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To investigate the operation techniques and clinical effects of hollow lag screws for the treatment of Hoffa fractures.From February 2001 to May 2009, 13 patients with Hoffa fractures were treated with hollow lag screws, including 8 males and 5 females, ranging in age from 23 to 45 years, with a mean age of 34.2 years. Six patients had the fractures on the left, 7 patients on the right. According to the Letenneuer type, femur lateral condyle: type I in 3 cases, type III in 2 cases; femur medial condyle: type I in 3 cases, type II in 2 cases, type III in 3 cases. According to the type of fracture, hollow lag screws were used to treat the fracture with different approach.All the patients were followed up, and the duration ranged from 12 to 23 months,with a mean of 16.5 months. All the patients had no complications such as popliteal artery, tibial nerve or peroneal nerve injuries. According to Letenneur knee function score: 10 patients got an excellent result, 3 good. At the half year after operation, the X-ray showed all the fractures had bone union. There were no hollow lag screw loosening, broken or nonunion.The clinical effect of hollow lag screw for the treatment of Hoffa fractures is satisfactory. The surgical approach and fixation should be determined by the type of fracture, the location of the fracture line and the size of fracture fragments.

To investigate the feasibility and clinical effects of titanium elastic nails (TEN) for adolescent clavicular fracture.From October 2008 to November 2009, 17 adolescent patients with clavicular fracture were treated with internal fixation, including 11 males and 5 females who ranged in age from 12 to 18 years (mean 15.3 years). The mean time from injury to surgery was 3.5 days (2-7 days). Constant function score before surgery and that 3 months after surgery and shoulder ROM before surgery and that 2 months after surgery were compared. Fracture reduction and healing were followed up by X-rays to analyze internal fixation with the TEN technique.All patients were followed up for a mean of 6.5 months (range 3-8 months), during which no infection, TEN fracture or skin bursting was observed. The Constant score rose from preoperative (45.3 +/- 6.1) to (85.6 +/- 4.3) at 3-month follow up (t = 22.164, P0.01),and the shoulder activity degree at 2-week follow up was improved obviosly from preoperative (P0.01). X-ray at 12-16 weeks after surgery showed good bone healing and recovery of shoulder function.Internal fixation with TEN in the treatment of adolescent clavicular fracture is safe, minimally invasive,reliable and cosmetic. This technique provides a liable ption for the treatment of adolescent clavicular fractire

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.

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.

In order to enhance the efficiency of enzymatic hydrolysis of excess sludge, sodium dodecyl sulfate (SDS) was added to the system to explore the feasibility of promotion the enzyme hydrolysis. The results showed that the enzymatic hydrolysis of excess sludge could be greatly improved by SDS, and the mixed enzymes system was more effective than that by single enzyme system. SCOD releasing increased linearly with the increase of SDS dosage at the mixed enzymes concentration of 0.06 g/g. SCOD/TCOD increased from 1.3% to 54.3% and VSS reduction achieved to 43.2% at the SDS dosage of 0.20 g/g. Further studies indicated that SDS could improve the activity of external enzymes. At SDS dosage of 0.10 g/g, the protease activity of SDS + protease showed a 2. 3-time increase and the amylase activity of SDS + amylase showed a 1.2-time increase compared with enzymatic treatment. After 4 h hydrolysis, the concentration of protein, NH4+ -N and soluble sugar in SDS + mixed enzymes system were improved by 85.4%, 92.5% and 64.0%, respectively. Correspondingly, sludge hydrolysis within prior 4 h was consistent with first-order reaction dynamics. The reaction rate constant (K) of soluble sugar increased from 0.23 to 0.41, which indicated that the reaction rate of hydrolysis increased significantly.

To assess the control effect of transmission control of schistosomiasis in 14 counties (cities, districts) of Jiangsu Province.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.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.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.

To develop a spatio-temporal model of schistosomiasis japonica based on Bayesian model, and to analyze the spatio-temporal pattern of schistosomiasis, as well as to evaluate the impact of environment changes on schistosomiasis endemic.Different Bayesian models were established by employing the data of the periodical surveillance on schistosomiasis during 1996-2005 period by taking into account of the uncertainty in sensitivity and specificity of diagnostic test, then the best fitness model was selected to analyze the spatio-temporal pattern of schistosomiasis and evaluate the impact of environment changes on schistosomiasis.The model with space-time interaction was a better fitting model. No significant temporal correlation was found in human infection rate of Schistosoma japonicum, and the difference of spatial structure between human infection rates of each year was significant. The prediction map of S. japonicum infection showed the changes of infection in the south areas of the Yuan River were not significant, while the prevalence increased significantly in the north areas of the river, which indicated that the impact of the implementation of project on partial abandon areas for water storing on prevalence of S. japonicum was stronger than that of the project on completed abandon areas for water storing.It is feasible to develop the spatio-temporal model of schistosomiasis japonica based on Bayesian model, and this inetegrated Bayesian model approach may become a powerful and statistically robust tool for estimating and evaluating the control strategy.

Based on the transmission status of schistosomiasis in People's Republic of China, the challenges and road map for achieving the transmission interruption of schistosomiasis by 2020 in the country was discussed, particularly focused on elimination strategy, surveillance and response approaches, and key technique needs in the three stages, e.g. pre-elimination, elimination and post-elimination stages. Recommendation of strengthening studies on transmission threshold and technological innovation at the low transmission level of schistosomiasis japonica were put forward.

Mathematical modelling of helminth infections has the potential to inform policy and guide research for the control and elimination of human helminthiases. However, this potential, unlike in other parasitic and infectious diseases, has yet to be realised. To place contemporary efforts in a historical context, a summary of the development of mathematical models for helminthiases is presented. These efforts are discussed according to the role that models can play in furthering our understanding of parasite population biology and transmission dynamics, and the effect on such dynamics of control interventions, as well as in enabling estimation of directly unobservable parameters, exploration of transmission breakpoints, and investigation of evolutionary outcomes of control. The Disease Reference Group on Helminth Infections (DRG4), established in 2009 by the Special Programme for Research and Training in Tropical Diseases (TDR), was given the mandate to review helminthiases research and identify research priorities and gaps. A research and development agenda for helminthiasis modelling is proposed based on identified gaps that need to be addressed for models to become useful decision tools that can support research and control operations effectively. This agenda includes the use of models to estimate the impact of large-scale interventions on infection incidence; the design of sampling protocols for the monitoring and evaluation of integrated control programmes; the modelling of co-infections; the investigation of the dynamical relationship between infection and morbidity indicators; the improvement of analytical methods for the quantification of anthelmintic efficacy and resistance; the determination of programme endpoints; the linking of dynamical helminth models with helminth geostatistical mapping; and the investigation of the impact of climate change on human helminthiases. It is concluded that modelling should be embedded in helminth research, and in the planning, evaluation, and surveillance of interventions from the outset. Modellers should be essential members of interdisciplinary teams, propitiating a continuous dialogue with end users and stakeholders to reflect public health needs in the terrain, discuss the scope and limitations of models, and update biological assumptions and model outputs regularly. It is highlighted that to reach these goals, a collaborative framework must be developed for the collation, annotation, and sharing of databases from large-scale anthelmintic control programmes, and that helminth modellers should join efforts to tackle key questions in helminth epidemiology and control through the sharing of such databases, and by using diverse, yet complementary, modelling approaches.

Diagnostic tools appropriate for undertaking interventions to control helminth infections are key to their success. Many diagnostic tests for helminth infection have unsatisfactory performance characteristics and are not well suited for use in the parasite control programmes that are being increasingly implemented. Although the application of modern laboratory research techniques to improve diagnostics for helminth infection has resulted in some technical advances, uptake has not been uniform. Frequently, pilot or proof of concept studies of promising diagnostic technologies have not been followed by much needed product development, and in many settings diagnosis continues to rely on insensitive and unsatisfactory parasitological or serodiagnostic techniques. In contrast, PCR-based xenomonitoring of arthropod vectors, and use of parasite recombinant proteins as reagents for serodiagnostic tests, have resulted in critical advances in the control of specific helminth parasites. The Disease Reference Group on Helminths Infections (DRG4), established in 2009 by the Special Programme for Research and Training in Tropical Diseases (TDR) was given the mandate to review helminthiases research and identify research priorities and gaps. In this review, the diagnostic technologies relevant to control of helminth infections, either available or in development, are reviewed. Critical gaps are identified and opportunities to improve needed technologies are discussed.

To evaluate the effect of comprehensive control for schistosomiasis in key areas of Jiangsu Province.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.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.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.

The surveillance of schistosomiasis in Sanzhou Village, a national schistosomiasis surveillance site, in Gaoqiao Town of Dantu District, Zhenjiang City from 2005 to 2009 showed that the schistosomiasis morbidity remained in a low level in the surveillance site; however, the Oncomelania snails and infected snail areas remained high. It is suggested that, in addition to snail control, comprehensive control measures should be strengthened, and the causes of infected snails in marshland should be investigated, so as to clarify the roles of various hosts in transmission of schistosomiasis.

To study the risk factors of schistosomiasis related to household economic condition and individual behavior in marshland and lake regions, so as to provide evidences for schistosomiasis control.Six villages were sampled with the stratified cluster sampling method, 2 339 villagers from 1 247 households were surveyed by a questionnaire and meanwhile their sera were assayed for schistosomiasis by IHA. The Logistic regression was used to analyze the relationship between the results of serological examinations and risk factors.The Logistic regression model fitted well (R2 = 0.598 4) and it indicated that there existed a regressive relationship between the antibody positive rate and the endemic situation of village, family economic status, age, education level and infection history of schistosomiasis.Suitable measures should be made in according to the local economic situation, endemic type and population to control the transmission of schistosomiasis effectively.

To investigate safe range of acetabular prosthesis angle and the optimum combination of cup and neck in the range of activities of daily living (ADL).A three-dimensional generic parametric and kinematic simulation module of THA was developed. Range of motion (ROM) of flexionor = 110 degrees, internal-rotationor = 30 degrees at 90 degrees flexion, extensionor = 30 degrees and external rotationor = 40 degrees were defined as the normal criteria for desired ROM for activities of daily living (ADL), and ROM of flexionor = 120 degrees, internal-rotationor = 45 degrees at 90 degrees flexion, extensionor = 30 degrees and external rotationor = 40 degrees as the severe criteria. The range of the changes in the general head-neck ratios (GR), the femoral neck anteversion (FA), the operative anteversion (OA) and operative inclination (OI) of the cup component were 2-2.92, 0 degrees-30 degrees, 0 degrees-70 degrees, 10 degrees-60 degrees respectively. For the collodiaphyseal angle (CCD) of 135 degrees, the corresponding OA related to the OI which every 5 degrees was calculated, and described using dots and lines in a coordinate system in which OI of acetabular cup was the horizontal ordinate and OA of acetabular cup was the vertical ordinate. All data was analyzed by SAS 6.12 software.Large GR greatly increased the size of safe range and it was recommended that GR be more than 2.37 when the CCD-angle was 135 degrees as it further increases the size of safezone. The size of cup safety range of the severe criteria was smaller than normal criteria. When the CCD-angle was 135 degrees, the optimum relationship between OA of acetabular and FA of the normal criteria and the severe criteria can be estimated by the formula: Y1=-0.816X1 + 39.76 (R2=0.993), Y2=-0.873X2 + 47.04 (R2=0.999) respectively.Large GR greatly increases the size of safe-zone and it is recommended that GR be more than 2.37, so it extends the acceptable range of error that clinicians cannot avoid it completely. The larger range of the hip motion, the smaller size of the cup safe-zone,but can retrieve by increase the GR. The OA is negative with FA.

To compare the curative effects of newly suture anchors and traditional steel wire for the reconstruction of near distal tendo achillis rupture.The clinical data of 56 patients with near distal tendo achillis rupture from June 2007 to February 2011 were retrospectively analyzed. Among 31 patients receiving reconstruction by suture anchors, 22 patients were male and 9 patients were female, with a mean age of 35.5 years (ranging from 16 to 52 years ). Among 25 patients treated with traditional steel wire, 19 patients were male and 6 patients were female, with a mean age of 37.6 years (ranging from 22 to 53 years). The different rehabilitation was conducted for every patient at different times after operation. The position of suture anchor and steel wire were recorded. The clinical data such as operative time, complications of the surgery and the function of stendo achillis were analyzed. The healing of stendo achillis and functional recovery were assessed by Arner-Lindholm standard.All the patients were followed up with an average during of 24.2 months. There were no intraoperative injuries on blood vessels, nerve and tendon. The average operative time and postoperative complications of suture anchors were lower than there of the traditional steel wire (t = 8.75, P = 0.00; Chi2 = 5.42, P = 0.02). The functional recovery of tendo achillis repaired by suture anchors was better than that in the group of traditional steel wire (Chi2 = 7.65, P = 0.02).Compared to the traditional steel wire, suture anchor demonstrate the superior performance on repairing rupture of the near distal tendo achillis, which is a reliable and effective treatment methods.

Recognising the burden helminth infections impose on human populations, and particularly the poor, major intervention programmes have been launched to control onchocerciasis, lymphatic filariasis, soil-transmitted helminthiases, schistosomiasis, and cysticercosis. The Disease Reference Group on Helminth Infections (DRG4), established in 2009 by the Special Programme for Research and Training in Tropical Diseases (TDR), was given the mandate to review helminthiases research and identify research priorities and gaps. A summary of current helminth control initiatives is presented and available tools are described. Most of these programmes are highly dependent on mass drug administration (MDA) of anthelmintic drugs (donated or available at low cost) and require annual or biannual treatment of large numbers of at-risk populations, over prolonged periods of time. The continuation of prolonged MDA with a limited number of anthelmintics greatly increases the probability that drug resistance will develop, which would raise serious problems for continuation of control and the achievement of elimination. Most initiatives have focussed on a single type of helminth infection, but recognition of co-endemicity and polyparasitism is leading to more integration of control. An understanding of the implications of control integration for implementation, treatment coverage, combination of pharmaceuticals, and monitoring is needed. To achieve the goals of morbidity reduction or elimination of infection, novel tools need to be developed, including more efficacious drugs, vaccines, and/or antivectorial agents, new diagnostics for infection and assessment of drug efficacy, and markers for possible anthelmintic resistance. In addition, there is a need for the development of new formulations of some existing anthelmintics (e.g., paediatric formulations). To achieve ultimate elimination of helminth parasites, treatments for the above mentioned helminthiases, and for taeniasis and food-borne trematodiases, will need to be integrated with monitoring, education, sanitation, access to health services, and where appropriate, vector control or reduction of the parasite reservoir in alternative hosts. Based on an analysis of current knowledge gaps and identification of priorities, a research and development agenda for intervention tools considered necessary for control and elimination of human helminthiases is presented, and the challenges to be confronted are discussed.

To analyze the changing rules of schistosomiasis endemic situation in the area of transmission that has been interrupted before and after they reach the criteria of transmission interruption, so as to offer the basis of amending to the criteria of schistosomiasis transmission interruption and a more scientific, standardized assessment and evaluation of the effects of schistosomiasis control in the future.Nineteen counties of transmission that has been interrupted in 9 provinces nationwide were selected and investigated with the retrospective research method to collect and record the endemic detailed data 10 years before they reach the criteria of transmission interruption and several years later (ended in 2008 or 2009) and then a database was established. The changing rules of various disease indices in different endemic areas before and after reaching the criteria of transmission interruption were analyzed and compared.The average time from the transmission control to the transmission interruption was 17 years in the 17 counties. After reaching the criteria of transmission interruption, the infection rates of people turned down to a minimum level in various endemic areas, the infection rates in a few numbers of lake endemic areas and hilly endemic areas increased slightly after the transmission interruption 4-9 years later, but all of them were below 1%. The densities of living Oncomelania snails in lake endemic areas and water-network endemic areas were high and the changes were great each year, and the densities of living snails were much lower in hilly endemic areas than in the above two types of areas and they came to the lowest 4 years before and after the transmission interruption. The infected snails appeared occasionally in lake endemic areas, and they recurred 6 years and 10 years after the transmission interruption in water-network endemic areas and hilly endemic areas, respectively. The continued time without infected snails found before reaching transmission interruption was 2.71 +/- 1.10 years averagely in transmission-interrupted counties with endemic stable, and was 3. 80 +/- 1.43 years in lake endemic areas.It is possible to maintain a low level of population schistosome infection, and the endemic rebound is shown as snail rebound after the endemic areas reach the criteria of transmission interruption, The infected snails could be the comprehensive index reflecting the control achievement and the risk of schistosomiasis transmission. So the persistent control of infected snails is the fundament of schistosomiasis transmission interruption. It is suggested that in our current social and economic development and science and technology capacity conditions, the status of no infected snails found continuously for 5 years would be one of the criteria of schistosomiasis transmission interruption.

To summarize and analyze the process of the changes of schistosomiasis infection and Oncomelania snails in schistosomiasis transmission-controlled areas to explore the rules of the impact of changes of snail indexes on human infection before and after the stage of transmission control, so as to provide the evidence for editing snail indexes in the schistosomiasis controlled criterion and a more scientific, standardized control assessment and evaluation.Twenty-one schistosomiasis transmission-controlled or transmission-interrupted counties in lake endemic areas and hilly endemic areas in 8 provinces were selected and investigated retrospectively to collect schistosomiasis epidemiological information 10 years before these counties reached the criterion of transmission control and the subsequent years until 2008 or 2009. A " Standard county schistosomiasis epidemic survey data review software" was developed to establish a national epidemic retrospectively database; the trends of changes of snail status, infected snail status and human infection status were analyzed in different years. The trends and rules of the changes of snail areas, emerging snail areas, living snail densities, infected snail densities, snail infection rates and human infection rates were analyzed and compared before and after the counties reached the schistosomiasis transmission-controlled criterion in different types of endemic areas.Before the transmission control, the human infection rate presented a declining trend in endemic areas. In lake endemic areas, the human infection rate declined to below 5% 4 years before the transmission control; in hilly endemic areas, the human infection rate declined to below 3% 8 years before the transmission control, and the human infection rates of the lake and hilly endemic areas declined to 2.10% and 1.45%, respectively, at the year of transmission control. However, 3 to 4 years after transmission control, the disease began to rebound, especially in lake endemic areas. The snail areas and snail densities declined year by year 10 years before the transmission control in the lake and hilly endemic areas, and the proportion of snail areas occupying the historic snail areas declined the lowest, being 2.75% and 0.55%, respectively, at the year of transmission control. The average densities of living snails kept a low level from 3-4 years before the transmission control to 9-10 years after the transmission control, and then rebounded. The new snail areas appeared 6-7 years after the transmission control and the snail areas and densities of living snails rebounded 9-12 years after the transmission control.The snail status can maintain a relatively low level during about 10 years after the transmission control in the lake and hilly schistosomiasis endemic areas, but the schistosomiasis status rebounded 5 years after the transmission control. While the comprehensive measures mainly including infectious source controlled are implemented, the snail surveillance and control should be still strengthened, and it is recommended that "the proportion of snail areas decreased" and "the control of infected snails" would be the indicators of the criterion of schistosomiasis transmission control.

To analyze the changes of schistosomiasis endemic situation before and after reaching the criteria of schistosomiasis transmission control or transmission interruption in endemic rebounded areas, so as to offer the information for modifying the criteria of schistosomiasis control and elimination, and consolidating achievements of schistosomiasis control in People's Republic of China.Twelve counties with endemic rebound were selected from seven endemic provinces and investigated with the retrospective research method. The data including the epidemic information and relative materials 10 years before the counties reached the criteria of transmission control and several years later (until 2008 or 2009) were collected. The changes of epidemic situation of these counties before and after the transmission was under control or interrupted, and the factors causing the endemic rebound were analyzed.Counties consolidated the endemic situations with an average time of 5 +/- 3 years after the transmission control, with endemic rebound normally caused by single factor. The ratio of Oncomelania snail areas to historically accumulative snail areas increased over 10% in hilly endemic regions and lake endemic regions in 7 and 12 years separately, while it was stabilized in a low level in water-network endemic areas. The rebound peak time of infected snail densities was consistent with or later than that of densities of living snails. The prevalence of schistosome infection in humans in lake endemic regions rebounded 2 years after transmission under control. The transmission interruption counties consolidated the endemic situations with an average time of 7 +/- 4 years. The human prevalence of schistosome infection decreased to a very low level after the counties reaching the criteria of transmission interruption. The snail areas increased to over 2% of historically accumulative snail areas 3-6 years after transmission interruption in lake, water-network endemic areas successively, while densities of living snails and infected snails were increased at the same year or 2-3 years later.The endemic rebound in regions after the transmission under control or interrupted is caused by biological, natural and social factors and mainly presents as the rebound of snail status. The modification of criteria for schistosomiasis control and elimination should consider the influence of variation of snails, snail areas and density of infected snails on endemic situations in different endemic areas comprehensively. Sensitive and valid surveillance and forewarning system should be established to strengthen the monitoring and consolidating endemic situation in endemic areas after the transmission under control or interrupted.

Background Clonorchiasis is among the most neglected tropical diseases. It is caused by ingesting raw or undercooked fish or shrimp containing the larval of Clonorchis sinensis and mainly endemic in Southeast Asia including China, Korea and Vietnam. The global estimations for population at risk and infected are 601 million and 35 million, respectively. However, it is still not listed among the Global Burden of Disease (GBD) and no disability weight is available for it. Disability weight reflects the average degree of loss of life value due to certain chronic disease condition and ranges between 0 (complete health) and 1 (death). It is crucial parameter for calculating the morbidity part of any disease burden in terms of disability-adjusted life years (DALYs). Methodology/Principal Findings According to the probability and disability weight of single sequelae caused by C. sinensis infection, the overall disability weight could be captured through Monte Carlo simulation. The probability of single sequelae was gained from one community investigation, while the corresponding disability weight was searched from the literatures in evidence-based approach. The overall disability weights of the male and female were 0.101 and 0.050, respectively. The overall disability weights of the age group of 5–14, 15–29, 30–44, 45–59 and 60+ were 0.022, 0.052, 0.072, 0.094 and 0.118, respectively. There was some evidence showing that the disability weight and geometric mean of eggs per gram of feces (GMEPG) fitted a logarithmic equation. Conclusion/Significance The overall disability weights of C. sinensis infection are differential in different sex and age groups. The disability weight captured here may be referred for estimating the disease burden of C. sinensis infection., Author Summary Clonorchiasis is caused by eating incompletely cooked fishery product which carries the larval of Clonorchis sinensis. Millions of people are estimated to suffer in Southeast Asia. However, it is still among the most neglected tropical diseases due to the lack of clear evaluation, of which no disease burden available is one important reason. Our study is the first attempt to estimate the disability of C. sinensis infection, which reflects the average loss of life value due to some conditions and is crucial for calculating disease burden in terms of disability-adjusted life years (DALYs). After obtaining the probability and disability of single sequelae caused by C. sinensis infection through community investigation and literatures reviewing respectively, the overall disability was captured through model simulation. It was showed the overall disability of the male was higher than that of the female, positive correlation occurred between disability and infection intensity, and gallstone took the major attributable proportion. Thus, C. sinensis infection can cause apparent disability. The disability captured here may promote the further studies and benefit the final estimation of disease burden, which will promote health awareness and implementation of intervention.

To investigate the relationship between pain and knee function after the internal fixation of femoral fractures.The clinical data of 73 patients after internal fixation on femoral fractures from June 2006 to December 2009 were retrospectively analyzed. All the patients were divided into two groups according to the degree of postoperative pain: low score group and high score group. Among the 39 patients in low score group (VAS 1 to 5 point), 25 patients were male and 14 patients were female, with a mean age of (37.5 +/- 5.3) years (ranged from 27 to 63 years ). Among 34 patients in high score group (VAS 6 to 10 point), 22 patients were male and 12 patients were female, with a mean age of (36.3 +/- 9.6) years (ranged from 29 to 62 years). The intra-articular pressure of knee and hospital for special surgery knee rating scale (HSS) were recorded and analyzed.All the patients were followed up for an average duration of 24.1 months. The intra-articular pressure of knee was rising for two groups, there were significant difference for the high score group compared with the low score group at 3 days after operation (t=15.67, P=0.000) and the end time of follow up (t=5.63, P=0.000). As to knee joint function, in low score group, 21 patients got an excellent result, 4 good, 7 poor and 2 bad; in high score group, 31 patients got an excellent result, 6 good, 2 poor and no bad. The knee function of low score group was better than that of high score group.The intra-articular pressure of knee is an important factor of the knee functional recovery, and its external symptoms of pain can be seen as an important index to forecast the prognosins of knee function in early time.

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.

To research the efficacy,security and necessity of combined therapy for preventing postsurgery stiffness after elbow fracture.From May 2009 to April 2010, 60 patients with elbow fractures treated by operation were randomly divided into two groups: combined therapy group and past procedure group. Thirty patients in the combined therapy group,including 12 males and 18 females, ranging in age from 23 to 63 years, averaged (43.53 +/- 7.74) years old; 15 patients had two parts fractures, including humeral intercondylar fractures combined with olecroanon and (or) ulna coronoid process fractures in 8 cases, fractures of exterior and interior humeral condyle combined with capitulum radius in 3 cases, fractures of olecroanon and ulna coronoid process in 3 cases, fractures of olecroanon and capitulum radius in 1 case; other 15 patients had one part fractures, including fractures of exterior or interior humeral condyle in 8 cases,fractures of olecroanon or ulna coronoid process in 6 cases, fractures of capitulum radius in 1 patient. Thirty patients in the past procedure group,including 11 males and 19 females, ranging in age from 24 to 67 years, averaged (46.13 +/- 6.22) years; 15 patients had two parts fractures, including fractures of humeral intercondylar fracture combined with olecroanon and(or) ulna coronoid process in 7 cases, fractures of exterior and interior humeral condyle combined with capitulum radius in 2 cases,fractures of olecroanon and ulna coronoid process in 5 cases,fractures of humeral intercondylar fracture combined with capitulum radius in 1 patient; 15 pa- tients had one part fracture, including fractures of exterior or interior humeral condyle in 6 cases, fractures of olecroanon or ulna coronoid process in 8 cases, fractures of capitulum radius in 1 patient; the patients in the past procedure group were treated with past procedure methods. Mayo Elbow Performance Score (including gmotion of elbow joint) and security (using X-ray to recheck displacement fracture, internal fixation failure and heterotopic ossification) were evaluated at postoperative 6 months. From 2002 to 2006, 30 patients were reviewed as historical control group, including 17 males and 13 females, ranging in age from 27 to 62 years, averaged (47.17 +/- 7.83) years; 15 patients had two parts fractures, including fractures of humeral intercondylar combined with olecroanon and(or) ulna coronoid process in 7 cases, fractures of exterior and interior humeral condyle combined with capitulum radius in 1 case, fractures of olecroanon and ulna coronoid process in 6 cases, fractures of ulna coronoid process and capitulum radius in 1 case; 15 patients had one part fractures,including fractures of exterior or interior humeral condyle in 9 cases, fractures of olecroanon or ulna coronoid process in 5 cases,fractures of capitulum radius in 1 case. The Mayo Elbow Performance Score of the patients in historical control group was evaluated retrospectively at postoperative 6 months and the results were compared with that of past procedure group.Mayo score of combined therapy group was (91.00 +/- 7.81)surpassed to (76.83 +/- 10.71) of the past procedure group and (73.17 +/- 1.99) of historical control group (F = 24.98, P0.05). The range of motion of elbow was (102.40 +/- 9.16) degrees of combined therapy group surpassed to (83.57 +/- 6.21) degrees of the past procedure group (t = 9.325, P0.05). There were no internal fixation loose,obvious fracture displacement and heterotopic ossification in each X-ray examination of patients in the combined therapy group. The Mayo score of historical control group was (73.17 +/- 11.99), showing no significant differences when compared with (76.83 +/- 10.71) of the past procedure group (LSD, P = 0.172).Combined therapy including different stage, different method combination and different subject to practice to prevent postsurgery stiffness after elbow fracture is effect, security and necessity.

To explore proteins associated with non-traumatic osteonecrosis of the femoral head in adults by using high throughput proteomic approach.From July 2008 to February 2009, 10 patients with non-traumatic osteonecrosis of the femoral head (7 males, 3 females) and 10 patients with fresh femoral head fracture (5 males, 5 females) who underwent total hip arthroplasty were enrolled randomizedly in the study. The median age was 52 years and 63 years respectively. Necrotic bone tissues were harvested as experimental group from the femoral head of patients with osteonecrosis of the femoral head, and normal bone tissues were collected as the control group from the patients with femoral head fracture. After bone tissues were demineralized, total bone proteins were extracted sequentially by using four different lysis buffers. Thereafter, SDS-PAGE, in-gel digestion and subsequent multi-dimensional liquid chromatography-tandem mass spectrometry (MDLC-MS/MS) were applied to separate and identify the extracted proteins. Different expression level of the proteins in both groups was investigated by TPP software,and different expression protein analysis was then carried out by Turbo SEQUEST. Western blot was applied finally to evaluate the accuracy of mass spectrometry.The in-depth proteome analysis in experimental and control groups revealed 1 233 and 999 high-confidence proteins with two or more peptides respectively,and the false-positive rate was 0.8%. In total, 192 differentially expressed proteins were identified in experimental samples. At compared with the control, 107 and 53 proteins were identified with the level upregulated and downregulated at least 3 folds respectively. Among them, 34 proteins were found highly associated with osteonecrosis of the femoral head. Downregulated expression of GPCR26 and CHST2, similar with results of mass spectrometry analysis,were confirmed by Western blot in the necrotic bone tissues.The pathogenesis of the non-traumatic osteonecrosis of the femoral head has been demonstrated a complicated process and remained unknown. These identified differentially expressed proteins might be promising biomarker candidates for early diagnosis of the devastating disease. This study sheds new light on novel approach to understand the pathogenesis of osteonecrosis of the femoral head.

To evaluate the safety and accuracy of "funnel technique" in planting thoracic pedicle screws.From August 2005 to March 2008, a total of 39 patients with at least one thoracic pedicle screw in T1-T10 using "funnel technique" were retrospectively reviewed. Among the patients, 27 patients were male and 14 patients were female, with a mean age of 38.5 years (ranged from 17 to 56 years). One patient was lost follow-up, and other 1 patient was dead before follow-up. The accuracy of screw placement and the complications related to thoracic pedicle screws were analyzed by postoperative CT-scans.All the patients were followed up ranging from 18 to 30 months, averaged 23.2 months. There were no vascular or viscera complications as well as iatrogenic neurologic injuries. The total number of screws was 208. There was no statistical difference between the percentage of fully contained screws at T1-T4 versus T5-T8 (P = 0.80),T5-T8 versus T9-T10 (P = 0.07), T1-T4 versus T9-T10 (P = 0.06). Twenty-seven screws (13.0%) were misplaced, 14 screws (6.7%) violated lateral cortex of pedicle, 7 screws (3.4%) medially, 5 screws (2.4%) superiorly, 1 screw (0.5%) violated lateral cortex of vertebral body. No violations occurred superiorly or anteriorly. Only 4 screws (1.9%) was a critical perforation.The "funnel technique" is a simple, safe, accurate and cost-effective technique for pedicle screw placement. It provides even an entry-level surgeon with a safe way to identify and place thoracic pedicle screws.

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% (P0.001) 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% (P0.001). 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 P0.001). 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.

The purpose of this study was to deepen our understanding of Plasmodium vivax malaria transmission patterns in the People’s Republic of China (P.R. China). An integrated modeling approach was employed, combining biological and statistical models. A Delphi approach was used to determine environmental factors that govern malaria transmission. Key factors identified (i.e. temperature, rainfall and relative humidity) were utilized for subsequent mapping and modeling purposes. Yearly growing degree days, annual rainfall and effective yearly relative humidity were extracted from a 15-year time series (1981-1995) of daily environmental data readily available for 676 locations in P.R. China. A suite of eight multinomial regression models, ranging from the null model to a fully saturated one were constructed. Two different information criteria were used for model ranking, namely the corrected Akaike’s information criterion and the Bayesian information criterion. Mapping was based on model output data, facilitated by using ArcGIS software. Temperature was found to be the most important environmental factor, followed by rainfall and relative humidity in the Delphi evaluation. However, relative humidity was found to be more important than rainfall and temperature in the ranking list according to the three single environmental factor regression models. We conclude that the distribution of the mosquito vector is mainly related to relative humidity, which thus determines the extent of malaria transmission. However, in regions with relative humidity >60%, temperature is the major driver of malaria transmission intensity. By integrating biology-driven models with statistical regression models, reliable risk maps indicating the distribution of transmission and the intensity can be produced. In a next step, we propose to integrate social and health systems factors into our modeling approach, which should provide a platform for rigorous surveillance and monitoring progress towards P. vivax malaria elimination in P.R. China.

To investigate the techniques and curative effects of transcatheter artery embolization (TAE) for massive bleeding due to pelvic fractures.The clinical data of 92 patients with haemorrhage due to pelvic fractures from March 1998 to February 2008 were retrospectively analyzed. Among 53 patients treated conservatively such as massive transfusion and fluid infusion in the control group, 43 patients were male and 10 patients were female, ranging in age from 27 to 61 years, averaged (37.2 +/- 5.7) years. Among 39 patients who were hemodynamically unstable or had evidences of ongoing hemorrhage required TAE, 26 patients were male and 13 patients were female, ranging in age from 26 to 62 years, with a mean age of (35.3 +/- 9.5) years. The clinical date such as blood or fluid transfusion volume, shock redress time and survival rate were compared between the two groups. The hemostatic efficiency and complications of the surgery were also analyzed.The average hemostasis time of TAE group was 2 hours. There were no intraoperative injuries of blood vessels, nerve or vital organs. Three patients had lower limbs numbness and 5 patients had gluteal skin redness after the operation. The blood transfusion or fluid infusion volume, shock redress time and survival rate were all significantly better than those in the conservative group.TAE is an early,rapid and effective method in controlling haemorrhage due to pelvic fractures.

The control efforts on Oncomelania hupensis, the intermediate snail host of Schistosoma japonicum, cannot be easily excluded from the integrated approach of schistosomiasis control in China. Application of chemical compounds, molluscicides, in snail habitats is a common method for snail control in addition to environmental modification. We conducted a systematic review and meta-analysis to assess the molluscicidal effects of the currently recommended 50% niclosamide ethanolamine salt wettable powder and a new 4% niclosamide ethanolamine salt powder developed by Chinese researchers. Literature was searched from three Chinese databases, i.e. Chinese Biomedical Database, VIP Database and Wanfang Database, on field mollusciciding trials of niclosamide in China (from January 1, 1990 to April 1, 2010). Molluscicidal effects on reduction of snail population of the 50% or 4% niclosamide formulations in field trial were evaluated 3 days, 7 days or 15 days post-application. Out of 90 publications, 20 papers were eventually selected for analysis. Publication bias and heterogeneity tests indicated that no publication bias existed but heterogeneity between studies was present. Meta-analysis in a random effect model showed that the snail mortality of 3, 7 and 15 days after spraying the 50% niclosamide ethanolamine salt wettable powder were 77% [95%CI: 0.68-0.86], 83% [95%CI: 0.77-0.89], and 88% [95%CI: 0.82-0.92], respectively. For the 4% niclosamide ethanolamine salt powder, the snail mortality after 3, 7 and 15 days were 81% [95%CI: 0.65-0.93], 90% [95%CI: 0.83-0.95] and 94% [95%CI: 0.91-0.97], respectively. Both are good enough to be used as molluscicides integrated with a schistosomiasis control programme. The 4% niclosamide ethanolamine salt powder can be applied in the field without water supply as the surrogate of the current widely used 50% niclosamide ethanolamine salt wettable powder. However, to consolidate the schistosomiasis control achievement gained, it is necessary to continuously perform mollusciciding more than twice annually in the field.

To study the influences of head/neck ratio and femoral antetorsion on the safe-zone of operative acetabular orientations, which meets the criteria for desired range of motion (ROM) for activities of daily living in total hip arthroplasty (THA).A three-dimensional generic, parametric and kinematic simulation module of THA was developed to analyze the cup safe-zone and the optimum combination of cup and neck antetorsion. A ROM of flexionor =120 degree internal rotationor = 45 degree at 90 degree flexion, extensionor = 30 degree and external rotationor =40 degree was defined as the criteria for desired ROM for activities of daily living. The cup safe-zone was defined as the area that fulfills all the criteria of desired ROM before the neck impinged on the liner of the cup. For a fixed stem-neck (CCD)-angle of 130 degree theoretical safe-zones fulfilling the desired ROM were investigated at different general head-neck ratios (GR=2, 2.17, 2.37, 2.61 and 2.92) and femoral anteversions (FA equal to 0 degree,10 degree,20 degree and 30 degree).Large GRs greatly increased the size of safe-zones and when the CCD-angle was 130 degree, a GR larger than 2.37 could further increase the size of safe-zones. There was a complex interplay between the orientation angles of the femoral and acetabular components. When the CCD-angle was 130 degree the optimum relationship between operative acetabular anteversion (OA) and femoral antetorsion (FA) could be estimated by the formula: OA equal to -0.80 multiply FA+47.06, and the minimum allowable operative acetabular inclination (OI(min)) would be more than 210.5 multiply GR(-2.255).Large GRs greatly increase the size of safe-zones and it is recommended that the GR be more than 2.37 so as to extend the acceptable range of error that surgeons cannot avoid completely during operation. As to the optimum operative acetabular inclination (OI), surgeons need to make a decision combining with other factors, including stress distribution, soft tissue and cup wear conditions, as well as patients'individual situations and demands. The data obtained from this study and the module of THA can be used to assist surgeons to choose and implant appropriate implants.

This review focuses on implementing a geospatial health infrastructure for control of schistosomiasis and other helminthic infections in Southeast Asia, with special focus on the People's Republic of China and the Philippines, using a model working group approach. Health workers have lagged in utilization of geospatial analysis and widely available, low-cost spatial data resources for epidemiological modelling and control programme management. The critical limitation on development of useful health applications to date has not been the availability of geospatial data and methods. Rather, the key barriers have been the speed of adoption of geospatial analysis tools by health scientists and the quality of geographic information system (GIS)-friendly medical databases. Regional GIS applications on Asian schistosomiasis are reviewed to illustrate recent geospatial health analysis applications. A model programme is presented for implementation of training programmes and establishment of regional working groups to facilitate development and use of geospatial health infrastructure resources by health workers in Southeast Asia.

Climate change-according to conventional wisdom-will result in an expansion of tropical parasitic diseases in terms of latitude and altitude, with vector-borne diseases particularly prone to change. However, although a significant rise in temperature occurred over the past century, there is little empirical evidence whether climate change has indeed favoured infectious diseases. This might be explained by the complex relationship between climate change and the frequency and the transmission dynamics of infectious diseases, which is characterised by nonlinear associations and countless other complex factors governing the distribution of infectious diseases. Here, we explore whether and how climate change might impact on diseases targeted by the Regional Network for Asian Schistosomiasis and Other Helminth Zoonoses (RNAS(+)). We start our review with a short summary of the current evidence-base how climate change affects the distribution of infectious diseases. Next, we introduce biology-based models for predicting the distribution of infectious diseases in a future, warmer world. Two case studies are presented: the classical RNAS(+) disease schistosomiasis and an emerging disease, angiostrongyliasis, focussing on their occurrences in the People's Republic of China. Strengths and limitations of current models for predicting the impact of climate change on infectious diseases are discussed, and we propose model extensions to include social and ecological factors. Finally, we recommend that mitigation and adaptation strategies to diminish potential negative effects of climate change need to be developed in concert with key stakeholders so that surveillance and early-warning systems can be strengthened and the most vulnerable population groups protected.

Schistosomiasis japonica, a chronic and debilitating disease caused by the blood fluke Schistosoma japonicum, is still of considerable economic and public health concern in the People's Republic of China, the Philippines, and Indonesia. Despite major progress made over the past several decades with the control of schistosomiasis japonica in the aforementioned countries, the disease is emerging in some areas. We review the epidemiological status and transmission patterns of schistosomiasis japonica, placing it into a historical context, and discuss experiences and lessons with national control efforts. Our analyses reveal that an integrated control approach, implemented through intersectoral collaboration, is essential to bring down the prevalence and intensity of Schistosoma japonicum infections and disease-related morbidity, and to sustain these parameters at low levels. The need for innovation and a sufficiently flexible control approach to adapt interventions in response to the changing nature and challenges of schistosomiasis control from the initial phase of morbidity control to the final state of elimination is emphasised. The aim of the presentation and the analyses is to inspire researchers and disease control managers elsewhere in Asia, Africa, and the Americas to harness the experiences gained and the lessons presented here to improve the control and eventual elimination of schistosomiasis and parasitic diseases.

To study the therapeutic effects and clinical experiences of second-stage revision in postoperative infection after total hip replacement and to explore its security and validity.From January 2006 to March 2009, 17 hips in 17 patients (7 males and 10 females, ranging in age from 43 to 75 years, with an average of 58.5 years) were treated with second-stage revision. All the patients suffered from different degrees of hip pain. In bacilliculture of Synovial fluid or peritonsillar tissue, 11 patients showed positive results and 6 patient negative. The intraoperative periprosthetic histopathological examination showed that all the patients had acute inflammation. Eight patients had sinus communicating with prosthesis; 15 patients had increased ESR, and 15 patients had C reactive protein increased. All the patients had osteolysis, prosthesis loosening, and the performance of periosteal reaction in X-ray. All the patients were treated with second stage revision. In the first operation, thorough debridement was perfumed and the prosthesis was removed. Then the prosthesis of antibiotic--loaded acrylic cement was implanted. After giving antibiotics intravenously for 4 weeks, the antibiotics were taken orally for another six weeks. The ESR and C response protein were examined at regular time, and the second-stage revision surgery was perfumed when the ESR and C response protein were normal. The Harris score was used to evaluate therapeutic effects of second-stage revision surgery before and after treatment.All the patients were followed up with an average of 19.5 months, ranged from 12 to 35 months. No complications occurred. Postoperative X-ray showed prosthesis in the correct position. The Harris score increased from preoperative (39.3 +/- 5.6) to postoperative (84.4 +/- 10.3) (t = 15.86, P0.01).The second-stage revision in postoperative infection after total hip replacement has a good efficacy, safety and reliability advantages. This technology provides an alternative in postoperative infection after total hip replacement.

To investigate the techniques and therapeutic effects of suture anchors for the reconstruction of distal tendo achillis rupture.The clinical data of 16 patients of distal tendo achillis rupture repaired with suture anchors from June 2005 to August 2008 were retrospectively analyzed. Among them, there were 13 males and 3 females with a mean age of 33.5 years (ranged from 17 to 46 years). The postoperative rehabilitation was conducted for every patient. The operation time, position of suture anchor and complications of the surgery were analyzed. The healing of stendo achillis and functional recovery were assessed by Arner-Lindholm standard.All the patients were followed up for an average of 13.2 months. There were no complications of foreign-body reaction or re-rupture. The average operation time was 35.5 minute. There was no intraoperative injuries of blood vessels, nerves or tendons. A total of 19 suture anchors were used, and only 1 anchor was displaced. The functional recovery of tendo achillis was rated as excellent in 13 cases,good in 2 cases, bad in 1 case. All patients were satisfied with the effects on their current work and life. And no displacement of anchors was found in radiographic films.Repairing of the distal tendo achillis rupture with suture anchors can make operation simple and quick, rigid fixation, less complications, and provide good therapeutic effects.

To approach the short-term result and clinical application of metal on metal total hip arthroplasty with large diameter heads and evaluate its safety and efficacy clinically.From January 2007 to March 2008, 39 hips in 37 patients (24 males and 13 females,ranging in age from 43 to 75 years, with an average of 58.5 years) were treated with metal on metal total hip arthroplasty with large diameter heads (ASRTM XL) included 14 cases of osteonecrosis (ON), 2 cases of osteoarthritis (OA), 18 cases of fresh femoral neck fracture, 3 cases of developmental dysplasia of the hip (DDH). All patients were evaluated by self assessment form, hip function examination, radiographs, preoperative and postoperative Harris hip score. Based on the short-term results, its design characteristic and clinical properties were analyzed.All the incision healed well and there were not any complications such as femoral fracture, infection, dislocation and neurovascular injury. All patients obtained the follow-up and an average time was 16.5 months (12 to 19 months), all the joints had good or excellent clinical results. Radiographically, the positions of the prostheses were normal, the average limbs length and femoral eccentricity recovered as normal. The average range of motion of the hip improved remarkable, such as flexion improved from (20.1 +/- 8.2) degrees to (85.7 +/- 9.8) (t = 32.86, P0.01), abduction improved from (10.2 +/- 4.4) degrees to (41.5 +/- 9.1) degrees (t = 19.34, P0.01), adduction improved from (16.3 +/- 8.8) degrees to (40.3 +/- 10.4) (t = 11.00, P0.01),external rotation improved from (12.3 +/- 5.2)0 to (42.0 +/- 7.7) degrees (t = 19.96, P0.01), internal rotation improved from (3.4 +/- 1.1) degrees to (23.0 +/- 9.8) degrees (t = 12.41, P0.01). The Harris score rose from preoperative (39.3 +/- 5.6) to (91.4 +/- 10.3) at the latest follow up (t = 27.75, P0.01).Short-term results show that metal on metal hip joint prosthesis with large diameter heads has advantages of small deformation of acetabular cup, lower wearing, large range of motion and few dislocation. It offers a newly valuable technology for treatment of osteonecrosis, osteoarthritis, femoral neck fracture and DDH with the higher requirement of movement after the operation.

Schistosomiasis japonica, a chronic and debilitating disease caused by the blood fluke Schistosoma japonicum, is still of considerable economic and public health concern in the People's Republic of China, the Philippines, and Indonesia. Despite major progress made over the past several decades with the control of schistosomiasis japonica in the aforementioned countries, the disease is emerging in some areas. We review the epidemiological status and transmission patterns of schistosomiasis japonica, placing it into a historical context, and discuss experiences and lessons with national control efforts. Our analyses reveal that an integrated control approach, implemented through intersectoral collaboration, is essential to bring down the prevalence and intensity of Schistosoma japonicum infections and disease-related morbidity, and to sustain these parameters at low levels. The need for innovation and a sufficiently flexible control approach to adapt interventions in response to the changing nature and challenges of schistosomiasis control from the initial phase of morbidity control to the final state of elimination is emphasised. The aim of the presentation and the analyses is to inspire researchers and disease control managers elsewhere in Asia, Africa, and the Americas to harness the experiences gained and the lessons presented here to improve the control and eventual elimination of schistosomiasis and parasitic diseases.

This review focuses on implementing a geospatial health infrastructure for control of schistosomiasis and other helminthic infections in Southeast Asia, with special focus on the People's Republic of China and the Philippines, using a model working group approach. Health workers have lagged in utilization of geospatial analysis and widely available, low-cost spatial data resources for epidemiological modelling and control programme management. The critical limitation on development of useful health applications to date has not been the availability of geospatial data and methods. Rather, the key barriers have been the speed of adoption of geospatial analysis tools by health scientists and the quality of geographic information system (GIS)-friendly medical databases. Regional GIS applications on Asian schistosomiasis are reviewed to illustrate recent geospatial health analysis applications. A model programme is presented for implementation of training programmes and establishment of regional working groups to facilitate development and use of geospatial health infrastructure resources by health workers in Southeast Asia.

Climate change-according to conventional wisdom-will result in an expansion of tropical parasitic diseases in terms of latitude and altitude, with vector-borne diseases particularly prone to change. However, although a significant rise in temperature occurred over the past century, there is little empirical evidence whether climate change has indeed favoured infectious diseases. This might be explained by the complex relationship between climate change and the frequency and the transmission dynamics of infectious diseases, which is characterised by nonlinear associations and countless other complex factors governing the distribution of infectious diseases. Here, we explore whether and how climate change might impact on diseases targeted by the Regional Network for Asian Schistosomiasis and Other Helminth Zoonoses (RNAS(+)). We start our review with a short summary of the current evidence-base how climate change affects the distribution of infectious diseases. Next, we introduce biology-based models for predicting the distribution of infectious diseases in a future, warmer world. Two case studies are presented: the classical RNAS(+) disease schistosomiasis and an emerging disease, angiostrongyliasis, focussing on their occurrences in the People's Republic of China. Strengths and limitations of current models for predicting the impact of climate change on infectious diseases are discussed, and we propose model extensions to include social and ecological factors. Finally, we recommend that mitigation and adaptation strategies to diminish potential negative effects of climate change need to be developed in concert with key stakeholders so that surveillance and early-warning systems can be strengthened and the most vulnerable population groups protected.

Despite sustained efforts for its control made over the past 50+ years, the re-emergence of schistosomiasis in China was noted around the turn of the new millennium. Consequently, a new integrated strategy was proposed to stop the contamination of schistosome eggs to the environment, which emphasizes health education, access to clean water and adequate sanitation, mechanization of agriculture and fencing of water buffaloes, along with chemotherapy. Validation of this integrated control strategy in four pilot counties in the provinces of Anhui, Hubei, Hunan and Jiangxi revealed significant reductions in the rate of Schistosoma japonicum infection in humans and intermediate host snails. Importantly, this strategy showed an impact on diseases beyond schistosomiasis, signified by concomitant reductions in the prevalence of soil-transmitted helminth infections. In view of China's new integrated strategy for transmission control of schistosomiasis showing an ancillary benefit on other helminthic diseases, we encourage others to investigate the scope and limits of integrated control of neglected tropical diseases.

To study the accuracy the pedicle screw placement in the thoracic spine using funnel technique and free hand technique.Eight cadavers including 5 males and 3 females were analysed. The age ranged from 57 to 82 years (mean 68 years). Cadawers were randomly assigned to one of two instrumentation groups. In four cadavers, "funnel technique" was used for screw placement. In the remaining four cadavers,free hand technique then was used. Success of pedicle screw placement was judged by CT scan. The rate of success of two ways was compared using statistic analysis.Ninety-six screws were inserted by "funnel technique" and free hand technique respectively, 84 of "funnel technique" were successful, and 73 of free hand technique were successful. Significant differences were found between two ways (P0.05). Chanciness tresis occurred in "funnel technique" on 2 screws and free hand technique on 9 screws. There were significant differences in rates of chanciness tresis (P0.05).Funnel technique is simple, safe and cost-effective alternative to any other thchnique for pedicle screw placement in thoracic spine,funnel technique is able to reduce the chance of critical injury of nerve root and dura.

To explore the effect of improved EPSTR on prevention of dislocation after total hip arthroplasty.From January 2006 to May 2007, the posterior structures were repaired using improved EPSTR in 85 cases (87 hips) of total hip arthroplasty, which involved 39 males and 46 females, with an average age of 69.5 years (range, from 62 to 85 years). Fifty-eight cases were of fresh femoral neck fracture, 25 cases were of aseptic necrosis of femoral head, 3 cases were of osteoarthritis, 1 case was of a internal fixation failure of femoral intertrochanteric fracture.All 85 cases were followed up for 8-24 months (average 15 months). None of these 85 patients had posterior dislocation, external rotation contracture and greater trochanter fracture. The Harris score at the 6th month postoperatively was 89.2 +/- 4.5.Improved EPSTR is an effective, simple and timesaving method in prevention of dislocation after total hip arthroplasty, it has clinical application value.

The 1st International Symposium on Geospatial Health was convened in Lijiang, Yunnan province, People's Republic of China from 8 to 9 September, 2007. The objective was to review progress made with the application of spatial techniques on zoonotic parasitic diseases, particularly in Southeast Asia. The symposium featured 71 presentations covering soil-transmitted and water-borne helminth infections, as well as arthropod-borne diseases such as leishmaniasis, malaria and lymphatic filariasis. The work made public at this occasion is briefly summarized here to highlight the advances made and to put forth research priorities in this area. Approaches such as geographical information systems (GIS), global positioning systems (GPS) and remote sensing (RS), including spatial statistics, web-based GIS and map visualization of field investigations, figured prominently in the presentation.

The transmission of mosquito-borne diseases is strongly linked to the abundance of the host vector. Identifying the environmental and biological precursors which herald the onset of peaks in mosquito abundance would give health and land-use managers the capacity to predict the timing and distribution of the most efficient and cost-effective mosquito control. We analysed a 15-year time series of monthly abundance of Aedes vigilax, a tropical mosquito species from northern Australia, to determine periodicity and drivers of population peaks (high-density outbreaks). Two sets of density-dependent models were used to examine the correlation between mosquito abundance peaks and the environmental drivers of peaks or troughs (low-density periods). The seasonal peaks of reproduction (r) and abundance () occur at the beginning of September and early November, respectively. The combination of low mosquito abundance and a low frequency of a high tide exceeding 7 m in the previous low-abundance (trough) period were the most parsimonious predictors of a peak's magnitude, with this model explaining over 50% of the deviance in . Model weights, estimated using AICc, were also relatively high for those including monthly maximum tide height, monthly accumulated tide height or total rainfall per month in the trough, with high values in the trough correlating negatively with the onset of a high-abundance peak. These findings illustrate that basic environmental monitoring data can be coupled with relatively simple density feedback models to predict the timing and magnitude of mosquito abundance peaks. Decision-makers can use these methods to determine optimal levels of control (i.e., least-cost measures yielding the largest decline in mosquito abundance) and so reduce the risk of disease outbreaks in human populations., Author Summary Mosquitoes carry several diseases that are potentially fatal to people. The risk of disease transmission is high when mosquitoes are abundant in an area, and it is therefore the job of health professionals to control or prevent mosquito outbreaks in certain areas, especially those close to human habitation. Biologists that study mosquito populations have the ability to predict peaks in mosquito population abundance by relating measures of these with environmental variables, such as tidal events and rainfall. Here we analysed data of mosquito (Aedes vigilax) populations from northern Australia over 15 years. We compared the highs and lows in mosquito numbers to possible drivers of these, such as tides. We found that low tide events prior to the mosquito peaks were followed by a boom in mosquito numbers. We also found the highest population growth rate is in September, which is two months earlier than the peak of mosquito abundance. Thus, following low tide events in the dry season, targeted control (such as spraying in earlier September) of mosquito breeding areas may allow for more effective control of mosquitoes close to human settlement, and therefore reduce the likelihood of disease outbreaks.

To explore the role of reconstruction of the posterior capsule and external rotators in prevention of postoperative dislocation in total hip arthroplasty revision following the posterolateral approach.Forty-five patients (47 hips) with the mean age of 65 years (55 to 78 years)of failed total hip arthroplasty were revised following the posterolateral approach. Posterior capsule was sutured to the anterosuperior portion of the capsule from where it had been detached, and the external rotators were then reattached to the soft tissue at the tip of the greater trochanter using 1.0 silk suture in surgery. The dislocation rate and risk factors were reviewed retrospectively to determine if closing the posterior capsule resulted in fewer dislocations. The femoral prosthesis and acetabular prosthesis were revised in 29 patients (31 hips), the liner was exchanged in 5 patients (5 hips), and the acetabular prosthesis or femoral components were revised in 10 patients (10 hips) and one patient (one hip) respectively. The procedure was the patient's first revision in 29 patients (30 hips), the second revision in 15 patients (16 hips), and the third revision in one patient(one hip). Radiographic evaluation included lower limb discrepancy, acetabular phase, femoral offset, anteversion angle, prosthetic loosening before and after revision. Function evaluation based on Harris score system.All patients were followed up with an average of 2.7 years. None of the patients sustained dislocation or infection, except one patient felt the anterior instability but without dislocation, X-ray revealed the acetabular component was in excessively anteversion. Lower leg discrepancy, acetabular abduction, anteversion femoral offest and collodiaphyseal angle were restored to normal level after operation on the basis of X-ray. One of the acetabular components and one of the femoral components were loose without dislocation. The Harris hip score improved from (49.13 +/- 15.53) points preoperatively to (83.59 +/- 6.93) points at the final follow-up (P0.05). According to Harris functional evaluation, 36 hip got an excellent result, 5 good, 5 fair and 1 bad.The historically high dislocation rate with the posterolateral approach for total hip arthroplasty revision can be reduced by careful soft tissue balancing,correction of implant alignment, meticulously closure of the posterior capsule, and reattaching the external rotators.

To assess clinical result of soft tissue balancing in primary total hip arthroplasty for severe developmental dysplasia of the hip in adults.From December 2000 to August 2006, 26 primary cementless total hip arthroplasties combined with soft tissue balancing were performed in 21 cases for the treatment of severe developmental dysplasia of the hip. Patients were classified as type III (20 hips) and type IV (6 hips) according to Crowe classification. All acetabular cups were placed in their original anatomic location by soft tissue releasing and subtrochanteric shortening osteotomy. Thereafter, postoperative clinical and radiological results were evaluated.The mean length of follow-up was 4.8 years (range, 13 months-7 years). Limp improved by at least one grade in 62% of the cases. Leg-length discrepancy was corrected significantly and osteotomy was undertaken in 13 hips with a mean decrease length of 0.9 cm by effective releasing. Harris scores improved significantly from a mean of 41.2 preoperatively to 89.6 postoperatively. No dislocations, infections and prosthesis loosening were found at the final follow-up evaluation.Soft tissue balancing in total hip arthroplasty can facilitate acetabular reconstruction to normalize the hip center in severe developmental dysplasia of the hip, as a result, satisfactory short-term result can be obtained by restoring normal function and anatomic structure.

Appraisal of the present and future impact of climate change and climate variability on the transmission of infectious diseases is a complex but pressing public health issue. We developed a biology-driven model to assess the potential impact of rising temperature on the transmission of schistosomiasis in China. We found a temperature threshold of 15.4 degrees C for development of Schistosoma japonicum within the intermediate host snail (i.e., Oncomelania hupensis), and a temperature of 5.8 degrees C at which half the snail sample investigated was in hibernation. Historical data suggest that the occurrence of O. hupensis is restricted to areas where the mean January temperature is above 0 degrees C. The combination of these temperature thresholds, together with our own predicted temperature increases in China of 0.9 degrees C in 2030 and 1.6 degrees C in 2050 facilitated predictive risk mapping. We forecast an expansion of schistosomiasis transmission into currently non-endemic areas in the north, with an additional risk area of 783,883 km(2) by 2050, translating to 8.1% of the surface area of China. Our results call for rigorous monitoring and surveillance of schistosomiasis in a future warmer China.

The aim of this study is to better understand ecological variability related to the distribution of Oncomelania hupensis, the snail intermediate host of Schistosoma japonicum, and predict the spatial distribution of O. hupensis at the local scale in order to develop a more effective control strategy for schistosomiasis in the hilly and mountainous regions of China. A two-pronged approach was applied in this study consisting of a landscape pattern analysis complemented with Bayesian spatial modelling. The parasitological data were collected by cross-sectional surveys carried out in 11 villages in 2006 and mapped based on global positioning system (GPS) coordinates. Environmental surrogates and landscape metrics were derived from remotely-sensed images and land-cover/land-use classification data. Bayesian non-spatial and spatial models were applied to investigate the variation of snail density in relation to environmental surrogates and landscape metrics at the local scale. A Bayesian spatial model, validated by the deviance information criterion (DIC), was found to be the best-fitting model. The mean shape index (MSI) and Shannon's evenness indexes (SEI) were significantly associated with snail density. These findings suggest that decreasing the heterogeneity of the landscape can reduce snail density. A prediction maps were generated by the Bayesian model together with environmental surrogates and landscape metrics. In conclusion, the risk areas of snail distribution at the local scale can be identified using an integrated approach with landscape pattern analysis supported by remote sensing and GIS technologies, as well as Bayesian modelling.

The objectives of this investigation were to assess the effect of temperature on the development of Schistosoma japonicum harboured in Oncomelania hupensis and to determine the lowest temperature threshold at which the hibernation of O. hupensis occurs. In the first experiment, adult infection-free O. hupensis, collected from Jiangsu province in eastern China, were infected with S. japonicum miracidia and raised at different temperatures under laboratory conditions. The development of miracidia until the release of cercariae was monitored employing the cercarial shedding method. In the second experiment, batches of O. hupensis were kept at temperatures below 13 degrees C with the temperature gradually reduced. Snail activity was assessed by a pin puncture method. We found a positive relationship between the development of S. japonicum within O. hupensis and temperature. In snails kept at 15.3 degrees C, S. japonicum arrested their development, while the fastest development occurred at 30 degrees C. The temperature at which half of the snails were in hibernation (ET(50)) was 6.4 degrees C. Our results underscore the pivotal role temperature plays on the biological activity of O. hupensis and the development of S. japonicum within the intermediate host. These findings are likely to have implications for the transmission of schistosomiasis in a warmer future China.