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Existing chronic kidney disease (CKD) is among the most potent predictors of postoperative acute kidney injury (AKI). Here we quantified this risk in a multicenter, observational study of 9425 patients who survived to hospital discharge after major surgery. CKD was defined as a baseline estimated glomerular filtration rate <45 ml/min per 1.73 m2. AKI was stratified according to the maximum simplified RIFLE classification at hospitalization and unresolved AKI defined as a persistent increase in serum creatinine of more than half above the baseline or the need for dialysis at discharge. A Cox proportional hazard model showed that patients with AKI-on-CKD during hospitalization had significantly worse long-term survival over a median follow-up of 4.8 years (hazard ratio, 3.3) than patients with AKI but without CKD. The incidence of long-term dialysis was 22.4 and 0.17 per 100 person-years among patients with and without existing CKD, respectively. The adjusted hazard ratio for long-term dialysis in patients with AKI-on-CKD was 19.8 compared to patients who developed AKI without existing CKD. Furthermore, AKI-on-CKD but without kidney recovery at discharge had a worse outcome (hazard ratios of 4.6 and 213, respectively) for mortality and long-term dialysis as compared to patients without CKD or AKI. Thus, in a large cohort of postoperative patients who developed AKI, those with existing CKD were at higher risk for long-term mortality and dialysis after hospital discharge than those without. These outcomes were significantly worse in those with unresolved AKI at discharge. [ABSTRACT FROM AUTHOR]

Objective: To understand the Oncomelania hupensis distribution and infection status in the schistosomiasis surveillance sites of Yunnan Province, so as to provide the evidence for making the control and prevention measures., Methods: Eighteen administrative villages were selected as the surveillance sites where the schistosomiasis endemic was serious in 18 epidemic counties, one village for one county. The snail status was investigated with the systematic sampling and environmental sampling methods, and the infection status of the snails was detected by a microscope and loop-mediated isothermal amplification (LAMP). The surveillance database was established and descriptively analyzed., Results: In 2015, the total surveillance area was 1826.55 hm², and the area with snails was 55.03 hm², that was reduced by 57.70% as compared to that in 2013, and by 40.63% as compared to that in 2014. No new snail area was discovered, and also no schistosome infected snails were discovered. Totally 718,532 frames were surveyed, and the occurrence rate of frames with snails was 0.45% and the density of living snails was 0.013 9 snail/0.1 m². In the endemic controlled areas, the snail area and density of living snails were both the highest. The snails concentrated on the environments of paddy field, ditch, bottomland, small reservoir, and dry land, and the vegetations of rice, dry crop, weed and wood. The snail area, occurrence rate of frames with snails, total number of snails and number of living snails all showed a downward trend. No infected snails were found for three years., Conclusions: The Oncomelania hupensis snails have been effectively controlled in the national schistosomiasis surveillance sites of Yunnan Province. However, the comprehensive snail control measures still should be continually strengthened in order to consolidate the achivements.

Objective: To evaluate the current prevalence situation of schistosomiasis in Yunnan Province, so as to provide the evidence for making further control strategy., Methods: The data of schistosomiasis were collected and analyzed statistically in Yunnan Province in 2014., Results: There were 7 transmission controlled counties and 11 interrupted counties in Yunnan Province in 2014, and Oncomelania hupensis snails were not found in 5 of the 11 interrupted counties for at least 5 years. In the transmission controlled areas, the schistosomiasis endemic villages, population, farm cattle, and snail areas accounted for 80.94%, 83.72%, 79.32% and 82.00% of whole schistosomiasis endemic areas in Yunnan Province, respectively. The infection source was not completely eliminated., Conclusion: In the transmission controlled areas, the elimination of infection source should still be strengthened; in the transmission interrupted areas, the import infection sources should be prevented.

Objectives: To evaluate the effect of comprehensive schistosomiasis control project in Yunnan Province after its implementation for ten years, so as to provide the evidence for formulating the future prevention and control strategy., Methods: The data of the schistosomiasis comprehensive control project and the endemic situation were collected and analyzed to evaluate the control effect of the project in Yunnan Province from 2004 to 2013., Results: After the comprehensive control project implementation for ten years, the Oncomelania hupensis snail area in Yunnan Province decreased from 4,364.79 hm2 in 2004 to 1,528.50 hm2 in 2013, with a reduction rate of 64.98%, and the occurrence rate of frames with snails and the density of living snails decreased from 4.71% and 0.26 snails/0.1 m2 in 2004 to 1.35% and 0.04 snails/0.1 m2 in 2013, with the reduction rates of 71.34% and 84.62%, respectively. The schistosome infected snails were found only in 2011 and 2013 since 2008. In 2013, the infection rates of human (0.0021%) and cattle (0.0209%) decreased by 99.84% and 99.44%, respectively, compared to those in 2004, and no acute schistosome infection cases were found since 2008. The 212 villages with relatively serious endemic situation (Type One, Type Two and Type Three) all declined to the slight endemic villages (Type Four and Type Five), therefore, they reached the criteria of schistosomiasis transmission controlled or interrupted. The awareness rates of schistosomiasis control among villagers and students in endemic areas were above 90% and 98%, respectively., Conclusion: The effect of the comprehensive schistosomiasis control project is significant in Yunnan Province, but the task to consolidate and enlarge the control results still remains a challenge.

Objective: To evaluate the molluscicidal effect of 5% powder of niclosamide ethanolamine salt granules (NEG) in the field of mountainous areas in Yunnan Province., Methods: The grasslands with Oncomelania hupensis snail habitats were chosen in Beideng Village, Heqing County, Yunnan Province, and were divided into 7 groups (groups of NEG 30 g/m2, NEG 40 g/m2, NEG 50 g/m2, NEG 40 g/m2 plus obstacle clearing, 50% niclosamide ethanolamine salt wettable powder (WPN) 6 g/m2, WPN 6 g/m2 plus obstacle clearing, and fresh water). The snail death rates and the densities of living snails were investigated and the results were compared in the different groups 7 d, 15 d, and 30 d after the implementation., Results: Seven d, 15 d, and 30 d after the implementation, the snail death rates of the groups of NEG 30 g/m2, 40 g/m2, and 50 g/m2 were from 72.75 % to 95.83%, and the average descent rates of living snail densities were from 72.26% to 95.54%. Seven d, 15 d, and 30 d after the implementation, in the NEG 40 g/m2 group, the snail death rates were from 81.69% to 87.19%, and the average descent rates of living snail densities were from 81.42% to 87.91% ; in the NEG 40 g/m2 plus obstacle clearing group, the snail death rates were from 84.89% to 88.24% and the average descent rates of living snail densities were from 85.63% ~ 88.22%; in the WPN 6 g/m2 group, the snail death rates were from 85.23% to 86.17% and the average descent rates of living snail densities were from 85.76% to 86.05%; in the WPN 6 g/m2 plus obstacle clearing group, the snail death rates were from 88.89% to 92.10% and the average descent rates of living snail densities were from 86.71% to 92.20%. The obstacle clearing improved the molluscicidal effect., Conclusion: NEG has a good molluscicidal effect in the field of mountainous areas in Yunnan Province.

Objective: To establish and perfect the surveillance and forecast system of schistosomiasis, and timely discover the suspicious high risk environments for preventing the human and livestock from schistosomiasis., Methods: Eight villages of three counties were selected as survey points. Then, the surveillance and forecast of sentinel mice were carried out in the key water regions. The recovered sentinel mice were dissected in laboratory. The sentinel mouse serum antibodies against schistosome were detected by ELISA, the suspicious water contacts of residents and livestock were investigated and the results were analyzed, and the epidemic risk was assessed., Results: Totally 300 sentinel mice were placed, the recovery rate was 94.67%, and the mortality rate was 8.80%. There were no mice with positive serum antibodies against schistosome, and the results of the dissection of all the sentinel mice were negative. The humans who contacted with the suspicious water were mainly villagers, students, children and fishermen by washing hands and feet, washing vegetables, harvesting, fishing and swimming. The Oncomelania hupensis snail areas, human infection rates, and cattle infection rates were obviously declined in recent 3 years. However, the epidemic risks still existed., Conclusion: Although schistosomiasis transmission was effectively controlled in the three counties, the comprehensive control measures still should be strengthened.

Objective: To evaluate the effect of schistosomiasis control in Yunnan Province since achieving the transmission control standards, so as to provide the evidence for formulating the next prevention and control strategy., Methods: The schistosomiasis epidemic monitoring reports, annual reports, relevant information about Oncomrnelania hupensis snails, and schistosomiasis patient conditions were collected and analyzed for epidemic condition and characteristics of schistosomiasis in Yunnan Province from 2009 to 2012., Results: The various epidemic monitoring indicators all decreased. In 2012, compared with 2009, the prevalence reduced by 33.33% after correction; the number of villages with schistosomiasis patients reduced by 55.56%; the adjusted positive rate of livestock stool tests reduced by 45.45%; the number of villages with infected cow reduced by 42.25%; the actual area with snails reduced by 13.58%; the density of living snails reduced by 25.66%, and no schistosome infected snails were found in 2012., Conclusion: There still exist schistosome infections in human and animals in some local areas of Yunnan Province, and it is difficult to achieve the standard of schistosomiasis transmission interrupted in a short period.

Objective: To understand the types of schisotsome infection sources and their roles in schistosomiasis transmission in mountainous endemic regions in Yunnan Province, so as to provide the evidence for implementing the comprehensive control measures based on infection source control., Methods: Two villages of typical mountainous regions in Nanjian County were chosen for field investigation. The Oncomelania hupensis snail status was surveyed by the methods of systematic and environmental sampling. The infections of schistosomiasis were surveyed in residents with the indirect haemagglutination and the hatching method, in livestock with the hatching method and in wild animals with the anatomical method and the hatching method. The distribution and pollution status of wild faeces were investigated in the snail environments nearby villages or with livestock frequent activities. The positives of schistosomiasis in wild faeces were tested with the hatching method. The pollution index of wild feces was calculated., Results: A total of 533.56 hm2 were investigated in two villages, and the area with snails was 16.52 hm2. The rate of frame with snails was 1.03%, the average density of snails was 0.07 snails/0.1 m2, and no positive snails were found. The positive rate of blood examinations of population was 1.61%, but no persons were positive with the hatching method. The infection rates were 0.90%, and 0.62% in cattle and equus, respectively, and there were no positives in other livestock. Totally 472 piles of wild feces of 6 species (human, cattle, equus, goat, pig and dog) distributed in the investigation areas, and among them, the densities of wild feces of cattle, equus, and dog were 7.2, 4.3 piles/hm2, and 2.1 piles/hm2 respectively, being relatively higher than others. The hatching positive rates of wild faeces of cattle, equus, and dog were 2.27% (3/132), 2.63% (2/76), and 3.70% (1/27), respectively. The relative pollution indexes of wild faeces of cattle, equus, and dog were 80.68%, 15.89%, and 3.43%, respectively., Conclusions: After schistosomiasis transmission is controlled, the potential epidemic factors still remain in the mountainous endemic regions of schistosomiasis in Yunnan Province. The cattle are still the most infection source of schistosomiasis, but equus and dog as infection sources should be not neglected. We should extend the investigation and monitor scope of the infection sources, and carry out scientific and feasible control technique and management measures.

The molluscicidal effects of 10% salt of quinoid- 2' ,5-dichloro-4'-nitrosalicylanilide (LDS) with dusting method, 26% amine molluscicide (MNSC) and 50% niclosamide (WPN) with insufflation method were tested in the fields of mountainous areas of Yunnan Province. After 7, 15 and 30 days of the tests, the death rates of snails, decline rates of living snail densities, and occurrence rates of frames with living snails of the 10% LDS group were 72.69%-87.16%, 74.10%-88.84%, and 20.00%-30.00%, respectively; those of the 26% MNSC group were 66.21%-91.06%, 69.55%-91.36%, and 19.44%-27.78% respectively; those of the 50% WPN group were 78.10%-90.18%, 82.44%-91.60%, 17.50%-20.00%, respectively. The results showed that the molluscicidal effects of 10% LDS, 26% MNSC and 50% WPN were basically equal.

Objective: To evaluate the molluscicidal effect of 26% suspension concentrate of metaldehyde and niclosamide (MNSC) in the fields of mountainous areas in Yunnan Province., Methods: Some representative Oncomelania snail environments of schistosomiasis endemic regions were selected as study areas in Heqing County, Yunnan Province and 26% MNSC and 50% wettable powder of niclosamide ethanolamine salt (WPN) were used to kill the snails with the mechanical spraying and sprinkler spraying methods respectively., Results: Seven, 15, 30 days after the spraying with the mechanical spraying method, in corn fields, the snail mortality rates were from 88.68% to 92.88% in the MNSC group, and from 89.86% to 90.32% in the WPN group respectively, and in the ditch, the snail mortality rates were from 89.97% to 94.46% in the MNSC group and from 90.08% to 96.74% in the WPN group respectively, and there was no significant difference between the 2 groups (P > 0.05); 7, 15, 30 days after the spraying with the sprinkler spraying method, in corn fields, the snail mortality rates were from 66.14% to 89.11% in the MNSC group, and from 78.40% to 91.22% in the WPN group, respectively, in the ditch, the snail mortality rates were from 84.13% to 94.27% in the MNSC group, and from 85.81% to 95.26% in the WPN group respectively, and there was no significant difference between the 2 groups (P > 0.05)., Conclusion: 26% MNSC has good molluscicidal effect in the fields of mountainous areas in Yunnan Province