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Aim This study investigated the cost-effectiveness of a community-based colorectal cancer-screening program (C-CRCSP) in Shanghai, China, with a comparison of urban, suburban, and rural areas. Methods A Markov model was constructed to evaluate the cost-effectiveness of a 25-year-long annual C-CRCSP with 100,000 samples. Cost-effectiveness was determined by the incremental cost-effectiveness ratio (ICER) referring to either life-years gained, or quality-adjusted life-years (QALYs) gained. The threshold was gross domestic product per capita. Univariate and multivariate sensitivity analyses were performed to investigate the influence of compliance, prevalence, technological performance, price, and an annual cost discount rate (3.5%) on ICERs. A probabilistic sensitivity analysis evaluated the probability of cost-effectiveness of C-CRCSP at different maximum acceptable ceiling ratios. Results Compared with no screening, the C-CRCSP could result in total gains of 7840 QALYs and 2210 life-years, at a total cost of CNY 58.54 million; that is, the ICERs were CNY 7460/QALY and CNY 26,650/life-year. Stratifying by residency, the highest cumulative gains in QALYs and life-years were estimated for the rural population, followed by the suburban and urban. The cost for the urban population was 3- and 6-fold that of the suburban and rural populations. The ICERS for QALYs ranged from 2180 (rural) to 16,840 (urban). Conclusion The cost-effectiveness of a C-CRCSP in Shanghai was most favorable for the rural population, while the urban population would realize lesser benefit in terms of QALYs. ICERs could be enhanced by measures that increase compliance. This article is protected by copyright. All rights reserved.

Background There have been few studies on children hospitalized with respiratory syncytial virus (RSV) published from mainland China. We performed a retrospective review of medical charts to describe the epidemiology, clinical features and direct medical cost of laboratory-proven RSV children hospitalized in Suzhou, China. Methods Testing is routine for RSV for children admitted to the respiratory ward at Suzhou University Children's Hospital. We performed a retrospective study on children with documented RSV infection hospitalized at Suzhou University Children Hospital during 2005-2009 using a structured chart review instrument. Results A total of 2721 hospitalized children (15.0% of those tested) were positive by immunofluorescent assay for RSV during 2005-2009, and 64.0% of them were male. Eighty-seven percentage of the RSV-infected children were 2 years old and younger, and 56.6% were ≤ 6 months of age. The median length of hospital stay was 8 days. Of the RSV-infected children, 92.5% developed pneumonia and 21.8% experienced wheezing. In total, 49 (5.1%) of RSV-positive children were transferred to the ICU. Children ≤ 6 months old and who had congenital heart disease had higher risk of severe RSV disease. The mean cost of each RSV-related hospitalization was US$571.8 (US$909.6 for children referred to ICU and US$565.4 for those cared for on the wards). Multivariable logistic regression showed that compared with the ≤ 6 months children, those aged >6 months old had higher hospitalization cost; children with respiratory distress or with chronic lung diseases tended to have higher hospitalization costs than others. Conclusions RSV infections and severe RSV diseases mostly occurred in early infancy. The direct medical cost was high relative to family income. Effective strategies of RSV immunization of young children in China may be beneficial in addressing this disease burden.

Background Very little is known about the effect of modifiable lifestyle factors on outcomes of triple-negative breast cancer. We examined this association in a population-based prospective cohort study of patients with triple-negative breast cancer. Methods A total of 518 women with confirmed triple-negative breast cancer, recruited by the Shanghai Breast Cancer Survival Study, completed 6-, 18-, 36-, and 60-month postdiagnosis surveys. We applied Cox proportional hazard models to evaluate the associations. Results The mean age at diagnosis was 53.4 (standard deviation = 10.6) years old. After a median follow-up of 9.1 years (range: 0.6-11.8), 128 deaths and 112 recurrences were documented. Exercise during the first 60 months postdiagnosis was inversely associated with total mortality and recurrence/disease-specific mortality with adjusted hazard ratios (HRs) of 0.67 (95% confidence interval [CI] = 0.46, 0.96) and 0.58 (95% CI = 0.39, 0.86), respectively. Women with higher exercise-metabolic equivalent scores (≥7.6 metabolic equivalent-hours/week) and longer duration of exercise (≥2.5 hours/week) had lower risk of total and recurrence/disease-specific mortality than did nonexercisers. Compared with nontea drinkers, survival was better among women who were regular tea drinkers during the first 60 months for all cause (HR = 0.57, 95% CI = 0.34, 0.93) and recurrence/disease-specific mortality (HR = 0.54, 95% CI = 0.31, 0.96). There was no dose-response pattern for tea consumption. No interactions were observed for body mass index, menopausal status, and comorbidity. Conclusions These findings show that postdiagnosis exercise and tea intake were associated with improved survival among women with triple-negative breast cancer.

A prospective study was performed to determine serotype distribution and antimicrobial resistance in Streptococcus pneumoniae (S. pneumoniae) from Chinese children

Schistosoma japonicum in China has been one of the most serious public problems. Subspecies of the pomatiopsid snail species Oncomelania hupensis is well known as the intermediate S. japonicum host. We used the simple sequence repeat anchored PCR (SSR-PCR) to assess the systematic position of the snail populations from the northwestern part of Guangxi Province, and to assess the degree to which SSR-PCR derived relationships are congruent with the allozymes, COI, and AFLPs results. For 19 populations studied, the genetic distance D ranged from 0.00 to 0.73, with an average value 0.22 ± 0.013. The cophenetic correlation coefficient for the Complete-link cluster, Single-link cluster, UPGMA cluster and NJ cluster was 0.932, 0.906, 0.939 and 0.733, respectively. The goodness of fit for these clusters except NJ cluster was very good. These results were very similar to the results of the AFLPs analysis data. The patterns of genetic differentiation are basically consistent with geographic distribution a...

Insight into the spatial and temporal contamination of the environment by bovine faeces in China can provide important information on the significance of bovines in the transmission of human schistosomiasis. This insight will be useful for the new evidence-based strategy of the Chinese national schistosomiasis control programme. To enhance our understanding of the spatio-temporal relationship between the prevalence of human and bovine schistosomiasis, we performed correlation and regression analyses using data from three national sampling surveys on schistosomiasis, carried out in 1989, 1995 and 2004. In addition, we established a geographical information system and performed spatial analyses to identify the high-risk areas of the disease. We found that schistosomiasis is mainly concentrated in the marshlands along the Yangtze River. It was also noted that, although the human prevalence and force of transmission in highly endemic areas has been reduced since 1989, the relative importance of bovine schistosomiasis has increased. This is seen in a declining Spearman correlation coefficient between the infection prevalence in humans and in bovines over time (0.812 in 1989, 0.754 in 1995 and 0.376 in 2004). In parallel, the slope of the linear regression decreased from 0.395 in 1989 to 0.215 in 2004. Our data therefore suggest that future schistosomiasis control efforts in China should more vigorously address the important role of bovines in the transmission of human schistosomiasis, and to reduce the environmental contamination of Schistosoma japonicum eggs by bovines.

Although the number of human infections decreased, human prevalence increased from 4.9% in 1995 to 5.1% in 2004., Results from the third nationwide cluster sampling survey on the epidemiology of schistosomiasis in the People’s Republic of China, conducted by the Ministry of Health in 2004, are presented. A stratified cluster random sampling technique was used, and 239 villages were selected in 7 provinces where Schistosoma japonicum remains endemic. A total of 250,987 residents 6–65 years of age were included in the survey. Estimated prevalence rates in the provinces of Hunan, Hubei, Jiangxi, Anhui, Yunnan, Sichuan, and Jiangsu were 4.2%, 3.8%, 3.1%, 2.2%, 1.7%, 0.9%, and 0.3%, respectively. The highest prevalence rates were in the lake and marshland region (3.8%) and the lowest rates were in the plain region with waterway networks (0.06%). Extrapolation to all residents in schistosome-endemic areas indicated 726,112 infections. This indicates a reduction of 16.1% compared with a nationwide survey conducted in 1995. However, human infection rates increased by 3.9% in settings where transmission is ongoing.

Summary Objectives To understand the association between the outbreak of severe acute respiratory syndrome (SARS) and meteorological factors and air pollution. Study design An ecological study was conducted. Methods Three hundred and fifty primary probable SARS cases diagnosed in mainland China between 1 January and 31 May 2003, and their 6727 close contacts during the period of their clinical symptoms before admission, were included in this study. Of the 6727 close contacts, 135 (2.0%) later developed clinical symptoms and were diagnosed as probable SARS cases. The daily meteorological data and daily air pollution data during the same SARS outbreak period in mainland China were used in the data analysis. Logistic regression analyses were conducted to explore the association between the secondary attack rate of SARS and meteorological factors and air pollution. Results In univariate analyses, daily average temperature (DAT), daily average air pressure (DAAP), and daily average relative humidity (DARH) were inversely associated with secondary attack rate (P

Background. Surveillance for pneumococcal respiratory illness was conducted in children hospitalized at Affiliated Pediatric Hospital of Fudan University in Shanghai from August 2000 to August 2001. Methods. Sputum cultures were obtained from pediatric patients admitted with pneumonia or respiratory distress by tracheal aspirate. Blood cultures were also performed on a subset of patients. All pneumococcal isolates were serotyped and tested for antibiotic susceptibility. In addition clinical information on the patients including prior antibiotic history was abstracted. Streptococcus pneumoniae tracheal isolations were attempted in a total of 1013 pediatric patients hospitalized during this period. Among these samples 112 specimens were S. pneumoniae-positive. These positive isolates underwent serotyping and antibiotic susceptibility testing. Results. Five serotypes (19F, 23F, 6A, 14, 6B) of S. pneumonia accounted for 81% (91 of 112 cases). Other serotypes accounted only for 12% (13 of 112 cases), and 7% (8 of 112 cases) of isolates could not be typed by quelling test. Only one blood culture isolate was positive, probably reflecting the frequent use of antibiotic treatment before hospitalization. Fifty-one and 8.0% of isolates had intermediate and high level penicillin resistance, respectively. Fifty-eight percent were resistant to ampicillin, 6.6% to cefazolin, 25.0% to cefaclor, 6.6% to ceftriaxone, 85.7% to erythromycin, 66.7% to clindamycin and 28.2% to chloramphenicol. Among 66 isolates that were not susceptible to penicillin, serotype 19F was the most common, followed by 23F and 14. Conclusion. S. pneumoniae is a common cause of respiratory illness requiring hospitalization in young children in Shanghai, with antibiotic resistance increasingly common. Five serotypes account for most disease.

OBJECTIVE Our objective was to determine the secular trend in prevalence of type 2 diabetes in Shanghai, China. RESEARCH DESIGN AND METHODS Two consecutive population-based surveys for type 2 diabetes were conducted in randomly selected adults aged 35–74 years in Shanghai in 2002–2003 (n = 12,329) and in 2009 (n = 7,423). Diagnosed type 2 diabetes was determined based on self-report, whereas those undiagnosed were identified by measured fasting and postload glucose according to 2009 American Diabetes Association criteria. RESULTS Age-standardized prevalence of diagnosed and undiagnosed type 2 diabetes increased from 5.1 and 4.6% in 2002–2003 to 7.4 and 5.2% in 2009. The prevalence of type 2 diabetes increased with age and was higher among men and in urban residents in both surveys (P < 0.001). Between the two surveys, the increase in the prevalence was more evident in the rural population (P < 0.001) and appeared more rapid in younger birth cohorts (P < 0.05). CONCLUSIONS Our results suggest that Shanghai has experienced an increasing burden of type 2 diabetes.

To understand the distribution of univalvia molluscs in Eastern Dongting lake area where the Oncomelania hupensis is extinct, so as to explore the causes of extinction and to provide the evidence for formulating schistosomiasis control strategy.The univalvia molluscs of the Qianliang Lake district, Jianxin District and Junshan Park were investigated in August of 2013. All the collected snails were classified and identified. The data were analyzed by using the method of Shapiro-Wilk normality test and non-parametric test. The ecological biodiversity differences from each district were compared by the biodiversity indexes.The univalvia molluscs collected were from 6 species in 3 families in Gastropoda class, namely Oncomelania hupensis Gredler in Pomatiopsidae family, Parafossarulus striatulus, Alocinma longicornis, Parafossarulus sineasis, Bithynia fuchsisana in Bithyniidae family, and one genus provisioy nally named Radix in Lymaneidae family. In Junshan Park, a total of 4553 snails were collected, among which 1264 were Oncomelania snails. In Jianxin District, 336 univalvia molluscs were collected, and no Oncomelania snails were found. In Qianliang Lake district, there were only 7 Alocinma longicornis snails, 2 Parafossarulus sinensis snails and 1 Parafossarulus striatulus snail collected. There were significant differences among the distributions of the samples from the three districts (chi2 = 166.225, P0.01) .The Simpson's diversity indexes in Qianliang Lake area, Jianxin Dis- trict and Junshan Park were 0.4028, 0.7186 and 0.6788, respectively, and the Shannon-Wiener indexes of the 3 areas were 0.7215, 1.4313 and 1.1999, respectively.With the extinction of Oncomelania snails, the species and quantities of other snails become rare in Qianliang Lake area. Whether their causes are relevant is worth further studying.

To understand the change trend of Oncomelania hupensis snails in the bottomland areas of Qian Liang Lake district in Eastern Dongting Lake area so as to provide the evidence for formulating a schistosomiasis control strategy.The monitoring data of snails of Qianliang Lake district from 1988 to 2011 were collected retrospectively and analyzed by using the method of the trend Chi-square test. The correlations among the snail density indicators were analyzed.1988 to 2011, the area of snails surveyed did not change and was 433.2 hm(2). The monitoring data showed that the change trend of the density of living snails and the schistosome infection rates of snails were not obvious (P0.05), but the mortality of snails showed a falling trend (P0.05); There were positive correlations between the average density of infected snails and the mortality of snails (r = 0.640, P0.05) , the infection rate of snails (r = 0.639, P0.05) , and the average density of living snails (r = 0.646, P0.05) , respectively. There was no correlation among other snail indicators. In 1999, only 7 snails were found, of them, only one snail was alive. The alive snails were not found after 2000.In the bottomland areas of Qianliang Lake district, the change trend of the density of alive snails were not obvious from 1988 to 1998, but the number of snails underwent a sharp drop in 1999 and snails have been not found till now.

To explore the impact of the impoundment of Three Gorges reservoir on Oncomelania snail habitats of Poyang Lake.Four counties with schistosomiasis endemic around the Poyang Lake, naming as Xingzi, Duchang, Jinxian and Xinjian, were selected as study areas. The average daily water level of four major hydrological stations near the above 4 counties from 1997 to 2008 were collected, as well as the elevation of 215 marshlands with snails in those 4 counties, the data of schistosomiasis endemic situation and snail survey of 4 counties in the year before the impoundment of Three Gorges reservoir (2002) and the 6th year after the impoundment of Three Gorges reservoir (2008). The fluctuations of water levels of Poyang Lake, flooding day of marshland with snails as well as the changes of the indicators in snail survey and prevention and control measures before and after the impoundment of Three Gorges reservoir were compared.Before the impoundment of Three Gorges reservoir, the fluctuations of average water level of the four hydrological stations around Poyang Lake was 6.91-12.93 m; which reduced to 5.72 - 10.75 m after the impoundment. The D-value of the fluctuations of average water level was (1.06 ± 0.47) m. The date of the annual maximum water level delayed by an average of 12 d; while the date of annual minimum water level arrived an average of 12 d earlier than the impoundment of Three Gorges reservoir. The average flooding days of marshland with snails were separately (100.04 ± 42.06) d before the impoundment and (64.13 ± 22.30) d after the impoundment. The difference was statistically significant (t = 3.70, P0.05). The density of snails in the 4 counties around Poyang Lake was 0.8437/0.1 m(2) after the impoundment; declining by 31.04% from the snail density (1.2234/0.1 m(2)) before the impoundment. The density of infectious snails was 0.0014/0.1 m(2) after the impoundment; dropping by 67.34% from it (0.0042/0.1 m(2)) before the impoundment; the infection rate of snails was separately 0.34% after the impoundment and 0.16% before the impoundment. The difference was statistically significant (χ(2) = 53.25, P0.05). The coverage rate of chemotherapy increased from 4.45% (35 558/798 200) in 2002 to 9.80% (79 457/810 400) in 2008; the difference was statistically significant (χ(2) = 17 336.63, P0.05). The coverage rate of snail killing increased from 1.35% (389.04/28 824.66) in 2002 to 7.49% (2260.90/30 166.22) in 2008; the difference was also statistically significant (χ(2) = 28 824.66, P0.05).The impact of the impoundment of Three Gorges reservoir shortened the flooding days of marshland with snails and helped the prevention and control of schistosomiasis in Poyang Lake regions as the environment went against the breeding of the snails.

To explore the risk factors of primary open angle glaucoma (POAG) in women.This retrospective, case-control study collected 128 female patients with POAG and 142 female with normal controls without POAG from 2009 to 2010. The risk factors including family history, hypertension, diabetes, age of menarche, age of menopause, parity, oral contraceptive (OC) use, hormone therapy were analyzed by logistic regression analysis.Compared with normal control group using logistic regression analysis, there were significant differences in such risk factors in POAG group as family history (OR = 43.36, 95%CI: 5.69 - 346.67; P0.001), hypertension(OR = 3.29, 95%CI: 1.82 - 5.94; P0.001), age of menarche (OR = 2.046, 95%CI: 1.17 - 3.54; P = 0.011), age of menopause (OR = 0.57, 95%CI: 0.32 - 0.99; P = 0.049), hormone therapy (OR = 0.29, 95%CI: 0.09 - 0.92; P = 0.036).Family history and hypertension are high risk factors to develop POAG for women. However, female hormones may play a protective role in women with POAG.

To investigate the relationships between hyperuricaemia, serum uric acid (SUA) level and the chronic kidney disease (CKD) in adult residents of Pudong New Area, Shanghai.3326 residents aged 20 - 80 years were randomly selected from Pudong New Area, Shanghai through multistage sampling and interviewed between April and July of 2008. Fasting blood sample and morning ovid urine sample were collected for each participant for testing of SUA, serum creatinine, urinary albumin and creatinine. Both urine albumin to creatinine ratio (ACR) and glomerular filtration rate (GFR) were calculated to estimate the renal function.The overall prevalence of CKD was 16.0% (age standardized 13.2%). The mean values of estimated GFR in participants with CKD and without CKD were (89.19±27.25) and (105.88±98.37) ml×min(-1)×(1.73 m2)(-1), respectively. The prevalence rates of CKD in serum uric acid quartiles: first quartile, less than 4.2 mg/dl; second quartile, 4.2-5.0 mg/dl; third quartile, 5.0-6.0 mg/dl; and fourth quartile, 6.0 mg/dl or more were 13.9%, 15.0%, 15.8%and 19.4% (P0.05) respectively, increasing along with the increase of SUA among both sexes. Compared to the serum uric acid first quartile, the multivariate-adjusted odds for CKD of the second, third and fourth quartiles were 1.19 [95% confidence interval (CI): 0.90-1.58], 1.27 (95%CI: 1.02-1.70), 1.28 (95%CI: 1.10-1.68), respectively.Hyperuricaemia was independently associated with the increased prevalence of CKD among population living in the Pudong New Area, Shanghai.

To observe the compliance of film-coated praziquantel tablets in the schistosomiasis transmission controlled areas, so as to provide the evidence for the establishment of chemotherapy intervention measures in these areas.In the areas of schistosomiasis transmission controlled in Sichuan Province, 234 people were selected as film-coated praziquantel group (FCPG), and 203 people were selected as praziquantel group (PG). A questionnaire survey was implemented and the compliance of chemotherapy of the 2 groups was compared.In PG, all the people indicated that the praziquantel tablets has bad smell, 98.0% of the people had side-effects, such as nausea, headache, 69.5% thought the medicine was harmful to health subjectively, and 99.5% thought that it was too much dose of tablets for taking one time. In FCPG, all the people indicated that the film-coated praziquantel tablets had no bad smell, 18.8% of the people had side-effects, and 74.4% would like to choose film-coated praziquantel tablets. The rates of knowledge of praziquantel of PG and FCPG were 50.7% and 29.1%, respectively ( chi2 = 21.449, P = 0.01).The film-coated praziquantel tablets have no bad smell and lighter side-effects. The compliance of the film-coated praziquantel tablets is high in the areas of schistosomiasis transmission controlled, so the film-coated praziquantel tablets are worth to popularize and apply.

To evaluate the cost-benefit for the Influenza Type A H1N1 Virus (Influenzae H1N1) vaccination in Shanghai primary and junior schools.A semi-experiment study was selected to evaluate the cost-benefit for Influenza H1N1 vaccination in primary and junior schools in 6 districts of Shanghai, including 414 636 students in total. According to the voluntary principle, the students were divided into the vaccinated group (233 445 students) and control group (181 191 students). The information of vaccine cost was collected from CDC in 19 districts in Shanghai by questionnaire; and the information of medical treatment cost was collected from questionnaire and abstracts of retrospective medical records, which included 31 mild cases and 15 severe cases. The cost-benefit analysis was conducted by health economic evaluation.In total, there were 414 636 students enrolled in this study; while 233 445 (56.3%) students were in the vaccinated group and 181 191 in the control group. The attack rate in vaccinated group and control group was 0.61% (1433/233 445) and 1.76% (3166/181 191) respectively. The protection ratio was 65.34% ((1.76 - 0.61)/1.76) in the vaccinated group. The average cost of Influenza H1N1 was 36.81 yuan/person; and the average cost of medical treatment was (358.3 ± 243.6) yuan/mild case and (49 188.4 ± 99 917.3) yuan/severe case. The total benefit of vaccination in schools was 19 155 566.3 yuan, and the net benefit was 10 560 673.7 yuan. Therefore, the benefit-cost ratio was 2.24:1.Influenza H1N1 vaccine could protect the students from Influenza H1N1 infection, and the cost-benefit analysis showed that the intervention strategy was worth trying.

To detect the schistosomiasis clusters in marshland and lake areas in 2008, so as to provide the reference for schistosomiasis control and the methodology for detection of cluster areas of related diseases.SaTScan was used to detect the schistosomiasis clusters based on the spatial database from GIS and related variables, including the number of current patients and population in endemic areas.A total of 5 clusters including 39 counties (districts) were detected by SaTScan, the RRs and the Log-likelihood ratios of 3 clusters among them were over 3 and 1 000 (P0.05), respectively. The one with the highest RR and Log-likelihood ratio was located in the boundary of Hubei and Hunan provinces, and the cluster range there was the biggest. From there to the downstream of the Yangtze River, the area and RRs of the 5 clusters became smaller and smaller.The 5 provinces in the marshland and lake areas are still the key spatial clusters of schistosomiasis, especially near the boundary of Hubei and Hunan provinces.

The surveillance network of schistosomiasis in China can be roughly divided into three parts, namely repetitive cross-sectional sample survey, regional surveillance, and fixed longitudinal surveillance. The result of the network provides an important basis for decision-making to realize the endemic situation of schistosomiasis, to develop and evaluate the control planning and its effects in various stages. However, there still exist some problems in the surveillance network of schistosomiasis, such as relatively backward of the surveillance technology, low utilization of data, lack of an effective monitoring network evaluation system and so on. With the advances in socio-economic and technology, the surveillance network of schistosomiasis will develop from a single integrated disease surveillance towards a multi-disciplines surveillance, and gradually establish an efficient and timely surveillance system integrating early warning and multi-disciplines surveillance after the establishment and improvement of real-time reports and other basic information platform.

To detect and analyze the clusters of schistosomiasis on marshland and lake areas based on geographic information system (GIS) in 2008 and to provide suggestions for the development of integrated methodology on the detection of clusters on related diseases.Moran's I of global spatial autocorrelation, Getis-Ord Gi of local spatial autocorrelation and SaTScan were used to detect the schistosomiasis clusters based on GIS and comparison of the results for different methods were performed.Results from the global Moran's I tests for all the marshland and lake areas related to the schistosomiasis were statistically significant (P0.05) and indicated spatial heterogeneity;the z-score outcomes as calculated by Getis-Ord Gi indicated high cluster that 50 clusters were categorized at the 0.05 significance level and the z-score of these 45 clusters were more than 0. Results of SaTScan statistics appeared the same as local spatial autocorrelation and almost showing the existence of 5 cluster areas.The geographical distribution of clusters where schistosomiasis was prevalent showed that it was closely corresponded to the middle and lower Yangtse river and in particular, many clusters were located near the boundary of Hubei and Hunan province.

To analysis the spatial autocorrelation on the small-scale distribution of the genetic variation in the population of Oncomelania hupensis in Puge county, Sichuan province, using simple sequence repeat (SSR) marker.5 pairs of SSR primer were used to amplify the genomic DNA of Oncomelania hupensis, and the alleles with frequency ranging from 15% to 85% were used to calculate Moran's I spatial autocorrelation coefficients in 14 distance band based on equal numbers of paired samples.A total of 274 alleles were scored by 5 pairs of SSR primer, the average polymorphic information content of the 274 alleles were 0.965 which indicated a high level of genetic diversity. 39 alleles showed different patterns of positive spatial autocorrelation of genetic variation, which was non-random spatial structure. When the distance band increased, the spatial auto-correlativity decreased based on the average Moran's I value at 14 distance band. The alleles which showed a negative spatial autocorrelation were not found in any distance band.The spatial distribution of the genetic variation of SSR showed positive spatial autocorrelation in the population of Oncomelania hupensis, and the spatial auto-correlativity decreased with the increase of distance band.

To analyze the sequence of microsatellite and the flanking sequence from four populations of Oncomelania hupensis.We cloned 159 SSR-PCR amplification products of a commonly used primer, (CA)(8RY), using O. hupensis genomic DNA as template, and sequenced 82 products.The sequences obtained were novel O. hupensis genomic sequences but not repeat simple sequence. It was observed that 36 out of 82 clones contained microsatellites between priming sites. The flanking sequences of certain microsatellite were invariant. Both (GA/CT)(n) and (TTAGGG/CCCTAA)(n) were found in four populations of O. hupensis. However, (CAA)(n) were found only in O. hupensis from Fuqing, Fujian province and (TCTCTG)(n) were found only in O. hupensis from Guichi, Anhui province and (GAA/TTC)(n), (CAA/TTG)(n), (CAT)(n) were found only in O. hupensis from Puge, Sichuan province.The results obtained by SSR-PCR should not be interpreted as the amplification of microsatellite loci, and analytical rules similar to those for Random Amplified Polymorphic DNA should be used. SSR-PCR could not make the most of the priority of microsatellite. It seems better to amplify the microsatellites with the primers designed on the basis of the flanking sequence.

To explore the spatial pattern of the distribution of Oncomelania hupensis population in marshland and lake region.Four bottomlands were selected randomly for the investigation along the Qiupu River in Guichi District, Anhui Province. The quadrats were placed randomly for snail survey, and the mean crowding, mean density, aggregation indices (diffusion coefficient (C), morisita index (Idelta), index of patchiness (m*/m) ), Taylor's power law and Iwao's m*-m regression index were analyzed.For 4 bottomlands in different time, the diffusion coefficients, Morisita indices, and m*/m indices were all more than one. There was a close linear relationship between the logarithm of the snail density and its variance (P0.01), and the correlation coefficient was 0.972. In Taylor's power law, the lg a was 0.602 and b was 1.427. There was a close linear relationship between the mean crowding (m*) and the snail density (m) (P0.01), and the correlation coefficient, alpha and beta was 0.984, 2.367 and 1.617 respectively.The spatial pattern of Oncomelania hupensis population shows an aggregation distribution in marshland and lake region, and the basic components of snail distribution are in colonies.

To investigate the antimicrobial resistance of Streptococcus pneumoniae (S.pneumoniae) isolated from Chinese children with pneumonia.Hypopharyngeal aspirate specimens were collected from hospitalized children with pneumonia who were admitted to the children's hospital located in Beijing, Shanghai, Guangzhou or Shanghai from February 16, 2006 to February 16, 2007. The minimum inhibitory concentration (MIC) of S.pneumoniae isolates against penicillin, amoxicillin, cefuroxime (sodium), ceftriaxone, erythromycin, vancomycin, ofloxacin and imipenem was determined by E-test method.A total of 279 S.pneumoniae isolates were obtained. Eighty-six percent of the isolates were not susceptive to penicillin, and 23.3% was resistant to penicillin. The rate of susceptibility of the isolates to amoxicillin was 92.1%, and to cefuroxime and ceftriaxone was 19.0% and 75.3%, respectively. The isolates also showed a high susceptibility to vancomycin (99.6%) and ofloxacin (97.8%). Seventeen point six percent of the isolates were not susceptive to imipenem, and most of those were intermediate. Almost of all isolates were resistant to erythromycin. There were some distinct regional differences in the susceptibility to antimicrobials tested except for erythromycin, vancomycin and ofloxacin.The S.pneumoniae isolates from Chinese children with pneumonia were susceptive to amoxicillin, vancomycin and ofloxacin, but were not susceptive or resistant to penicillin, cefuroxime and erythromycin. The isolates kept susceptibility to ceftriaxone and imipenem to a certain extent.

To understand the etiology of pneumonia in hospitalized patients less than 3 years of age.A total of 316 children with pneumonia admitted to the Children's Hospital of Suzhou University in Jiangsu Province from March, 2006 to January, 2007 were enrolled in this study. Sputum samples were obtained by deep nasotracheal aspiration technique for bacterial and viral cultures.Of the 316 samples, specific microbial etiology was obtained in 192 cases (60.8%). Bacterial infection was found in 162 cases (51.3 %), viral infection in 19 cases (6.3%)and compound infection with virus and bacteria in 11 cases (3.5 %). Haemophilus influenzae was the most common agent (46 cases; 14.6%) in bacterial infection, followed by Streptococcus pneumoniae (32 cases; 10.1%). Respiratory syncycial virus (RSV) was the most common agent (12 cases; 4.0%) in viral infection, followed by adenovirus (11 cases; 3.6%).Bacterial infection was a leading cause of pneumonia in children less than 3 years of age in Suzhou area. Haemophilus influenzae was the most common agent, followed by Streptococcus pneumoniae.

To explore the genetic diversity among populations of Oncomelania hupensis.Simple sequence repeat-anchored PCR method was used to amplify the genomic DNA of nineteen snail populations from 8 provinces, and the genetic diversities among these snail populations were analyzed.The genetic distance D among nineteen snail populations ranged from 0 to 0.73 with average genetic distance as D 0.22 +/- 0.013. All the 19 snail populations were clustered into four groups: one group included 16 snail populations distributed throughout the Yangtze River drainage system below the Three Gorges of the river (Hunan, Hubei, Jiangxi, Anhui, and Jiangsu provinces); Snail populations from Yizhou city, Guangxi province, Fuqing city from Fujian province, and Dali city from Yunnan province belonged to an independent group respectively.The distribution of Oncomelania hupensis in mainland China could be divided into four subspecies, i.e. Oncomelania hupensis hupensis (O. h. hupensis ), O. h. robertsoni, O. h. tangi , and O. h. guangxiensis.

A total of 1,811 individuals from two villages located in the areas of China endemic for Schistosoma japonicum were analyzed by the Kato-Katz parasitologic examination, indirect hemagglutination assay (IHA), and enzyme-linked immunosorbent assay (ELISA). Statistical analysis of the results showed the kappa indices ranged from 0.106 to 0.234 between IHA and the stool examination and ranged from 0.037 to 0.134 between ELISA and the fecal examination. The sensitivity value of the IHA was 83.7% in Village A and 92.3% in Village B; the specificity value of the IHA was 55.8% in Village A and 67.3% in Village B. The sensitivity value of the ELISA was 88.4% in Village A and 96.2% in Village B; the specificity value of the ELISA was 38.4% in both Village A and Village B. A search for a good diagnostic test that can be applied in field situations in China should be given high priority.

To explore the genetic diversity among populations of Oncomelania hupensis.Amplified fragment length polymorphism method was used to amplify the genomic DNA pools of twenty five snail populations from ten provinces, and the genetic diversities among these snail populations were analyzed.The coefficient rates of similarity (GS(DICE)) among twenty five snail populations were ranged was from 0.694 to 0.831 while Nei's unbiased genetic identity was from 0.635 to 0.799. Genetic distance D from 0.169 to 0.306, and Nei's unbiased genetic distance from 0.225 to 0.452. Genetic variation among smooth-shell snail populations was higher than that of ribbed shell snail populations. Twenty five snail populations were divided into three groups: group A including smooth-shell snail from Fuqing of Fujian province and Yizhou of Guangxi province while group B consisted of smooth-shell snail from Dali of Yunnan province and Xichang, Puge, Danleng, Pujiang, Guanghan of Sichuan. Group C was composed of other seventeen snail populations from the Yangtze River drainage below the Three Gorges.Big genetic variation was found among these populations of Oncomelania hupensis. The clustering result of snail populations in genomic level was consistent basically with geographical distribution.

To specify the trends of endemic situation among twenty one national surveillance sites for schistosomiasis from 2000 to 2004.According to the national surveillance protocol, longitudinal surveillance on endemic situation of schistosomiasis was carried out at twenty-one sites since 2000.The infection rate of Schistosoma japonicum declined in six of the twenty-one surveillance sites. The density of living snails and of infected snails decreased in two sites but not well controlled in most other sites. The prevalence in cattle fluctuated yearly in most sites and maintained at a relatively high level. During the surveillance period, acute cases were found annually and the number of advanced patients did not increase significantly. No new case and infected snails were found in Jinshan, Shanghai, since 2000, where transmission of schistosomiasis was interrupted two decades ago.Routine control strategies such as selective chemotherapy combined with livestock chemotherapy, snail control in risk areas have a positive impact on the control of schistosomiasis. However, these strategies should be lasted for longer time and the surveillance on snails and cattle should be continued.

To explore the reasonable sample size and the number of molecular marker loci in the study of amplified fragment length polymorphism (AFLP) being used to analyze the genetic diversity of Ocomelania hupensis.The ribbed-shelled snails coming from Yueyang, Hunan province, were selected to analyze the relationship of the number of AFLP molecular marker loci and sample size with the reliability of information on genetic variation for Ocomelania hupensis by AFLP method.Correlations found among the numbers of AFLP molecular marker loci and the sample size with reliable information on genetic variation for Ocomelania hupensis. When sample size was less than 7 individuals, the total number of AFLP loci, the number of polymorphic loci, Nei's gene diversity and Shannon's information index appeared great changes. However, when sample size was bigger than 30 individuals, the values of these indices tended to be stabilized. When the number of AFLP loci was less than 128, the frequency of polymorphic loci, Nei's gene diversity, Shannon's information index and the standard deviation of these two indices changed greatly. Again, when the number of loci was bigger than 338, the values of these indices tended to be stabilized.When the genetic diversity of Ocomelania hupensis were analyzed by AFLP method, the sample size coming from each snail population should not be less than 30 individuals and the number of molecular loci analyzed not less than 338.

To search into a method for analyzing the quantitative data in amplified fragment length polymorphism (AFLP) electrophoresis.Oncomelania snails collected from the field were screened. Forty snails found uninfected with schistosomiasis were divided randomly into two groups and used to isolate genomic DNA. AFLP electrophoresis pattern was first transformed into quantitative data by Glyko BandScan software, and the bands were read according to different standards of band-reading to acquire the corresponding data. These data sets were analyzed by genetic statistics to get an inference set, and the analysis of this inference set was performed to reach a summary description.The results of genetic variation from different standards of band-reading were different With the increase of the standard value of band-reading, the indices indicating the genetic polymorphism of Oncomelania hupensis population (e.g. Shannon's information index) also increased. When the standard value reached at certain level, the values of these indices began to decrease. Compared with the above indices, the change for gene flow turned out contrary to the genetic identity. The distributions of inference results from different standards of band-reading all showed significant normal distribution. The mean value of genetic variation based on total grey was very close to that on the proportion of total grey. The average genetic identity between the "subpopulations" was 0.956 according to proportion of total grey or 0.958 from the total grey with an average genetic distance between the "subpopulations" of 0.045 and 0.043 respectively.It seems to be a reasonable and accurate method by quantifying the AFLP electrophoresis pattern followed by analyzing the data through the use of the different standards of band-reading.

Many epidemiologists have agreed that a refined estimate of the incubation period of severe acute respiratory syndrome (SARS) would need a sample size of about 200 cases and appropriate statistical methods enabling the inclusion of cases with defined periods of exposure. However, no such studies have been reported so far. Besides, determinants of the SARS incubation period remain unclear. In this study, 209 probable SARS cases with documented episodes of exposure between March 1 and May 31, 2003, in mainland China were included. A nonparametric method was used to analyze these data with defined periods of exposure to obtain the refined estimate of the SARS incubation period. Furthermore, the authors also explored the influence of various factors on the SARS incubation period by analysis of variance, linear regression analysis, and analysis of covariance. The estimates of mean and variance of the SARS incubation period were 5.29 days and 12.33 days2, respectively; 90% of patients would have an incubation period of less than 11.58 days with a probability of 0.8, and 99% of patients would have an incubation of less than 22.22 days with a probability of 0.9. The affected area showed a highly significant effect on the incubation period (p < 0.001), but the contact pattern, occupation, gender, and age did not.

To explore the consistency among different indices of abdominal ultrasonography for the diagnosis of schistosomiasis japonica related morbidity and the best combination of the indices.Six indices of abdominal ultrasonography were selected to investigate schistosomiasis related morbidity in residents in a village of Hunan Province, and the Kappa coefficients of diagnostic consistency among different indices and Cronbach's alpha coefficients of different combinations of indices were computed.The Kappa coefficients of 'liver parenchymaor = grade II' with 'right midclavicular subcostal' and with 'portal vein diameter' were 0.4131 and 0.4655 respectively, higher than normal level. The degree of their consistency was fair, and others showed poor or almost no consistency. Among the combinations made up of different indices, the Cronbach's alpha coefficient of the combination made up of 'liver parenchymaor = grade II', 'right midclavicular subcostal' and 'portal vein diameter' was 0.6566 which was the highest, showing the strongest internal consistency.The six indices can not be replaced with each other in assessing schistosomiasis related morbidity. Before abdominal ultrasonography is used extensively to assess the morbidity, it is necessary to study the diagnostic consistency of these indices and the best combination of the indices.

To build an epidemic model of severe acute respiratory syndrome (SARS) to be used to quantitatively evaluate the effectiveness of intervention measures.Following the nature of SARS epidemics, an epidemic model of SARS based on SEIR model of infectious disease was built, in which case management group was set up and some parameters related to control measures were included. As an example, data gathered from Beijing was fitted to illustrate its application to quantitatively evaluate the intervention measures.In the newly developed model of epidemics, parameters related to control measures could easily be modified. When scenario assumption was used, a model on SARS outbreak under various circumstances of intervention measures could be set. Thus, quantitative evaluation of intervention measures could perfectly be caried out. Pilot study revealed that the fitness existed in modeling the outbreak of SARS in Beijing and the intervention measures implemented around April 20, 2003, had major contribution to the control of SARS.The model of SARS epidemics seemed to be stable and reliable to be used to evaluate the effectiveness of intervention measures implemented during the SARS outbreak in a quantitative way.

To explore the biases and confoundings in Spatial Epidemiological studies.Possible bias and confounding and their impact on study results in Spatial Epidemiology were analyzed in given examples.In Spatial Epidemiology, biases related to ascertainment/numerator/denominator induced by the choice of the disease induction/latency period and mis-specification of exposure-disease model, exposure inaccuracy, spatial dependency, significance tests etc. were involved, as well as to ecological, socio-economic confoundings factors.The sources of bias in 'Spatial Epidemiology' were both numerous and complex, that might be overestimated or underestimated on the study results. Hence, careful interpretation of such studies was needed.

This paper presents a statistical method of familial correlation on family data from case-control studies.Marginal mean models of the probands and the relatives conditional on the proband's disease status, as well as the marginal association model of the relatives were modeled integrately. Conditional odds-ratio and marginal odds-ratio were used to measure the familial correlation.The parameter's interpretation in the model was in accordance with sample characteristics. This method is more efficient due to making fully use of information of the probands and relatives. In addition, the method has all advantages of GEE2.The method in this paper efficiently and conveniently analyzes the family data from case-control studies to estimate the familial correlation on disease.

To study the effect of infection control on schistosomasis Japonicum based on selective chemotherapy.Data were derived from national surveillance of schistosomiasis from 2000 to 2002, and random effect model of Meta-analysis was used to analyze the effect of chemotherapy on controlling schistosomiasis infection.One year after chemotherapy was started in the pilot villages where infection rate of schistosomiasis was more than 10%, the infection rates among residents and eggs per gram (EPG) of patients as well as population (geometric mean, GM) significantly reduced by 20.15%, 22.91% and 33.93% with 95% confidence interval (CI) 6.95 - 31.48, 14.69 - 30.34 and 11.69 - 50.68 respectively. In the pilot villages where infection rates were between 6% and 10%, the control measures largely base on chemotherapy significantly reduced the infection rate, by 24.50 (95% CI: 5.35 - 39.83). However the infection rates were no longer reduced in the pilot villages where the infection rate was less than 6%; EPG of patients and residents were maintained at the original level in the pilot villages where infection rate was 10% or less.In China, the rates of schistosomiasis Japonicum infection could be effectively reduced through the control measures largely based on chemotherapy, and they were kept at a relatively low level. However, it was very difficult to interrupt the transmission of schistosomiasis.

To explore the correlation of the ultrasound indices of liver and spleen in schistosomiasis japonica and with infection frequency, infection time and EPG.The canonical correlation was applied to analyze the correlation of the hepatosplenic ultrasound indices in schistosomiasis japonica, and the correlation of the ultrasound indices with infection frequency, infection time and EPG. The proportions of variation related to each other in liver and spleen were analyzed by the redundancy analysis.The correlation coefficients of the first pair correlation canonical variable were 0.7842, 0.5483 and 0.5800, 0.4220, respectively, in males and females without infection, males and females with infection history (P0.01). The correlation coefficients of the first pair correlation canonical variable were 0.6063, 0.5215 and 0.6595, 0.3849, respectively, in male negatives and female negatives, male positives and female positives (P0.01). In groups of males and females without infection, the variations of liver ultrasound indices related with the variation of spleen ultrasound indices were 43.5% and 17.5% respectively, and in groups infection history, they were 22.1% and 11.4% respectively. In male and female negative groups, the variations of liver ultrasound indices related with the variation of spleen ultrasound indices were 26.8% and 16.8% respectively, and in positive groups, they were 27.6% and 10.7% respectively. The infection frequency, infection time and EPG in the stool-positive groups were not significantly related with the canonical variables of liver and spleen ultrasound indices (P0.05).There is a significant canonical correlation between the liver and spleen ultrasound indices in schistosomiasis japonica, especially in males. In groups with infection history, the infection frequency, infection time and EPG of those stool-positives are not relevant to the canonical variables of liver and spleen ultrasound indices.

To identify the trends of endemic situation at the twenty-one national surveillance sites from 2000 to 2002.According to the protocol of the national surveillance system, longitudinal surveillance of endemic situation of schistosomiasis was carried out at the twenty-one surveillance sites since 2000.Relative indexes of endemic situation of schistosomiasis decreased in two surveillance sites annually. The infection rate of Schistosoma japonicum in human population decreased in most surveillance sites. The infection rate of cattle decreased in eight surveillance sites. However, acute cases were found in two sites each year. The density of live snails and infected snails was higher compared with that in 2000 among eight sites and infected snails were found in inner embankment in Junshan surveillance sites. Hunan Province, in 2002 at first time. The snail ridden areas increased significantly in Fengjin sites, Shanghai, where schistosomiasis was eliminated years ago.Current control strategies have some impact on the morbidity of schistosomiasis. However, these strategies should be lasted for longer time and surveillance on snails should be enhanced.

To explore the methods of estimating measurement reliability and their limitations.According to the given examples, reliabilities of measurement were calculated and limitations of the methods of estimating reliability were analyzed.The Kappa value of interobserver reliability was 0.793 between two pathologists. Between the two populations with different prevalence rates, the values of Kappa were 0.800 and 0.137 respectively, and with big difference. Cronbach's alpha coefficient of compositive index for A type behavior was 0.55.The Kappa index and alpha coefficient were both inherently population-specific. Before generalizing to different populations, the reliability needs to be measured.

To probe rational indices suitable for ecological surveillance on breeding ground for Oncomelania hupensis snails in areas prevalent with islet-type schisitosomiasis using remote sensing technology.Three adjacent islets, prevalent with islet-type schistosomiasis, along the Yangtze River within the boundaries of Dongzhi County, Anhui Province were selected as study field for remote sensing analysis. Multi-spectral data were composed and non-supervisedly classified in computer with Idisi software for remote sensing analysis. Values of the normalized difference vegetation index (NDVI), green vegetation index (GVI), bright index (BI), which reflect the greenness and brightness of landscape, were also calculated. Finally, all the results were comprehensively analyzed, combined with data from the field investigation.NDVI, GVI and BI could depict characteristics of the landscape quantitatively. Values of NDVI, BI and GVI were varied in different types of landscapes, and 95% confidence interval of these values suitable for breeding of snails was 0.0522 approximately 0.3566, 2.4162 approximately 28.2672 and 29.3404 approximately 40.3135, respectively. Classification of NDVI showed that type 5 anf type 6 were main breeding ground for snails, and type 4 with values of NDVI from 0 to 0.1 was potential areas for snail propagation. Classification of GVI showed that types 5, 6 and 7 were main breeding ground for snails, and also type 4 with values of GVI from 2 to 10 was potential areas for snail propagation. Both NDVI and GVI showed type 2 and type 3 were temporarily not suitable for snail breeding.Index figures of NDVI and GVI re-formed by reasonable classification could reflect not only breeding ground for snails and range of the areas for snail propagation in islets, but also their evolving rules, i.e., status of new marshland formation and vegetation growth.

To obtain the information of protein-protein interaction between the SARS-CoV proteins and caveolin-1, identify the possible caveolin-binding sites in SARS-CoV proteins.On the basis of three related caveolin-binding motifs, amino acid motif search was employed to predict the possible caveolin-1 related interaction domains in the SARS-CoV proteins. The molecular modeling and docking simulation methods were used to confirm the interaction between caveolin-1 and SARS-CoV proteins.Thirty six caveolin-binding motifs in the SARS-CoV proteins have been mapped out using bioinformatics analysis tools. Molecular modeling and simulation have confirmed 8 caveolin-binding sites. These caveolin-binding sites located in replicase 1AB, spike protein, orf3 protein, and M protein, respectively.Caveolin-1 may serve as a possible receptor of the SARS-CoV proteins, which may be associated with the SARS-CoV infection, replication, assembly, and budding.

To explore the synthetical index for diagnosing schistosomiasis with ultrasound and to assess the prevalence rate with the index.Ultrasound indexes of schistosomiasis Japonicum were analyzed by principal component analysis, and the synthetical indexes were assessed by ROC curve.Among the abnormal rates of the 6 indexes, the lowest was 1.6% comparing with the highest of 59.5%. Significant difference was noficed among the abnormal rates (chi(2) = 631.1, P0.01). The individual correlation of the six indexes to each other as will as with age distribution was significant (P0.05). The three principal components reflected the degree of pathological changes on liver and spleen. The first principal component was the factor reflecting the degree of liver pathological changes, and the second and third principal components reflected the degree of pathological changes on spleen. The synthetical index D(1) = 0.047X(1) + 0.428X(2) + 1.247X(3) + 0.095X(4) + 0.002X(5) + 0.213X(6) - 12.837 was found by adding the three weight principal components, and it's area under the ROC curve was 0.957. When -1.70 was taken as the critical value, the abnormal rate of population was 66.3%, close to the resident's actual prevalence rate 66.9%.Ultrasonography was considered as a method which could rapidly assessing the resident's prevalence rate in the endemic areas of schisitosomiasis Japonicum, and could also provide powerful information for development of strategy on chemotherapy.