the spread of infected snails at an early stage, sensitive and reliable methods to identify risk factors for the establishment of infected snails need to be developed., Methods: A total of 107 villages reporting the persistent presence of infected snails were selected. Relevant data on the distribution of infected snails, and human and livestock infection status information for the years 2003 to 2008 were collected. Spatio-temporal pattern analysis including spatial autocorrelation, directional distribution and spatial error models were carried out to explore spatial correlations between infected snails and selected explanatory factors., Results: The area where infected snails were found, as well as their density, decreased significantly between 2003 and 2008. Changes in human and livestock prevalences were less pronounced. Three statistically significant spatial autocorrelations for infected snails were identified. (i) The Moran's I of infected snails increased from 2004 to 2007, with the snail density increasing and the area with infected snails decreasing. (ii) The standard deviations of ellipses around infected snails were decreasing and the central points of the ellipses moved from West to East. (iii) The spatial error models indicated no significant correlation between the density of infected snails and selected risk factors., Conclusions: We conclude that the contribution of local infection sources including humans and livestock to the distribution of infected snails might be relatively small and that snail control may limit infected snails to increasingly small areas ecologically most suitable for transmission. We provide a method to identify these areas and risk factors for persistent infected snail presence through spatio-temporal analysis, and a suggested framework, which could assist in designing evidence based control strategies for schistosomiasis japonica elimination.

Based on the historical background for revision of the Control and Elimination Criteria for Schistosomiasis for 6 times, and the role of the criteria in promotion of national schistosomiasis control program of China at various stages, the present study demonstrated the necessity of further revision of the control criteria in the current schistosomiasis elimination program. In addition, the background for revision of the novel version of the Control and Elimination Criteria for Schistosomiasis was illustrated based on literature review, retrospective survey, expert argumentation and index improvement.

Objective: To understand the endemic situation of national surveillance sites in Jiangsu Province from 2005 to 2010, so as to provide the evidence for the prevention and control of schistosomiasis., Methods: According to the national surveillance protocol, a longitudinal surveillance on endemic situation of schistosomiasis was carried out in 8 national surveillance sites from 2005 to 2010., Results: In general, the positive rates of blood tests and infection rates of Schistosoma japonicum decreased from 9.04% and 0.22% in 2005 to 4.34% and 0.02% in 2010, and the rates of decline were 51.99% and 90.91%, respectively. The endemic situation of farmers, fishermen and business men were relatively serious, and the infection degree of the low-aged group of students was relatively serious. No local acute schistosomiasis case was detected. A total of 7 466.46 hm2 of environmental sites were investigated, and the areas with living Oncomelania hupensis snails and infected snails were 2 213.98 and 247.91 hm2, respectively, the densities of living snails and infected snails decreased gradually, and no infected snail was found in 2010. However, the total areas with living snails and infected snails still keep a relative high level, and the density of infected snails rebounded in special sites., Conclusion: The endemic situation of the national surveillance sites is under control, and the infection rate of human keeps at a low level in Jiangsu Province. The surveillance and control of snails and infection source should still be strengthened.

Objective: To compare the sensitivities of different isolates of Schistosoma japonicum in marshland and lake regions of Chinese Mainland to praziquantel, so as to provide experimental evidence for establishing the techniques of detecting and monitoring praziquantel sensitivity., Methods: Mice were infected with cercariae released from the S. japonicum-infected snails collected from the marshland and lake endemic regions of Hunan, Hubei, Jiangxi, Anhui and Jiangsu provinces, grouped, and treated with praziquantel at single oral doses of 37.5, 75, 150, 300 mg/kg and 600 mg/kg, while mice infected but treated with 2.5% Cremophor EL served as controls. The worm burden reductions caused by praziquantel treatment were observed, and the 50% effective dose (ED50 value) was calculated., Results: The administration with praziquantel at single oral doses of 37.5, 75, 150, 300 mg/kg and 600 mg/kg achieved worm burden reductions of 10.37%-19.81%, 23.22%-33.09%, 39.25%-49.61%, 62.87%-74.44% and 91.26%-98.09%, respectively, and no significant differences in worm burden reductions of different isolates of S. japonicum were detected following treatment with different doses of praziquantel (P > 0.05). The praziquantel ED50 values against different isolates of S. japonicum ranged from 134.1 to 186.7 mg/kg, and no significant differences of praziquantel ED50 values were found among different isolates (P > 0.05)., Conclusions: There were no significant differences of praziquantel sensitivities of different isolates of S. japonicum in marshland and lake regions of Chinese Mainland. Praziquantel ED50 value against schistosomes, as a quantitative index, can truly reflect the sensitivity of schistosome populations to praziquantel, which can be used to assess the risk of emergence of praziquantel resistance in schistosomes.

A basic framework for the rapid assessment of the risk for schistosomiasis was developed by combining spatial data from Google Earth® with a geographical information system (GIS) package, bundling the modules together with an Internet connection into a WebGIS platform. It operates through functions such as "search", "evaluation", "risk analysis" and "prediction" and is primarily aimed to be a dynamic, early-warning system (EWS) providing user-friendly, evidence-based, near real-time awareness of the status of an important endemic disease. It contributes to rapid information-sharing at all levels of decision-making, facilitating "point-of-care" response, i.e. treatment provided at newly discovered transmission sites. The experience using the platform is encouraging and it has the potential to improve support systems and strengthen schistosomiasis control activities, in particular with regard to surveillance and EWS. It can quickly and intuitively locate early, high-risk areas, retrieve all important data needed as well as provide detailed, up-to-date information on the performance of the control programme. This WebGIS, the first of its kind in the People's Republic of China, is not only applicable for schistosomiasis but can easily be adapted for improving control of any endemic disease in any geographical area.

The purpose of the current study was to investigate the susceptibility of Schistosoma japonicum to praziquantel in low endemic foci of China. During the non-transmission period of schistosomiasis, a total of 43 of 1,242 subjects were identified as being infected with the parasite using parasitological stool examinations in two low-endemicity areas of China, with a prevalence rate of 3.46%. All stool-egg-positive subjects were treated with praziquantel in a single oral dose of 40 mg/kg or 30 mg/kg for two successive days. Six weeks post-treatment, no S. japonicum eggs were detected in the 43 treated villagers. The results indicate that the current efficacy of praziquantel against S. japonicum seems satisfactory and has not changed over the past three decades in the low endemic areas of China. It is also suggested that no evidence of tolerance or resistance to praziquantel in S. japonicum is detected in areas with low endemicity in China.

According to the requirements of the Mid- and Long-term Plan for Prevention and Control of Schistosomiasis in China and based on the actual situation of schistosomiasis control in Jiangsu Province, this paper demonstrates the new technologies achieved by the scientific innovation and the novel control strategies including integrated control in key regions and control of key populations and surveillance and forecast of key water regions since 2004, with the emphasis on the control and elimination of infected Oncomelania snails. Such strategies and technologies implemented the result in continuous decrease in the endemic situation of schistosomiasis in the province, and the whole province achieved the goal of schistosomiasis transmission control in late 2010.

Background: The South-to-North Water Diversion Project (SNWDP) is the largest national water conservancy project in China. However, the Eastern Route Project (ERP) of SNWDP will refer to the habitats of Oncomelania hupensis, the intermediate host of Schistosoma japonicum. The present study was aimed at investigating the effects of some factors relating to the water diversion pattern on the spread north of O. hupensis and transmission of S. japonicum., Methods: Marked snails were attached to the floating debris, and then placed on the water surface, the passage of snails through water pumps was observed. Some marked living adult snails were placed under water in the 5 spots, 15, 30, 60, 90 and 120 days later, their survival and transfer under water were investigated. 2, 4, 8, 16, 32, 64 and 128 juvenile snails, with a male: female ratio of about 1, were caged, 1 year later, their reproductions were calculated., Results: The snails attached on the floating debris at 100-, 50- and 20-cm-distance from the inlet pipe of the big pump (with a diameter of 80 cm), could be absorbed into the pumps, with passing rates of 2.45%, 3.93% and 43.46%, respectively, compared with 72.07% and 91.00% for the snails at 20 cm and 10 cm-distance from the inlet pipe of the small pump (with a diameter of 20 cm). A total of 36,600 marked living snails were put into 5 ponds and ditches, with the water depths of 1-1.6 m, 15-120 days later, no marked ones were found along the ponds and ditches or in the straw packages. The juvenile snails did not reproduce until their density reached up to 8 snails (ratio of male: female of 1)/0.16 m2., Conclusions: During the construction of ERP of SNWDP, the risk of northward spread of schistosomiasis japonica will be decreased or eliminated as long as long-term reliable interventions for snail control are implemented.

Objective: To assess the control effect of transmission control of schistosomiasis in 14 counties (cities, districts) of Jiangsu Province., Methods: According to the requirement of the national assessment scheme of schistosomiasis, the effect of schistosomiasis control was evaluated. The schistosomiasis morbidity and changes in Oncomelania snail status in recent 2 years were assessed. The field survey was done by using the stratified sampling method. A heavy-endemicity administrative village was randomly sampled from the townships with low, moderate and heavy endemicities in each county, respectively as the assessment villages. The morbidity in resident populations and free-grazing domestic animals and the snail infections in the settings where snails were detected and frequent human and domestic animal activities were observed in recent 3 years., Results: During the period from 2007 through 2010, the transmission control effect of schistosomiasis was assessed in 14 counties (cities, districts) of Jiangsu Province, and field surveys were performed in 42 villages of 39 townships. A total of 264 settings, 1 679.73 hm2 and 39 894 frames were surveyed, and 2 179 snails were collected. Of the 405 living snails dissected, no infected snails were detected, and the snail infection rate was 0. Totally 22 147 residents were investigated. The serum examination of schistosome infection was performed in 22 147 residents, and 300 were sero-positive, with a sero-positive rate of 1.35% (0.30%-4.26%). The stool examination was done in 297 sero-positive cases, and no cases were stool-positive, with a stool-positive rate of 0. A total of 2 931 domestic animals were investigated, including 230 head of cattle, 2 333 pigs and 368 sheep, and no infections were detected. The files regarding the schistosomiasis morbidity and snail status have been established in 14 counties (cities, districts). All infected snails were killed in the 14 counties (districts, cities) 2 years prior to the assessment, and the mean time that no infected snails were detected was 2.71 years (2-4 years). No acute schistosomiasis patients were found in all 14 counties (districts, cities) more than 3 years prior to the assessment., Conclusion: According to the Criteria for Control and Elimination of Schistosomiasis in China (GB 15976-2006), the transmission of schistosomiasis in 14 countries (cities, districts) of Jiangsu Province has been controlled.

Background: Schistosomiasis japonica remains a major public health concern in China. There are many interventions implemented to control the transmission of the disease. The purpose of the present study was to investigate the effects of an integrated control strategy for schistosomiasis control., Methods: An integrated control strategy for schistosomiasis japonica with emphasis on removing cattle from snail-infested grasslands, providing farmers with mechanized farm equipment, improving sanitation by supplying tap water and building lavatories and latrines and providing boats with fecal-matter containers was implemented in 107 villages of the lower reaches of the Yangtze River, Jiangsu Province, China, during a 32-month period from May 2005 to 2008, and the effectiveness was investigated., Results: Following the effects of the comprehensive control, the snail habitat, infected snail habitat, snail infection rate, and S. japonicum prevalence in both humans and livestock all appeared a declining trend year by year, with reductions of 47.88%, 94.29%, 92.55%, 96.94%, and 100% compared with those before the comprehensive control. In addition, all of the 17 counties achieved the infection control in 2007, and 7 reached the criteria of transmission control in 2008. The confirmed snail habitats reduced from 107 to 20, and the acute infections have also been controlled for 2 successive years since 2007., Conclusions: The integrated control strategy for schistosomiasis japonica is effective to control the transmission of S. japonicum.

Objective: To evaluate the effect of comprehensive control for schistosomiasis in key areas of Jiangsu Province., Methods: The basic data and the data of implementation of comprehensive control measures were collected from the key areas of Jiangsu Province, including 30 townships, 87 marshlands and 78 anchor points. A field survey was carried out to investigate the Oncomelania snail status by using the systematic sampling method and schistosomiasis morbidity in humans and animals in the 12 key counties (districts). The changes of snail status and morbidity of humans and animals were statistically analyzed in key counties (districts) where comprehensive control measures was implemented, and the effects of schistosomiasis control before and after the implementation of the comprehensive control were compared., Results: From 2008 to 2010, a total of 84 100 harmless latrines were constructed, 339 600 persons were examined, 2.6938 million people received health education, 112 000 protective creams and 798 000 publicity materials were allocated, 9 085 domestic animals were reared in pens, 11 800 domestic animals were examined, 130 high-risk cattle were eliminated in 30 key townships of 12 countries (districts), Jiangsu Province. A total of 19 640.78 hm2 were controlled with molluscicides, 798 warning tablets were placed, 116.07 hm2 of farmlands were ploughed up and planted, 306.80 hm2 were dug for fish culture, and 506.74 hm2 were planted with trees for snail control in 87 high-risk marshlands. A total of 118.83 million Yuan were invested into the water resources development projects, 39.82 km-long rivers were dredged, 70.04 km-long bank were concreted, 30 culvert gates were re-constructed, and 22 snail sedimentation tanks were built. In the 78 anchor points, 95 harmless public toilets were built, 3 192 stool container were allocated, 28 700 boatmen were examined, 71 600 protective creams and 53 200 publicity materials were allocated, and 46 600 persons received health education. Following the implementation of comprehensive control, the settings with infected snails, infected snail areas, infection rates of snails reduced from 75, 802.73 hm2 and 0.10% before the comprehensive control in 2007 to all 0 in 2010, with reduction rates of all 100%. The infection rates of schistosome in both humans and domestic animals appeared declining trends in 12 counties (districts) from 2005 to 2010, and the human infection rates were 0.16%, 0.04%, 0.02%, 0.02%, 0.01% and 0.01%, respectively, while being 0.11%, 0.05%, 0, 0, 0 and 0, respectively in domestic animals. During the period of comprehensive control, totally 45 transmission-controlled townships and 183 villages were newly added. In 2010, all of the 12 counties (districts) reached the criteria of schistosomiasis transmission control., Conclusions: The comprehensive control with emphasis on the key areas where infected snails are found, is an effective measure to further facilitate schistosomiasis control and rapidly control the transmission of schistosomiasis.

Objective: To investigate the changes of sensitivity to praziquantel (PZQ) about PZQ-resistant isolates of Schistosoma japonicum established in laboratory by means of the resistance-inducement method during the stages of adult worms, cercariae and miracidia, so as to provide the basis for establishing the sensitivity-detecting technique to praziquantel., Methods: A Jiangsu laboratory-maintaining isolate and a Hunan field-collecting isolate of S. japonicum that were never treated with PZQ were as PZQ-susceptible isolates, and two PZQ-induced isolates that were established via drug-treated passage in laboratory were as PZQ-resistant isolates. Mice were infected with S. japonicum cercariae collected from above four isolates each. Thirty-five days after the infection, the mice were divided into 6 groups and administered orally with PZQ at dosages of 0, 37.5, 75, 150, 300 mg/kg and 600 mg/kg, respectively. All the mice were sacrificed two weeks after the treatment, and all the adult worms in the hepatic and portomesenteric veins were recovered and counted. The mean worm burden and reductions were calculated and input into Graphpad Prism 5.0 software, and the PZQ ED50 values of four isolates were calculated by the software. The cercariae of above four isolates were exposed to 10(-5), 5 x 10(-6), 10(-6), 5 x 10(-7), 10(-7) mol/L PZQ solutions for 20, 40, 60, 80, 100 min and the changes of tail shedding were observed under a dissecting microscope, then the tail shedding rates of cercariae were calculated. The miracidia of above four isolates were exposed to 5 x 10(-6), 10(-6), 5 x 10(-7), 10(-7) mol/L PZQ solutions for 1, 3 and 5 min and the morphological changes were observed under a dissecting microscope, then the morphological change rates of miracidia were calculated., Results: The PZQ ED50 values of PZQ-susceptible and PZQ-resistant isolates of Jiangsu were 147.7 mg/kg and 565.5 mg/kg, respectively, and the PZQ ED50 values of PZQ-susceptible and PZQ-resistant isolates of Hunan were 151.8 mg/kg and 467.2 mg/kg, respectively. When the cercariae were exposed to 10(-5) mol/L PZQ solution over 20 min, the tail shedding rate of cercariae from PZQ-susceptible isolate of Jiangsu was 68.8%, and the tail shedding rate of cercariae from PZQ-resistant isolate of Jiangsu was 38.2% (P < 0.01). When the cercariae were exposed to 10(-7) mol/L PZQ solution over 100 min, the tail shedding rate of cercariae from PZQ-susceptible isolate of Jiangsu was 15.9%, and the tail shedding rate of cercariae from PZQ-resistant isolate of Jiangsu was 6.7% (P < 0.01). When the cercariae were exposed to 10(-5) mol/L PZQ solution over 20 min, the tail shedding rates of cercariae from PZQ-susceptible isolate of Hunan was 59.4%, and the tail shedding rates of cercariae from PZQ-resistant isolate of Hunan was 54.6% (P < 0.05). When the cercariae were exposed to 5 x 10(-7) mol/L PZQ solution over 40 min, the tail shedding rates of cercariae from PZQ-susceptible isolate of Jiangsu was 34.3%, and the tail shedding rates of cercariae from PZQ-resistant isolate of Jiangsu was 18.4% (P < 0.01). When the miracidia were exposed to 5 x 10(-7) mol/L and 10(-7) mol/L PZQ solutions for 1, 3 and 5 min respectively, the morphological change rates of miracidia from PZQ-susceptible isolates of Jiangsu and Hunan were significantly higher than those of PZQ-resistant isolates (P < 0.01)., Conclusions: PZQ-resistant isolates of S. japonicum has been established in mice with sub-curative doses of PZQ by artificial selection in laboratory, and their sensitivities to PZQ are significantly lower than those of the isolates never treated with PZQ. The drug-resistance could exhibit in the stages of adult worms, cercariae and miracidia. The PZQ ED50 value of adult worms, the tail shedding rates of cercariae and the morphological change rates of miracidia as quantitative indicators can be used for monitoring the S. japonicum sensitivity to PZQ.

Objective: To investigate the possibility of the emergence of praziquantel resistance in Schistosoma japonicum in Mainland China under drug pressure., Methods: S. japonicum cercaria were released from the infected Oncomelania hupensis snails collected from the marshland in Hunan Province that was endemic for schistosomiasis japonica and raised in the laboratory of Jiangsu Institute of Parasitic Diseases, and mice were infected. O. hupensis snails were infected with miracidia hatched from the schistosome mature eggs that were isolated from the liver of the infected mice. The life cycles of a field isolate and a laboratory passage isolate of S. japonicum were established in laboratory via the cycle of mouse-snail. The mice were infected with 40 cercariae each, 35 days later post-infection, were grouped randomly into control and resistance-induced groups. All the mice in the control group were sacrificed on day 45 post-infection, and any adult S. japonicum worms in the hepatic and portomesenteric veins were recovered and counted, and the worm burdens were calculated. The mice in the resistance-induced group were administered orally with the sub-curative dose of praziquantel, and were sacrificed 22 days post-treatment. Any adult S. japonicum worms in the hepatic and portomesenteric veins were recovered and counted, and the worm burdens and reduction in the worms recovered which were obviously caused by the praziquantel treatment were calculated. The eggs in the liver of the mice in the resistance-induced group were isolated and hatched to yield miracidia, and then the snails were again infected with the newly hatched miracidia to complete the first-passage inducement. After raising in laboratory at 25 degrees C for 60-70 days post-infection, the infected snails were isolated and shed cercaria, and the mice were infected with the newly released cercaria to start a new passage of resistance-inducement. The oral dose of praziquantel for the first-passage inducement was 100 mg/kg, and an additional 100 mg/kg was given every 2-3 passages. The mice were infected with cercariae of the parasite with 8-passge resistance-inducement and the isolate that was not induced, and 35 days post-infection, were administered with praziquantel at a single oral doses of 300 mg/kg and 600 mg/kg respectively. All the mice were sacrificed 14 days post - treatment, and any adult S. japonicum worms in the hepatic and portomesenteric veins were recovered and counted, and the reductions in the worm burdens were calculated to assess the sensitivity of praziquantel in the parasites after 8-passage resistance-inducement., Results: Two isolates of Jiangsu laboratory passage of Jiangsu and field isolate of Hunan were established in the laboratory, and a total 8-passage resistance -inducement was completed. For the laboratory passage isolate, the worm burden reduction was 22.3% post-treatment with 100 mg/kg praziquantel during the first-passage inducement, and 53.7% post-treatment with 300 mg/kg praziquantel during the 8-passage inducement, appearing that the worm burden reduction increased with the increasing dose of praziquantel. For the field-collected isolate, the worm burden reduction was 66.8% post-treatment with 100 mg/kg praziquantel during the first-passage inducement, and 20.6% post-treatment with 300 mg/kg praziquantel during the 8-passage inducement, indicating that the worm burden reduction markedly decreased with the increasing dose of praziquantel. The worm burden reductions were 71.5% and 97.4% respectively for the mice infected with the non-induced laboratory passage isolate, while administered with praziquantel at doses of 300 mg/kg and 600 mg/kg respectively. After 8-passage treatment with sub-curative praziquantel, the corresponding worm burden reductions decreased to 32.6% and 68.1%, respectively. For the field-collected isolate without inducement, the worm burden reductions in the mice were 70.8% and 97.5% respectively post-treatment with praziquantel at doses of 300 mg/kg and 600 mg/ kg respectively, and the corresponding worm burden reductions decreased to 45.7% and 61.9%, respectively after 8-passage treatment. COCLUSIONS: S. japonicum (strain of Mainland China) is able to develop resistance to praziquantel under continuous drug pressure. However, there are variations in the potential of the emergence of resistance due to various susceptibility of praziquantel among different isolates. The successful establishment of praziquantel-resistant strain of S. japonicum (Mainland China) will provide the basis for exploring the mechanism of praziquantel resistance in S. japonicum, and developing related techniques to detect and monitor praziquantel resistance.

Background: Due to the success of the national schistosomiasis control programme in China, transmission has been sufficiently reduced in many areas to severely limit identification of areas at risk by conventional snail surveys only. In this study, we imported Google Earth technology and a Global Positioning System (GPS) into the monitoring system for schistosomiasis surveillance of the banks of the Yangtze River in Jiangsu Province, China., Methods: A total of 45 sites were selected and the risk was assessed monthly by water exposure of sentinel mice at these sites from May to September in 2009 and 2010. The results were assembled and broadcast via the Google Earth platform., Results: The intensity of schistosomiasis transmission showed peaks of risk in June and September of 2009, while there was only one small peak in June in 2010 as the number of detected positive transmission sites dropped dramatically that year thanks to improved mollusciciding. River ports were found to be areas of particular risk, but ferry terminals and other centres of river-related activities were also problematic., Conclusions: The results confirm that the surveillance system can be rapidly updated and easily maintained, which proves the Google Earth approach to be a user-friendly, inexpensive warning system for schistosomiasis risk.

Background: Schistosomiasis japonica, caused by contact with Schistosoma japonicum cercaria-infested water when washing, bathing or production, remains a major public-health concern in China. The purpose of the present study was to investigate the effect of a suspension concentrate of niclosamide (SCN) on killing cercaria of S. japonicum that float on the water surface, and its toxicity to fish, so as to establish an emergency-treatment intervention for rapidly killing cercaria and eliminating water infectivity., Results: At 30 min after spraying 100 mg/L SCN, with niclosamide dosages of 0.01, 0.02, 0.03, 0.04 g/m², the water infectivity reduced significantly and no infectivity was found at 60 min after spraying SCN. The surface of static water was sprayed with 100 mg/L SCN, the peak concentration was found at 0 min, and the solution diffused to site with a water depth of 10 cm after 10 min. 30 min later, SCN diffused to the whole water body, and distributed evenly. After spraying 100 mg/L SCN onto the surface of the water with a volume of(3.14 × 202 × 50)cm³, with niclosamide dosages of 0.02 g/m², 96 h later, no death of zebra fish was observed., Conclusions: By spraying 100 mg/L SCN, with a niclosamide dosage of 0.02 g/m² onto the surface of S. japonicum-infested water, infectivity of the water can be eliminated after 30-60 min, and there is no evident toxicity to fish. This cercaria-killing method, as an emergency-treatment intervention for infested water, can be applied in those forecasting and early warning systems for schistosomiasis.

The effectiveness of a comprehensive schistosomiasis japonica control program implemented in 8 villages along the Yangtze river in Jiangsu province from 2005 to 2008 was studied. Control measures included snail control, chemotherapy of humans and livestock, health education, and transmission cycle interruption using sanitation in dwellings and at anchorage sites for fishermen and sailors. The Schistosoma japonicum prevalence among residents and livestock, the total area of snail habitats, the Oncomelania hupensis snail density, and the percentage of infected snails served as indicators for the effectiveness of the control efforts. After 4 years of program implementation, the seroprevalence in humans had decreased from 9.03% to 3.24% (P < 0.001) and the parasitological prevalence among males had decreased from 0.42% to 0.12% (P = 0.004). Among females, it remained stable at a low level. The S. japonicum prevalence in livestock had decreased from 2.94% to 0% (P < 0.001). Additionally, the area where infected snails could be found had shrunk from 89.99 hectares (ha) to 16.00 ha, the snail density had decreased from 0.56 to 0.32 per 0.1m(2), and the percentage of infected snails had dropped from 0.38% to 0.12% (all P < 0.001). The results demonstrate that an integrated schistosomiasis japonica control strategy focusing on the main transmission cycles and reservoirs and combines chemotherapy, infrastructure interventions and health education combined with robust surveillance is feasible and allows to effectively control S. japonicum., (Copyright © 2010 Elsevier B.V. All rights reserved.)

Objective: To establish an approach to monitor the Schistosoma japonicum miracidia in waterbody of the Yangtze River, and monitor the infectivity of water body, so as to provide the evidence for tracing and controlling infection source and interrupting the transmission of schistosomiasis, and Oncomelania snail control., Methods: The floating bottle-nylon bag sentinel snails method was employed. A total of 45 surveillance sites were selected along the Jiangsu section of the Yangtze River, 500 snails were placed into each site from May to September, once every month. Twenty-eight hours later, all the snails were transferred and raised in an incubator at 25 degrees C. Two months after the first recovery, the snail infection was detected each month by using the cercaria-shedding test. Three months after the final placement, all the snails were dissected for observation of the infection. The activities of humans and domestic animals were surveyed in the settings where infected snails were found. The database of surveillance results of sentinel snails in the Yangtze River, Jiangsu Province was established, and the geographical distribution map of site with infected snails was drawn, and the probability that snails were infected with S. japonicum was estimated., Results: A total of 44 717 sentinel snails were placed in 45 sites during the period of 5 months, and 43 477 recovered, with a recovery rate of 97.23%. A total of 81 410 snails were detected by the cercaria-shedding test, no infections were found. A total of 13 033 snails were dissected, and 5 were infected, with an infection rate of 0.038%. The probability of snail infection in water was 4.11 out of a million. Five sites with infected snails were found in 45 sites, with an occurrence rate of 11.11%. The sites with infected sentinel snails were distributed in south bank (3, 21.43%), north bank (1, 5.56%) and river center (1, 7.69%), respectively. The occurrence rate of sites with infected snails in south bank was 3.8 times more than that in north bank. Among the 5 sites, 3 were anchor points of boat fishermen., Conclusions: The contamination of S. japonicum eggs in south bank of the Yangtze River is higher than that in north bank in Jiangsu Province, and the anchor point of boat fisherman is one of the important contamination regions. The floating bottle-nylon bag sentinel snails testing method is an effective approach to monitor the contamination of S. japonicum eggs in water.

Objective: To investigate the effect of suspension concentrate of niclosamide (SCN) on killing cercariae of Schistosoma japonicum on water surface, optimization and impact on fish, so as to establish an emergency-treatment intervention for rapidly killing cercariae and eliminating water infectivity., Methods: SCN was formulated into different concentrations of solutions, and then the solutions were sprayed on the surface of water containing S. japonicum cercariae. The water infectivity was determined by using mice at 0, 10, 30 min after spraying SCN. SCN was formulated into a solution of 100 mg/L and then sprayed on the surface of the water by using the spraying values of 0.01, 0.02, 0.03 g/m2 and 0.04 g/m2. At 30 min and 60 min after spraying, the water infectivity was determined by using mice. Zebra fish were transferred into the static water, then 100 mg/L SCN (s), using spraying values of 0.01, 0.02, 0.03 g/m2 and 0.04 g/m2, were sprayed on water surface. At 0, 10, 30, 60 min after spraying, the samples were collected at water depths of 0, 10, 20, 30, 40 cm, and niclosamide was determined by using high-performance liquid chromatography. The death of zebra fish was continually observed within 96 h after spraying SCN., Results: At 0, 10, 30 min after spraying 1 000, 100, 10, 1, 0.1 mg/L SCN on water surface, the infectivity of water significantly decreased. At 30 min after spraying 1 000 mg/L and 100 mg/L SCN, no schistosome infectivity was detected in the water. At 30 min after spraying 100 mg/L SCN, with spraying values of 0.01, 0.02, 0.03, 0.04 g/m2, the water infectivity significantly reduced, and no infectivity was found 60 min after spraying SCN. After the surface of static water was sprayed with 100 mg/L SCN, the peak concentration was found at 0 min, and the solution diffused to site with a water depth of 10 cm after 10 min, and 30 min later, SCN diffused to the whole water body, and distributed evenly. After spraying 100 mg/L SCN on the surface of water with a volume of (3.14 x 20(2) x 50) cm3, by using the spraying value of 0.02 g/m2, 96 h later, no death of zebra fish was found., Conclusions: From 30 to 60 min after spraying 100 mg/L SCN, with the value of 0.02 g/m2, on the surface of S. japonicum-infested water, the water infectivity can be eliminated, and there is no evident toxicity to fish. This cercaria-killing method, as an emergency-treatment intervention for infested water, can be applied in those surveillance and forecast sites.

In schistosomiasis transmission-interrupted provinces in China, the endogenous source of infection has been basically cleared, and the exogenous source of infection is considered as a major threat. The residual snail area has been increasing in different degrees, and imported snails are regarded as a potential risk. So the possibility of schistosomiasis recrudescence still remains. According to the endemic characteristics, the integrated solidification strategy with emphasis on control of residual snails and imported cases should be taken in the future.

Based on the objective of long- and mid-term development program for schistosomiasis control in China, the paper presents an analysis of strategy for schistosomiasis control and its function in the 12th Five-Year Plan. Meanwhile, the strategy and key elements of schistosomiasis control for recent years are put forward for different endemic areas.

This paper reviewed the current endemic features and situation of schistosomiasis in lake and marshland regions in China, and discussed the comprehensive control strategy for schistosomiasis with emphasis on infectious sources control, including its theoretical basis, the reality conditions of implementation and technical composition, and also introduced the effectiveness of the pilot trails and their large-scale application as well as several issues in the implementation. The aim of the review is to accelerate the process of schistosomiasis control in lake and marshland regions and promote the achievement of mid- and long-term goals in national schistosomiasis control program.

Praziquantel is widely used for the treatment of human schistosomiasis. However, in recent years, there has been increasing concern about the resistance of Schistosoma species to praziquantel. The study described here was designed to evaluate the current susceptibility to praziquantel in S. japonicum in China. During the non-transmission period of schistosomiasis, a random sample of 4760 subjects from the main endemic foci of China were examined using parasitological stool examination. In total, 584 subjects were identified as being infected with S. japonicum, with a prevalence rate of 12.27%. Among them, 565 stool-egg-positive subjects were treated with praziquantel in a single oral dose of 40 mg/kg. Six weeks post-treatment, among the 505 villagers re-examined, 480 (95.05%) had no detectable S. japonicum eggs. Twenty-one subjects still excreting eggs after the first treatment were treated with praziquantel for the second time. All stool samples, including those from those participants with second treatment were re-examined 6 weeks after the second treatment, and no stool-egg-positives were found. The results indicate that the current efficacy of praziquantel against S. japonicum is still high and has not changed after more than 2 decades of repeated, expanded chemotherapy in the main endemic areas of China. It is suggested that no evidence of tolerance or resistance to praziquantel in S. japonicum was detected in China.

Background: Autoimmune thyroid disease (AITD) often coexists with pernicious anemia (PA) among whites. The study aimed to determine thyroid autoimmunity in Chinese patients with PA., Methods: From the data of a hospital-based longitudinal study of Chinese PA patients (1994-2007), those with complete information of antibodies to thyroid peroxidase (TPO), thyroglobulin (Tg), and gastric parietal cell; serum thyroid-stimulating hormone and free thyroxine; gastric mucosal histology; and family history of AITD were analyzed., Results: Among 126 Chinese PA patients, 44% had TPO/Tg antibodies and 13.5% AITD. TPO/Tg antibodies occurred in 33% (16 of 49) of male and 52% (40 of 77) of female patients (P = 0.034). Graves disease (8 patients) tended to antedate PA and was associated with no or low titers of TPO/Tg antibodies. Primary hypothyroidism (9 patients) developed during follow-up and was associated with high TPO/Tg antibody titers. The TPO/Tg antibodies did not affect the clinical course of PA but was associated with an enhanced risk of developing AITD and vitiligo. Overall, AITD (before and after PA) occurred in 23% (13 of 56) and 5.7% (4 of 70) of PA patients with and without antibodies (P = 004). During follow-up (mean duration of 75.24 +/- 46.39 months), 10 patients developed AITD-7 new onset of hypothyroidism and 3 progression/relapse of prior AITD. Logistic regression analysis of presenting features of PA revealed 2 independent factors for AITD development during follow-up-presence of thyroid antibodies (odds ratio 20.2, 95% confidence interval 1.8-223) and history of prior AITD (odds ratio 39.8, 95% confidence interval 2.3-679)., Conclusion: It is recommended to screen thyroid antibodies and monitor thyroid function during follow-up.

The South-to-North Water Diversion Project (SNWDP) is currently the key, national, water-conservation project in China, designed to optimise the use of water resources and relieve the water shortages in the north of the country. As one of the main water intakes for the project, that of the Eastern Route Scheme (ERS), is a breeding site for Oncomelania hupensis (the intermediate host of Schistosoma japonicum), there is concern that the snail may be carried far to the north, in the water passing through the project. To see if they could survive and breed to the north of their current range in China, O. hupensis were collected in marshland near Nanjing City and transferred to cages, on the banks of fish ponds, in the cities of Zhenjiang (in Jiangsu province, at 32 degrees 10'N), Xuzhou (in the same province but at a latitude of 34 degrees 23'N) and Jining (in Shandong province, at 35 degrees 23'N). Except over the first 6 months in Xuzhou, the snails moved north of their natural distribution did not survive and reproduce as well as those in Zhenjiang, and all those transferred to Jining died out within 1 year. Although the snail populations in Xuzhou survived for 7-8 years and retained their infectivity to S. japonicum, histological and histochemical studies revealed abnormalities in the reproductive organs of these snails. It is concluded that, unless global warming significantly increases the minimum winter temperatures in northern China, the SNWDP is unlikely to result in the northward spread of schistosomiasis japonica.

Snail control by molluscicides is an important strategy for schistosomiasis control in China. Currently, only one chemical molluscicide, niclosamide, which is used as 50% wettable powder of niclosamide ethanolamine salt (WPN), is commercially available for field snail control in China. However, WPN is costly, toxic, and has a lower dispersibility and precipitates rapidly. In this paper, we describe the development of a novel formulation of niclosamide, a suspension concentrate of niclosamide (SCN). The efficacy of SCN was evaluated both in the laboratory and field. SCN showed better molluscicidal effects than conventional formulation of WPN, as determined by LC(50) for adult snails, young snails, and snail eggs. The acute toxicity of SCN to Brachdanio rerio hamiton was less than WPN. In conclusion, the novel formulation of SCN suspension is physically more stable, more effective, and less toxic. Therefore, it can be more useful for controlling snails in endemic areas of schistosomiasis in China.

Objective: To study the relationship between the changes of environment and the transmission of Schistosomiasis japonica after the construction of the Three Gorge Reservoir., Methods: On the basis of the predictive data on changes of water level and sediment in the middle and lower reaches of the Yangtze River after the dam construction provided by the Yangtze River Committee on Water Conservancy, corresponding data were collected and analyzed. In order to understand the effects of changes of water level and sediment on Oncomelania hupensis, the intermediate host of Schistosoma japonicum, field surveys and ecologically intimated experiments were done. The prevalence status and factors related to transmission were investigated by epidemiology, medical geography and public health., Results: Positive impact on control of schistosomiasis is that floods in the Yangtze River will occur less and will decrease the dispersal of snails and the chances of infection for humans and animals as well. Snail habitats' beach will be reduced in the flushed area along the Yangtze River. Exploitation of beach and elimination of snails will benefit from the beach's uplift in flushed area. The floods ahead of time in autumn will interfere with the development of snails. Negative impact is that the flushed beaches and migratory settlements at certain altitude may become snail habitats. So the reservoir area will be a potential transmission area of schistosomiasis due to dispersal of infectious resources and Oncomelania snails. The uprising of the water body level may cause the expending of the snail habitats in some places of Jianghan plain during the transition of spring to summer. The destruction of the embankments of the Dongting Lake will be put off by its delayed flush, which causes the beach in a situation of growing reed-grass or grass for a long time that benefits the reproduction of the snails. The chances for schistosome infection to humans and animals will be on the increase, because the water regression occurs ahead of time in the Dongting Lake beach in autumn. The distribution of snails will not be affected by the changes of water level in the lower reaches of the Yangtze River after the dam is built, but the flushed section in Anhui in the recent 80 years are suitable for the snails' development. The environmental changes due to dam construction will not obviously affect the development of snails and the transmission of schistosomiasis in the Poyang Lake area., Conclusion: The construction of the huge dam and the formation of the Three Gorge Reservoir on the Yangtze River may have both positive and negative impact on schistosomiasis transmission and control. Great effort must be made to decrease the negative impact to avoid or, at least, to decrease S. japonicum transmission.