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Introduction: Socio-economic inequalities in smoking and related health problems are a public health concern worldwide. To support the development of effective tobacco control policies, this study examines trends in smoking rates according to socio-economic status (SES) in China., Aims and Methods: We analyzed data from repeated cross-sectional China Health and Retirement Longitudinal Study (CHARLS) on adults aged ≥45 years for the years 2011 and 2018, which involved 16 471 participants in 2011 and 19 367 in 2018. We then estimated the SES of individuals based on four types of wealth-related variables, namely, education, occupation, household characteristics, and durable consumer goods. Principal-component analysis was conducted to measure SES, and the Erreygers normalised concentration index (ECI) was used to calculate socio-economic inequality in current smoking by gender, age, and region., Results: The overall ECI (95% confidence interval) for women was -0.042 (-0.054 to -0.031) and -0.038 (-0.047 to -0.029) for 2011 and 2018, respectively. The ECI (95% confidence interval) for men was -0.077 (-0.101 to -0.050) and -0.019 (-0.042 to 0.005) for 2011 and 2018, respectively. The inequality in smoking by SES for adults aged < 60 years in the Northeast region increased during 2011-2018, from -0.069 (-0.144 to 0.006) to -0.119 (-0.199 to -0.038) for women and from 0.009 (-0.115 to 0.132) to -0.164 (-0.296 to -0.032) for men., Conclusions: smoking inequality by socio-economic among adults aged ≥45 years declined in recent years in China. However, smoking inequality by SES increased in other population groups., Implications: Our research indicated that socio-economic inequality of current smoking among residents aged 45 years and older declined in 2018 when compared with 2011 numbers, particularly for men aged ≥ 60 years. Women in the Northeast region displayed more significant smoking inequality by SES than women in other regions did. During the study period, there was an increase in inequality in smoking by SES for adults aged < 60 years in the Northeast region. Thus, tobacco control policies and interventions should be targeted at high-risk subpopulations with lower SES, particularly in Northeast China., (© The Author(s) 2022. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: Aim to evaluate the effect of social participation on utilization of medical services among middle-aged and elderly residents in China., Methods: We used data from the 2018 wave of the China Health and Retirement Longitudinal Study. Social participation is classified into three types. Furthermore, to control for confounding factors, our study computed propensity score matching (PSM) to evaluate the effect of social participation on the utilization of medical services., Result: The result of PSM indicates that social participation significantly positively affects the utilization of outpatient services, the average treatment effect on the treated (ATT = 0.038 *** ) and the utilization of inpatient services (ATT = 0.015 ** ) by middle-aged and elderly residents. Furthermore, the utilization of outpatient health care services was significantly positively associated with leisure activities (ATT = 0.035 *** ), social activities to help others (ATT = 0.031 *** ), and learning activities to gain new knowledge (ATT = 0.034 *** ) among middle-aged and elderly residents. The utilization of inpatient health care was significantly positively associated with leisure activities (ATT = 0.015 *** ) but had no significant association with social deeds that help others and increased new knowledge among middle-aged and elderly residents., Conclusion: Thus, social participation significantly positively affects healthcare utilization by middle-aged and elderly residents. Hence, the government and society should provide more conveniences and promote social participation among middle-aged and elderly residents., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Liu, Qiu and Chen.)

Liquid-liquid phase separation (LLPS) explains many intracellular activities, but its role in extracellular functions has not been studied to the same extent. Here we report how LLPS mediates the extracellular function of galectin-3, the only monomeric member of the galectin family. The mechanism through which galectin-3 agglutinates (acting as a "bridge" to aggregate glycosylated molecules) is largely unknown. Our data show that its N-terminal domain (NTD) undergoes LLPS driven by interactions between its aromatic residues (two tryptophans and 10 tyrosines). Our lipopolysaccharide (LPS) micelle model shows that the NTDs form multiple weak interactions to other galectin-3 and then aggregate LPS micelles. Aggregation is reversed when interactions between the LPS and the carbohydrate recognition domains are blocked by lactose. The proposed mechanism explains many of galectin-3's functions and suggests that the aromatic residues in the NTD are interesting drug design targets.

Galectins are a family of lectins that bind β-galactosides through their conserved carbohydrate recognition domain (CRD) and can induce aggregation with glycoproteins or glycolipids on the cell surface and thereby regulate cell activation, migration, adhesion, and signaling. Galectin-3 has an intrinsically disordered N-terminal domain and a canonical CRD. Unlike the other 14 known galectins in mammalian cells, which have dimeric or tandem-repeated CRDs enabling multivalency for various functions, galectin-3 is monomeric, and its functional multivalency therefore is somewhat of a mystery. Here, we used NMR spectroscopy, mutagenesis, small-angle X-ray scattering, and computational modeling to study the self-association-related multivalency of galectin-3 at the residue-specific level. We show that the disordered N-terminal domain (residues ∼20-100) interacts with itself and with a part of the CRD not involved in carbohydrate recognition (β-strands 7-9; residues ∼200-220), forming a fuzzy complex via inter- and intramolecular interactions, mainly through hydrophobicity. These fuzzy interactions are characteristic of intrinsically disordered proteins to achieve liquid-liquid phase separation, and we demonstrated that galectin-3 can also undergo liquid-liquid phase separation. We propose that galectin-3 may achieve multivalency through this multisite self-association mechanism facilitated by fuzzy interactions., (© 2017 by The American Society for Biochemistry and Molecular Biology, Inc.)

Background: Schistosomiasis remains a major public health concern in China. Since 2004, an integrated strategy was developed to control the transmission of Schistosoma japonicum in China. However, the long-term effectiveness of this integrated strategy for the interruption of schistosomiasis transmission remains unknown in the mountainous and hilly regions of China until now. This longitudinal study aims to evaluate the effectiveness of the integrated strategy on transmission interruption of schistosomiasis in Sichuan Province from 2005 through 2014., Methods: The data regarding replacement of bovines with machines, improved sanitation, access to clean water, construction of public toilets and household latrines, snail control, chemotherapy, and health education were captured from the annual report of the schistosomiasis control programmes in Sichuan Province from 2005 to 2014, and S. japonicum infection in humans, bovines and snails were estimated to evaluate the effectiveness of the integrated strategy., Results: During the 10-year period from 2005 through 2014, a total of 536 568 machines were used to replace bovines, and 3 284 333 household lavatories and 15 523 public latrines were built. Tap water was supplied to 19 116 344 residents living in the endemic villages. A total of 230 098 hm 2 snail habitats were given molluscicide treatment, and 357 233 hm 2 snail habitats received environmental improvements. There were 7 268 138 humans and 840 845 bovines given praziquantel chemotherapy. During the 10-year study period, information, education and communication (IEC) materials were provided to village officers, teachers and schoolchildren. The 10-year implementation of the integrated strategy resulted in a great reduction in S. japonicum infection in humans, bovines and snails. Since 2007, no acute infection was detected, and no schistosomiasis cases or infected bovines were identified since 2012. In addition, the snail habitats reduced by 62.39% in 2014 as compared to that in 2005, and no S. japonicum infection was identified in snails since 2007. By 2014, 88.9% of the endemic counties achieved the transmission interruption of schistosomiasis and transmission control of schistosmiasis was achieved in the whole province in 2008., Conclusion: The government-directed and multi-department integrated strategy is effective for interrupting the transmission of schistosomiasis in the mountainous and hilly regions of China.

Schistosomiasis is a parasitic disease that affects over 200million people worldwide in at least 76 countries, ranking second only after malaria in terms of its socio-economic and public health importance in tropical and subtropical areas of the world. Chinese surveillance data since the mid-1950s have shown that endemic areas are divided into three types based on geographical, ecological and epidemiological factors, such as marshland and lake region, plain region with waterway networks and hilly and mountainous region. As confirmed by numerous epidemiological investigations, schistosomiasis endemic areas of the mountainous type are distributed in 178 counties in 11 provinces of The People's Republic of China. Over the past several decades great success in transmission control has been achieved by implementation of control strategies that were suitable for the mountainous and hilly endemic region., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

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

Objective: To establish an index system of the key factors of elimination of schistosomiasis., Methods: A questionnaire was designed based on the reference review, and 24 scientists working in the field of schistosomiasis control or research or management were investigated by using the Delphi method. The importance of each index reflecting the endemicity of schistosomiasis wis scored by each scientist. The assessing system for key factors of eliminating schistosomiasis was established, and the normalized weight and combined weight were calculated., Results: The assessing system included three indexes in the first grade, seven indexes in the second grade and thirteen indexes in the third grade. Among the indexes in the first grade, the normalized weights of endemicity, natural environment and social environment were 0.371 1, 0.339 5, and 0.289 4, respectively. Among the indexes in the second grade, the economy showed the highest combined weight of 0.289 4 while the agriculture and sanitation both showed the lowest score of 0.112 7. Among the indexes in the third grade, the infection rate of animals showed the highest combined weight of 0.124 6 while the agriculture and plant structure both showed the lowest score of 0.053 0., Conclusion: The indexes of the assessing system provide the scientific evidence for surveillance work when elirnination of schistosomiasis.

Coproantigen test kits for Echinococcus spp. worms in dogs, designed for commercial use, were obtained from three different Chinese producers, and were compared with a laboratory kit using reagents from New Zealand. None of the three producers would provide details of their test validation. From a known set of dog faeces obtained at necropsy from infected and uninfected dogs, and from faeces collected from dogs necropsied in the field, results differed between the kits. For field material, the Tiankang kit showed the best specificity but lacked sensitivity. The Combined kit showed best sensitivity but lacked specificity. Results for the Haitai kit were intermediate. With samples from experimentally infected dogs, both the Haitai and Combined kits lacked sensitivity. Kits will need to be validated by the user before they can be relied on to predict progress in Echinococcus spp. control in China or in other countries.

Molecular genetic tools are needed to address questions as to the source and dynamics of transmission of the human blood fluke Schistosoma japonicum in regions where human infections have reemerged, and to characterize infrapopulations in individual hosts. The life stage that interests us as a target for collecting genotypic data is the miracidium, a very small larval stage that consequently yields very little DNA for analysis. Here, we report the successful development of a multiplex format permitting genotyping of 17 microsatellite loci in four sequential multiplex reactions using a single miracidium held on a Whatman Classic FTA indicating card. This approach was successful after short storage periods, but after long storage (>4 years), considerable difficulty was encountered in multiplex genotyping, necessitating the use of whole genome amplification (WGA) methods. WGA applied to cards stored for long periods of time resulted in sufficient DNA for accurate and repeatable genotyping. Trials and tests of these methods, as well as application to some field-collected samples, are reported, along with the discussion of the potential insights to be gained from such techniques. These include recognition of sibships among miracidia from a single host, and inference of the minimum number of worm pairs that might be present in a host.

Objective: To evaluate the effect of schistosomiasis control in Lushan earthquake-stricken areas in Sichuan Province, so as to provide the evidence for formulating appropriate measures for schistosomiasis prevention and control., Methods: According to the data of historical schistosomiasis prevalence, 5 villages were selected as research sites and field investigations were conducted., Results: The average density of Oncomelania hupensis snails was 0.41 snails/0.1 m2, and there were no schistosome-infected snails. There were no acute schistosomiasis cases in these five villages. For local residents, the health education leaflets were more suitable than warning signs, and for migrant population, they were more concerned about the warning signs., Conclusion: After the implementation of effective prevention and control works, the epidemic risks of schistosomiasis have been controlled. However, the health education, surveillance, and prevention measures for schistosomiasis still need to be persisted in.

Objective: To assess whether Beichuan County reaches the national standard of schistosomiasis transmission interruption., Methods: Three villages in Beichuan County were sampled as assessment spots, and the schistosomiasis infections of residents and domestic animals, the status of Oncomelania snails and the past records were assessed according to the Criteria for Control and Elimination of Schistosomiasis in China., Results: No local schistosome infections were found in residents and cattle for successive 5 years and no snails were found for 2 successive years in the 3 villages. The files were documented completely. All the indices reached the national standard of schistosomiasis transmission being interrupted., Conclusion: Beichuan County has reached the national standard of schistosomiasis transmission interruption. However, the endemic surveillance of schistosomiasis still needs to continue.

Objective: To assess the impact of the "4 x 20" Lushan Earthquake on the risk of schistosomiasis transmission in Lushan and Tianquan counties, so as to provide the evidence for formulating appropriate measures for schistosomiasis prevention and control., Methods: Based on a comprehensive literature review, an analysis of schistosomiasis monitoring data in the earthquake affected counties, and a field investigation, a rapid assessment on the impact of the earthquake on schistosomiasis was conducted., Results: Lushan and Tianquan counties were two endemic areas of schistosomiasis with high transmission level in history, especially Lushan County where Oncomelania snail distribution/density was the highest in Sichuan Province. After the earthquake, the streams and damaged ditches were blocked up, potentially leading to the spread of Oncomelania snails, and the damaged sanitary facilities may also lead to the release of excrement, contaminating the environment where snails resided. Meanwhile, the people who were relocated due to the earthquake may have higher exposures to contaminated environment. In addition, increasing population mobility (e.g. relief workers) also had the potential to bring infection sources in the earthquake affected areas. Further, animals, which may serve as reservoirs for the parasite such as homeless dogs, may also add the complexity of local schistosomiasis transmission., Conclusions: The epidemic risk of schistosomiasis in Lushan and Tianquan counties is high. To prevent the outbreak and epidemic of schistosomiasis, the victim settlements should be established appropriately and the excrement should be managed carefully. Meanwhile, the snail control should be carried out in the high-risk environments. The health education, monitoring, patient treatments and expanded chemotherapy should be carried out and strengthened.

Objective: To understand the dynamics of schistosome antibodies in population in mountainous schistosomiasis low endemic regions, China, so as to provide the evaluation reference for immunodiagnosis., Methods: The people who consecutively received the indirect heamagglutination assay (IHA) for schistosomiasis and Kato-Katz technique were enrolled in this study in Guixiang Village, Danling County, Sichuan Province from 2006 to 2011. The positive rates for schistosome antibodies, antibody titers and eggs per gram (EPG) were analyzed., Results: A total of 353 people were investigated in this study from 2006 to 2011. The positive rates for schistosome antibodies decreased from 20.73% to 13.67%, and the geometric mean reciprocal titer (GMRT) decreased from 1.63 to 1.06. The antibodies tended to be negative in most antibody-positive people and the GMRT decreased gradually. The antibodies remained negative in most antibody-negative people. After chemotherapy in parasitology confirmed patients, the positive rate for schistosome antibodies decreased from 100% to 20%, and the GMRT decreased from 34.29 to 1.58. There was a highly positive correlation between GMRT and EPG (r = 0.94, P < 0.05)., Conclusion: The positive rate for schistosome antibodies in population in mountainous schistosomiasis low endemic regions is relatively high (13.67%). The standardization of immunodiagnostic methods is necessary and the suitable diagnostic reagents should be developed in this region.

The comprehensive control pattern centering on health education, deworming and improving drinking water and lavatories was adopted to control soil-transmitted nematodiasis in Danling County, Sichuan Province from 2007-2009. In 2009, the infection rate of soil-transmitted nematodes decreased from 57.12% of the baseline survey in 2006 to 10.06%.

Objective: To understand the current distribution and characteristics of patients with advanced schistosomiasis in Sichuan Province, so as to provide the scientific evidence for improving the management and treatment of advanced schistosomiasis., Methods: The patients who had been diagnosed as advanced schistosomiasis or were supposed with advanced schistosomiasis were the objects of the investigation. The epidemiological survey and medical examination were used to investigate these persons one by one according to the national standard., Results: There were 1 684 patients with confirmed diagnosis in 7 cities of Sichuan Province. There were 1 066 cases of splenomegaly including post-surgery (63.30%), 545 cases of ascites (32.36%), 44 cases of multiple granulomas in the colon (2.61%), and 29 cases of dwarf (1.72%). Most of the patients were old and 51.72% of them were more than 60 years old. A total of 1 331 patients (79.04%) needed treatment and assistance at present, and 36.44% of them who had ascites needed internal medicine treatment., Conclusion: There are also many patients with advanced schistosomiasis in Sichuan Province, and ascites and splenomegaly (post-surgery) were the main types. The patients with ascites should be the important objects of the treatment and assistance in the future.

Objective: To evaluate the effect of Ecological Civilized Homestead Construction on schistosomiasis control., Methods: The data of ecological civilized homestead construction and schistosomiasis control were collected and analyzed in Meiwan Village, Shuangqiao Town, Danling County, Sichuan Province from 2004 to 2010., Results: Ecological Civilized Homestead Construction was carried out from 2004 to 2010. Totally 454 bio-gas pools were built. All the farmers used well water. The popularized rates of the household bio-gas pool, sanitary toilet, sewage treatment pool reached 100%. The number of cattle was 4, which decreased by 91.30% compared with that in 2004, and all the cattle were fed in captivity. The schistosome infection rates of populations were 0.26% and 0.30% in 2005 and 2008, respectively, and nobody was infected in other years. The infection rate of cattle was 0 from 2004 to 2010. The awareness rate of knowledge about schistosomiasis control achieved 100% in the population over 6 years old. Most of the farmers could use certain protective measures while they were farming., Conclusion: The effect of ecological civilized homestead construction on schistosomiasis control is remarkable.

Objective: To understand the epidemic trend of schistosomiasis in Sichuan Province so as to provide the evidence for formulating schistosomiasis control strategy., Methods: According to the National Schistosomiasis Surveillance Protocol, the national surveillance sites in Sichuan Province were selected. The schistosomiasis surveillance was carried out continuously from 2005 to 2010., Results: Nine national schistosomiasis surveillance sites were established in Pujiang, Guanghan, Zhongjiang, Fucheng, Dongpo, Danling, Renshou, Xichang and Dechang counties. The Oncomelania hupensis snail area decreased from 351 853 m2 in 2005 to 128 285 m2 in 2010, the snail density from 0.70 to 0.21 per 0.1 m2, the snail infection rate from 0.06% to 0, the positive rate of human serum schistosome antibody from 19.41% to 7.62%, the schistosome infection rate of human population from 1.93% to 0.10%, and the infection rate of livestock from 4.50% to 1.02%. The snails were found mainly in ditch, rice field and other moist field., Conclusions: Though the endemic of schistosomiasis has reached a low level in Sichuan Province, the endemic situation fluctuates at a narrow range in some surveillance sites. Therefore, the surveillance work should be carried out continuously.

Background: The most recent strategy for schistosomiasis control in the People's Republic of China aims to reduce the likelihood of environmental contamination of schistosome eggs. Despite considerable progress, it is believed that achievements would be further consolidated with additional intermediate host snail control measures. We provide an empirical framework for discerning the relative contribution of intrinsic effects (density feedback) from other extrinsic drivers of snail population dynamics., Methods: We set up experiments in two study locations to collect reproduction data of Oncomelania hupensis, the intermediate host snail of Schistosoma japonicum. We applied a set of four population dynamic models that have been widely used to study phenomenological time-series data to examine the properties of demographic density feedback patterns from abundance data. We also contrasted the obtained results with the component feedback of density on survival rate to determine whether adult survival was the principal driver of the demographic feedback observed., Results: Demographic density feedback models (Ricker- and Gompertz-logistic) accounted for > 99% of Akaike's information criterion model weight, with the Gompertz ranking highest in all O. hupensis population groups. We found some evidence for stronger compensatory feedback in the O. hupensis population from Sichuan compared to a Jiangsu population. Survival rates revealed strong component feedback, but the log-linear relationships (i.e. Gompertz) had less support in the demographic feedback analysis., Conclusions: Our findings indicate that integrated schistosomiasis control measures must continue to reduce parasite abundance further because intermediate host snail populations tend to grow exponentially at low densities, especially O. hupensis populations in mountainous regions. We conclude that density feedback in adult survival is the principal component contribution to the demographic phenomenon observed in the population fitness (r)-abundance relationship., (© 2011 Yang et al; licensee BioMed Central Ltd.)

Background: Schistosoma japonicum is a major public health concern in the Peoples' Republic of China (PRC), with over one million people infected and another 50 million living in areas at risk of infection. Based on ecological, environmental, population genetic and molecular factors, schistosomiasis transmission in PRC can be categorised into four discrete ecosystems or transmission modes. It is predicted that the Three Gorges Dam (TGD) will impact upon the transmission of schistosomiasis in the PRC, with varying degree across the four transmission modes. We undertook longitudinal surveillance from 2002 to 2006 in sentinel villages both above and below the TGD across five provinces (Hunan, Jiangxi, Hubei, Anhui and Sichuan) to determine whether there was any impact of the TGD on schistosomiasis transmission during its construction. Here we present the results from a schistosomiasis-endemic village located above the dam in Sichuan Province., Results: Baseline results showed a human S. japonicum prevalence of 42.0% (95% CI: 36.6-47.5). At follow-up, results showed that the incidence of S. japonicum infection in the selected human cohort in Shian decreased by three quarters from 46% in 2003 to 11.3% in 2006. A significant (P < 0.01) downward trend was also evident in the yearly adjusted (for water contact) odds ratios. Over the four years of follow-up, the incidence of S. japonicum infection in bovines declined from 11.8% in the first year to zero in the final year of follow-up., Conclusions: The substantial decrease in human (75%) and bovine (100%) incidence observed in Shian village can probably be attributed to the annual human and bovine PZQ treatment of positives; as seen in drug (PZQ) intervention studies in other parts of PRC. If an increase in schistosome transmission had occurred as a result of the TGD, it would be of negligible size compared to the treatment induced decline seen here. It appears therefore that the construction of the TGD had virtually no impact on schistosomiasis transmission in Shian village over the period of study. Furthermore, contrary to previous reports from Sichuan downplaying the role of animals in human schistosome transmission, bovines may indeed play a role.

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

In this paper we summarize the epidemiological characteristics, trends, and control achievements of schistosomiasis in hilly regions of China, as well as analyze the challenges of schistosomiasis control in these areas after transmission control, and further explore the control measures and strategies in the post-transmission control period to strengthen the control achievements and sustainable development with the ultimate goal of achieving transmission interruption.

Aim: To establish an efficient culture system to support embryonic stem (ES) cell differentiation into hepatocytes that coexpress F-VIII and F-IX., Methods: Mouse E14 ES cells were cultured in differentiation medium containing sodium butyrate (SB), basic fibroblast growth factor (bFGF), and/or bone morphogenetic protein 4 (BMP4) to induce the differentiation of endoderm cells and hepatic progenitor cells. Hepatocyte growth factor, oncostatin M, and dexamethasone were then used to induce the maturation of ES cell-derived hepatocytes. The mRNA expression levels of endoderm-specific genes and hepatocyte-specific genes, including the levels of F-VIII and F-IX, were detected by RT-PCR and real-time PCR during various stages of differentiation. Protein expression was examined by immunofluorescence and Western blot. At the final stage of differentiation, flow cytometry was performed to determine the percentage of cells coexpressing F-VIII and F-IX, and ELISA was used to detect the levels of F-VIII and F-IX protein secreted into the culture medium., Results: The expression of endoderm-specific and hepatocyte-specific markers was upregulated to highest level in response to the combination of SB, bFGF, and BMP4. Treatment with the three inducers during hepatic progenitor differentiation significantly enhanced the mRNA and protein levels of F-VIII and F-IX in ES cell-derived hepatocytes. More importantly, F-VIII and F-IX were coexpressed with high efficiency at the final stage of differentiation, and they were also secreted into the culture medium., Conclusion: We have established a novel in vitro differentiation protocol for ES-derived hepatocytes that coexpress F-VIII and F-IX that may provide a foundation for stem cell replacement therapy for hemophilia.

Background: Alveolar echinococcosis is a major zoonosis of public health significance in western China. Overgrazing was recently assumed as a potential risk factor for transmission of alveolar echinococcosis. The research was designed to further test the overgrazing hypothesis by investigating how overgrazing influenced the burrow density of intermediate host small mammals and how the burrow density of small mammals was associated with dog Echinococcus multilocularis infection., Methods: The study sites were chosen by previous studies which found areas where the alveolar echinococcosis was prevalent. The data, including grass height, burrow density of intermediate host small mammals, dog and fox fecal samples as well as Global Positioning System (GPS) position, were collected from field investigations in Shiqu County, Sichuan Province, China. The fecal samples were analyzed using copro-PCR. The worms, teeth, bones and hairs in the fecal samples were visually examined. Single factor and multifactor analyses tools including chi square and generalized linear models were applied to these data., Results: By using grass height as a proxy of grazing pressure in the homogenous pasture, this study found that taller grass in the pasture led to lower small mammals' burrow density (chi(2) = 4.670, P = 0.031, coefficient = -1.570). The Echinococcus multilocularis worm burden in dogs was statistically significantly related to the maximum density of the intermediate host Ochotona spp. (chi(2) = 5.250, P = 0.022, coefficient = 0.028). The prevalence in owned dogs was positively correlated to the number of stray dogs seen within a 200 meter radius (Wald chi(2) = 8.375, P = 0.004, odds ratio = 1.198)., Conclusions: Our findings support the hypothesis that overgrazing promotes transmission of alveolar echinococcosis and confirm the role of stray dogs in the transmission of alveolar echinococcosis.

Objective: To determine the prevalence and evaluate the risk factors of canine echinococcosis based on a field survey of dog infections with Echinococcus granulosus and E. multilocularis in Chalong, Kalong, Dade and Chazha Townships in a district of Ganzi County, Sichuan Province, China., Method: Questionnaire associated with the acquisition of canine echinococcosis was administered to dog owners. Stray dogs were examined post-mortem and rectal faeces at necropsy were collected to validate a copro-antigen ELISA. Owned dogs were screened for Echinococcus spp. infection in faeces using the genus specific copro-ELISA and the effectiveness of dog treatment was assessed. Chi-square and one-way ANOVA were used for statistical analysis., Results: The prevalence of Echinococcus spp. infection at necropsy in stray dogs was 60.9% (14/23) in 2000; E. multilocularis infection accounted for 34.8% (8/23) and E. granulosus for 26.1% (6/23). The specificity of the copro-ELISA was 80.0% and the sensitivity was 92.3%, compared with the results at necropsy. Fifty percent of owned dogs (290/580) tested was copro-antigen positive at the beginning of the project in 2000, which decreased to 17% (99/580) in the same cohort of owned dogs after praziquantel treatment (5 mg/ kg) at 6-monthly period from 2003 to 2005. Analysis for risk factors associated with copro-antigen positive dogs showed that the never tethered dogs had a higher rate (40.4%, 65/161) than dogs tethered during the day (32.3%, 109/337), or tethered at night [29.2% (21/72)], or those always tethered [20%(2/10)](P<0.01). Dogs that their owners lacked hydatid transmission knowledge [38.1% (121/318)] and did not have de-worming practice [47.7% (92/193)] had significantly higher copro-antigen positive rate than those dogs that their owners knew relevant knowledge [28.6% (75/262)] and were dewormed regularly [20.4% (79/387)](P<0.05 and P<0.01). There was no correlation between the prevalence and dog sex or age or the varieties of livestock that the owner raised., Conclusion: Local dogs show high prevalence with both E. granulosus and E. multilocularis. The copro-ELISA can be used to detect infection of Echinococcus in dogs. Allowing dogs to roam, lack of the basic knowledge of hydatid disease transmission and no de-worming practice for dogs are significant factors for the transmission of canine echinococcosis.

Objective: To use a mathematical model and computer simulation to study transmission dynamics and control of schistosomiasis in mountainous regions of Sichuan., Methods: Based on studies of schistosomiasis japonica transmission in 20 villages in mountainous regions of Sichuan, a mathematical model was developed to characterize the impact of local environmental factors on transmission intensity. The model integrated site-specific factors and was calibrated to field epidemiological data from 3 subset villages. The dichotomic method was then used to predict different control measures., Results: The study showed high variations in prevalence of infection and infection intensity across villages, ranging between 3%-73%, 0.1-100 epg (eggs per gram stool), respectively. Important factors including occupation of local residents, exposure to contaminated water, microclimatic characteristics were integrated in the model. The predictions of dichotomic models showed that continuing chemotherapy (coverage between 50%-60%) could reduce infection intensities to 30%-80%, but could not change local transmission potential; therefore, the termination of chemotherapy would be followed by bouncing back of transmission. Sustaining targeted environmental interventions through snail and parasite oval control at certain coverage (30%-50%, respectively) could reduce the transmission to relatively stable levels. The model predictions showed that an integrated control (e.g., including both chemotherapy and environmental interventions) could suppress the transmission to an undetectable level even interruption of transmission between 5-10 years., Conclusion: The study demonstrated the feasibility of using a dynamic model, calibrated to local data, to gain insights into complicated processes underlying the transmission and informing site-specific control strategies.

Objective: To evaluate the effect of snail control through soil pasting mixed with niclosamide., Methods: Four sites were selected in different epidemic areas in Sichuan province. Soil pasting mixed with niclosamide was carried on, and the dosage was 0 g/m2, 4 g/m2, 6 g/m2, 8 g/m2 and 10 g/m2 respectively. The mortality rate of snail and the density of snail were observed after 7, 15, 30, 90 and 180 days., Results: The mortality rate of snail was more than 43.3% in blank group after 30 days. The mortality rate of snail was from 75.3% to 100.0% at 4 g/m2 group after 30 days. The mortality rate of snail in 4 g/m2 group was significantly higher than that in the blank group (chi2 = 31.27, P < 0.05). There was no significant difference in the mortality rate of snail among all study groups (chi2 = 1.07, P > 0.05). The decrease rate of snail density was more than 90%. The mortality rate of snail was about 30% higher in Chantu group than Qutu group. The unit cost of Pasting-Mixing Drug with Soil was from 5 to 7 times of spray method, but the total cost was similar for the. two methods at the endpoint of the snail control., Conclusion: The effect of soil pasting mixed with niclosamide is good, and the dosage of 4-6 g/m2 is suggested in snail control.

Objective: To further evaluate the efficacy and safety of tribendimidine in treatment of adult patients with intestinal nematode infections., Methods: An open and multi-center clinical trial was conducted in the provinces of Hainan, Sichuan and Guizhou. A total of 1,292 infected cases aged 15-70 years were enrolled in the study. Modified Kato-Katz method was used to diagnose the cases with intestinal nematode infections and assess the efficacy 3-4 weeks post treatment. Patients with Ascaris lumbricoides infection were treated orally with tribendimidine enteric coated tablets at a single dose of 300 mg, while in the patients with Ancylostoma duodenale, mixed A. duodenale and A. lumbricoides, or with other helminth infections, a single dose of 400 mg was administered., Results: The cure rate and effective rate of the patients with Ancylostoma infection were 88.4% (1,009/1,141) and 99.1% (1,131/1,141), respectively, while in patients with A. lumbricoides infection, they were 95.0% (419/441) and 99.8% (440/441), respectively. The cure rate of tribendimidine enteric coated tablet given to patients with Trichuris trichiura infection at a single dose of 400 mg was 76.8% (109/142). The adverse effect induced by tribendimidine was light and transient with a rate of 3.3% (42/1,292). No apparent impact was seen on blood and urine routine examinations, hepatic and renal functions as well as ECG examination., Conclusion: It is further confirmed that under the used dosage for expanding treatment in larger sample of patients with various ages and infected with Ancylostoma duodenale, A. lumbricoides and other helminths, tribendimidine enteric coated tablet is safe with satisfactory efficacy.

Objective: To evaluate the efficacy and safety of tribendimidine in treatment of children with hookworm and Ascaris lumbricoides infections., Methods: An open and multi-center clinical trial was conducted in the provinces of Hainan, Sichuan and Guizhou. 899 children aged 4-14 years were enrolled in the study. Hookworm, A. lumbricoides or other helminth infections were diagnosed by improved Kato-Katz method. All the patients were treated orally with tribendimidine enteric coated tablet at a single dose of 200 mg. The efficacy was evaluated by stool examination 3-4 weeks post treatment., Results: The cure rate and effective rate of the children with hookworm infection were 82.0% (433/528) and 99.2% (524/528), respectively, while in children with A. lumbricoides infection, they were 95.0% (576/639) and 99.8% (637/639), respectively. The efficacy of tribendimidine enteric coated tablet given to the children with Trichuris trichiura infection at a single dose of 200 mg was 36.8% (112/304). The adverse effect induced by tribendimidine, such as dizziness, nausea and vomiting, was light and transient with an adverse effect rate of 1.6% (14/899). No apparent impact was seen on the blood and urine routine examination, hepatic and renal function as well as ECG examination. Conclusion Tribendimidine given at a single dose of 200 mg exhibits lower adverse effect rate and potential efficacy in the treatment of children with hookworm and A. lumbricoides infections.

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.

Objective: To investigate water exposure modes and times of different populations in mountainous schistosomiasis endemic areas and to inform about the control strategies., Methods: All 1054 residents from populations around Qionghai Lake were randomly sampled according to occupation for a retrospective questionnaire survey in November 2001. Each individual was interviewed for his/her mode, frequency, and duration of water exposure occurring between April and October 2001., Results: The average exposure times and intensity were higher in farmers (median: 16 - 18 min/day and 2.41 - 2.5, respectively) who grow rice, tobacco, and vegetables than others (median: 3.74 - 7.39 min/day and 0.81 - 1.52, respectively); exposure frequency was found highest in farmers (median: 2.04 times/day) in all occupations; schoolchildren had low exposure frequency and times, but very high exposure intensity (median 2.34). Between April and June it is an agriculturally busy season, that is also a peak season of water exposure of adults. Schoolchildren's water exposure peaks on July and August, mainly due to playing water and swimming. Exposure times and intensities were higher in females than in males., Conclusion: Water exposure modes, times, and intensities of different populations were different in mountainous schistosomiasis endemic areas of Xichang. Between April and June should be the peak infection season of adults who are engaging in agricultural activities, while July to August should be the peak infection season for schoolchildren with non-agricultural activities.

A study of liver and colon cancers and their association with a previous diagnosis of schistosomiasis was performed in rural Sichuan, China. The data analysed came from 127 liver-cancer and 142 colon-cancer patients, each matched, by age, gender, hospital and township, with one or two controls. The cancer cases were identified from the hospital records of three Sichuan counties (all of which have some level of endemic schistosomiasis japonicum): Meishan (66 liver and 54 colon cases), Pujiang (16 liver and 22 colon cases) and Xichang (45 liver and 66 colon cases). Each control was selected using the hospital records for the same year the matched case of cancer was diagnosed, when the control had been found to have an illness other than cancer. Previous schistosomal infection was determined by examining the medical records at the county hospitals, searching the records at the local schistosomiasis-control stations or health-surveillance units, and, when no written record could be found, by interviews with the subjects or their relatives. Given the extremely strong association between hepatitis and liver cancer in China, only data from hepatitis-negative pairs were used in the analyses. Previous schistosomal infection was found to be significantly associated with both liver cancer (odds ratio = 3.7; 95% confidence interval = 1.0-13) and colon cancer (odds ratio = 3.3; 95% confidence interval = 1.8-6.1). The results indicate a fraction of disease attributable to schistosomiasis of 24% for colon cancer, and (among the hepatitis-negative population) one of 27% for liver cancer.

Partial (DNA) sequences are presented for 2 nuclear (18S and 28S rRNA genes) and 2 mitochondrial (12S rRNA and ND1 genes) loci for 5 species belonging to the Schistosoma japonicum, S. sinensium and S. indicum groups of Asian Schistosoma. Fresh field isolates were collected and cultured for the following taxa: S. incognitum (S. indicum group, central Thailand), S. mekongi (S. japonicum group, southern Laos), S. ovuncatum (S. sinensium group, northern Thailand), S. spindale (S. indicum group, northeast Thailand and central Thailand isolates) and S. sinensium (S. sinensium group, Sichuan Province, China). This represents the first published DNA sequence data for S. ovuncatum and for S. sinensium s.s. from the type locality in China. The paper also presents the first sequence data at the above loci for S. incognitum (except for the 28S sequences) and S. sinensium. Congruence was observed between the phylogenies estimated for each locus, although the relationships of S. incognitum were not so well resolved. Fitch-Margoliash, maximum likelihood (M/L) and maximum parsimony methods were used to estimate the phylogenies and the agreement between them was similar to that observed between loci. The ML tree was considered to best represent the data and additional 28S sequences (taken from the GenBank), for S. haematobium, S. japonicum, S. mansoni and Orientobilharzia turkestanicum, were used to construct an overall phylogeny. The S. indicum group taxa showed considerable divergence from the other Asian species and closest affinity with the African group. S. ovuncatum and S. sinensium appeared as sister taxa but their status as sibling species remained supported. The findings are discussed in the context of phylogeographical hypotheses for the origin of Schistosoma. An Asian origin for Schistosoma is also considered.

Objective: To determine the phylogenetic position of Schistosoma sinensium in the genus Schistosoma using mitochondrial cytochrome C oxidase 1 (CO1) and NADH dehydrogenase 1(ND1) as molecular markers., Methods: The genomic DNA of adult worms were extracted by the GNT-K method. The target regions were amplified by PCR using specific primers. The PCR products were purified before ligation into the plasmid Zero-Blunt. Recombinant plasmids were amplified in E. coli, extracted and purified using routine methods and then sequenced using M13 primers (F/R) on a Licor long-read auto-sequencer. Sequences of related schistosomes were retrieved from GenBank and aligned with our data in the sequence editor ESEE. Gene trees were constructed in PHYLIP and MEGA using both maximum parsimony and neighbor-joining methods. For parsimony analysis, all characters were treated as unordered and with equal weights. At least 3,000 cycles of bootstrapping were carried out. For analysis in MEGA, all gap columns were deleted. The third position of codon was included., Results: The nucleotide and amino acid sequences of CO1 and ND1 of S. sinensium were obtained., Conclusion: The phylogenetic trees from these molecular data suggested that S. sinensium belongs to the Asian schistosome group, and the results coincided with the previous rDNA (ITS2 & LSU) analysis results.

Objective: To determine the phylogenetic relationships between Schistosoma sinensium and other Schistosomatid species using DNA sequence data. Two segments of the nuclear rDNA repeat, the second internal spacer (ITS2) and large subunit (LSU/12S) were selected for sequencing., Methods: Adult worms stored in 100% methanol were washed 3 times with 0.1 x TE (pH8.0) and the genomic DNA was extracted by the GNT-K method. The target regions were amplified by PCR using specific primers. The PCR products were purified before ligation into the plasmid pT-adv (Clontech). Recombinant plasmids were amplified in E. coli (strain TOP10), extracted and purified using routine methods and then sequenced using M13 primers (F/R) on a Licor long-read auto-sequencer. Sequences of related schistosomes were retrieved from GenBank and aligned with our data in the sequence editor ESEE. Gene trees were constructed in PHYLIP (Version 3.6 alpha July, 2,000) and MEGA (version 2.0 beta build 3) using both Maximum Parsimony and Neighbor-Joining methods. For parsimony analysis, all characters were treated as unordered and with equal weights. At least 3,000 cycles of bootstrapping were carried out. For analysis in MEGA, all gap columns were deleted. Schistosomatium douthitti and Trichobilharzia were used as outgroups., Results: The ITS2 and LSU sequences of Schistosoma sinensium were obtained. The ITS2 sequence of Trichobilharzia sp. was reported here for the first time., Conclusion: The phylogenetic trees from these data of nuclear rDNA suggested that S. sinensium belongs to the Asian schistosome group. And this species might be an ancient member in the Asian clade.

Diagnostic ultrasound has been used in China since the early 1960's in the investigation of Schistosoma japonicum infection. This paper presents an overview of selected papers from the Chinese literature on the use of ultrasound in studies of schistosomiasis japonica, and briefly reports the results of studies not yet published elsewhere. The method is compared with other diagnostic procedures, and the benefits and limitations of using ultrasound are discussed.