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Objective To investigate the independent risk factors for acute severe cholangitis and related protective factors, and to construct a risk prediction scoring model for acute severe cholangitis. Methods A retrospective analysis was performed for the clinical data of 381 patients with acute cholangitis who were admitted to Department of Hepatobiliary Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, from January 2016 to July 2021, among whom there were 273 patients with non-severe cholangitis and 108 patients with severe cholangitis. Univariate and multivariate logistic regression analyses were used to screen out the independent risk factors for acute severe cholangitis and related protective factors, and then a logistic regression model was established. The receiver operating characteristic (ROC) curve was used to evaluate the discriminatory ability of the model, the calibration curve was used to evaluate the prediction accuracy of the model, and decision curve analysis (DCA) was used to evaluate the clinical value of the model. Moreover, the enhanced Bootstrap method was used to perform internal validation of the model and evaluate the performance of the model in internal validation. The model was visualized by the construction of Web calculator, nomogram, and scoring system. The two-independent-samples t test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups. Results The univariate and multivariate logistic regression analyses showed that total bilirubin (TBil) (odds ratio [ OR ]=1.014, 95% confidence interval [ CI ]: 1.009-1.020, P < 0.001), percentage of neutrophils ( OR =1.128, 95% CI : 1.088-1.175, P < 0.001), and age ( OR =1.053, 95% CI : 1.027-1.082, P < 0.001) were independent risk factors, and albumin (Alb) ( OR =0.871, 95% CI : 0.817-0.924, P < 0.001) was a protective factor. The above independent risk factors and protective factor were included in the logistic regression analysis for model fitting, and the predictive model obtained had an area under the ROC curve (AUC) of 0.925 (95% CI : 0.897-0.952), with a specificity of 0.817 and a sensitivity of 0.935 at the optimal cut-off value of 0.245. The calibration curve showed that the predicted probability of the model was approximately equal to the actual probability, with a Brier value of 0.098, and the decision curve analysis showed that the model had a higher net income within the threshold probability interval of 0.1-0.9. Internal validation showed an AUC internal validation of 0.915 and a Brier value internal verification of 0.106. Conclusion TBil, percentage of neutrophils, and age are independent risk factors for acute severe cholangitis, while Alb is a protective factor. The established risk prediction scoring model has good discriminatory ability, calibration, and clinical value and can identify patients with acute severe cholangitis at an early stage, which provides a reference for subsequent diagnosis and treatment.
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Objective:To evaluate radiofrequency ablation-assisted liver resection on early recurrence of hepatocellular carcinoma(HCC) with microvascular invasion (MVI).Methods:A total of 82 HCC patients from Jun 2015 to Jun 2020 were divided into assisted group ( n=41) and control group ( n=41) after local hepatectomy.And by pathology,both groups were further substratified into with or without MVI subgroups. Results:There was no statistically significant difference in the baseline data between two groups,nor there was difference in recurrence-free survival rate between the two groups ( χ 2=0.177, P=0.674). However, by subgroup analysis, the recurrence-free survival rate of ablation assisted group was higher than that of the simple local hepatectomy group among MVI positive patients ( χ 2=5.096, P = 0.024).Multivariate analysis showed that only tumor diameter ( HR=1.32, 95% CI: 1.02-1.72, P=0.036) was an independent risk factor for local recurrence at the incisal margin, while mode of operation ( HR=0.15 ,95% CI: 0.04-0.52 ,P=0.003) and MVI ( HR=8.65 ,95% CI: 2.19-34.19 ,P=0.002) were independent risk factors for intrahepatic distant metastasis. Conclusion:Local hepatectomy assisted by intraoperative radiofrequency ablation on hepatic cross section could effectively reduce the postoperative early recurrence rate for hepatocellular carcinoma patients with MVI.
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Objective To understand the epidemiological characteristics of patients with advanced schistosomiasis in Hunan Province,so as to provide the evidence for formulating the advanced schistosomiasis prevention strategies and measures. Meth-ods The data of advanced schistosomiasis patients were collected and analyzed retrospectively with the cross section research method and description method in Hunan Province,2012. Results There were 5 722 advanced schistosomiasis patients in Hu-nan Province,and among them,4 112 patients were male(71.86%),and 1 610 were female(28.14%). Totally 5 311 patients came from the schistosomiasis endemic areas(92.82%)and 411 patients from non-schistosomiasis endemic areas(7.18%). The prevalence rate of advanced schistosomiasis was 8.46/10 000. The mean age of advanced schistosomiasis patients was 60.30 ± 11.63 years,and the youngest was 17 years old and the oldest 92 years old. In the age composition of advanced schistosomiasis pa-tients,the greatest number of cases was in the 60-70 years age group (32.72%). There were 3 595 cases of ascites type (62.83%),2107 cases of splenomegaly type(36.82%),11 cases of dwarf type(0.16%),and 11 cases of colon proliferation type (0.35%). Conclusion The prevalence rate of advanced schistosomiasis is relatively stable in Hunan Province,and the age of the patients showed an old aging trend. The salvation of advanced schistosomiasis patients in non-endemic areas should be strength-ened.
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According to the requirement of the national assessment for achieving the infection control criteria, 42 villages (among them,25 villages belonged to the first stratum, and 17 villages belonged to the second stratum) in 14 counties from 5 provinces, including Hunnan, Hubei, Jiangxi, Anhui and Yunnan, were selected as sampling villages for the assessment.The results from the field assessment showed that 154 out of 9 067 people were found infected with Sckistosoma japonicum, with an average infection rate of 1.7% ranged from 0.31 % to 4.10% , and only Yongping Village from Weishan County and Tenglong Village from Eryuan County were not found any case. A total of 46 out of 3 323 head of cattle were infected with S. japonicum, with an average infection rate of 1.38% ranged from 0.26% to 3.79% , and no any infected individual detected in Nanling County. No outbreak occurred in those sampling villages. Therefore, it is indicated that the five sampling provinces have reached the national criteria on infection control of schistosomiasis.
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Although identification of water contact patterns is one of the most important factors for the prevention of <I>Schistosoma japonicum</I> infection, it is still insufficient for clarifying specific high-risk behaviors and their implications. Parasitological studies and behavioral observations were carried out in a rural village, the Dongting Lake region, China. A time-allocation study conducted by a time-saving spot-check method was implemented to quantify the behavioral risks. Of the 122 participants, 18 (14.8%; 95% confidence interval: 8.5, 21.0) were positive for S. japonicum. Among those diagnosed, the median (25−75% quartile) eggs per gram was 8 (8−16). A significant positive correlation with worm intensity was found among people who repair ships on the marshland (p&It;0.001), and this potential risk was consistent with previous suggestions. Although the parasitological techniques and study design require further improvements, our observational methods may be of use to explicitly identify behaviors at the local level that could be relevant to prevention.
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Objective To evaluate the therapeutic effect of spironolactone on schistosomal pulmonary arterial hypertension(SPAH). Methods A total of 62 patients suffered from hepatosplenic schistosomiasis with pulmonary arterial hypertension were divided into the spironolactone group(n=31) and control group (n=31). All the patients underwent serial echocardiography and the clinical effect before and after the treatment was evaluated by assessing the mean pulmonary arterial pressure (mPAP) and pulmonary arterial diameter (PAD). At the same time, the varieties of the clinical symptoms, signs and the distance of the 6-minute walking test (6-MWT) were investigated. Results In spironolactone group, mPAP(-x±s) decreased from (31.8±7.1) mmHg to (21.2±2.1) mmHg, PAD(-x±s) decreased from (28.0±5.0) mm to (20.0±3.5) mm before and after the treatment respectively(P<0.01). There were significant differences in mPAP, PAD, the distance of 6-MWT and the heart function before and after the treatment in the spironolactone group. However, the data did not show the significant difference in the control group. Conclusion The therapeutic effect of spironolactone in the treatment of SPAH is satisfactory.
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A cross-sectional case-control study on the association between the reduced work ability and S. japonicum infection was carried out in a moderate endemic area for schistosomiasis japonica in the southern part of Dongting lake in China. A total of 120 cases with reduced work ability and 240 controls paired to the case by age, sex, occupation and without reduced work ability, participated in the study. The mean age for individuals was 37.6 years old (21-60), the ratio of male:female was 60:40, the prevalence of S. japonicum in the individuals was 28.3. The results obtained in this study showed that the infection of S. japonicum in case and control groups was 49.2 (59/120) and 17.9 (43/240), respectively. Odds ratio for reduced work ability among those who had schistosomiasis was 4.34 (95), confidence interval was 2.58-7.34, and among those who had S. japonicum infection (egg per gram > 100) was up to 12.67 (95), confidence interval was 3.64-46.39. After odds ratio was adjusted by multiple logistic regression, it was confirmed that heavier intensity of S. japonicum infection and splenomegaly due to S. japonicum infection were the main risk factors for reduced work ability in the population studied.
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Humans , Male , Female , Adult , Middle Aged , Schistosomiasis japonica/epidemiology , Work Capacity Evaluation , China , Cross-Sectional Studies , Multivariate Analysis , Risk Factors , SplenomegalyABSTRACT
Objective To analyze the current endemic situation of schistosomiasis and evaluate the control effects of the implementation of comprehensive management measures for 4 years,so as to provide references for making control strategy in the next stage. Methods The endemic villages were grouped into categories based on egg positive rates of fecal examinations among villagers. Praziquantel chemotherapy regimens were provided for villagers and domestic animals,respectively. Snail control on the basis of niclosamide was conducted in snail habitat areas in the hilly area and inside embankment in Dongting Lake,and in infected snail distributed areas outside the embankment in the lake. A slow releasing formation of niclosamide were applied for cercariae killing in transmission areas outside the embankment in the lake in the flood season. The modification of snail habitat areas was integrated into the water conservancy and agricultural development projects. The varied health education,safe water supply and disinfestation toilet facilities were provided for residents in the community. Results The infection rate of schistosomiasis in residents dropped by 49.88%,and the estimated patients reduced by 39.62%. Acute schistosomiasis cases significantly decreased. The total number of advanced schistosomiasis cases slightly increased. The infection rate of schistosomiasis in livestock dropped by 66.36% and snail areas reduced by 33.31% as well as no infected snails were found inside the embankment. Yet,the total areas of snail habitats and distributed areas of infected snails slightly increased,with a high density. The first scale of villages and the second scale of villages were lowered into the third or fourth scale of villages. Out of 31 endemic counties (districts,farms),7 reached the criteria of transmission control,24 reached the criteria of infection control. Conclusions The implementation of the comprehensive management measure has achieved the anticipated results of reducing the infection rate of schistosomiasis among villagers and dropping the incidence of acute schistosomiasis. Yet the snail area on beaches outside the embankment slightly increases,with a high density of infected snails and so there is an infection danger there.
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Objective To understand the morbidity of schistosomiasis japonica and health status of the liver and spleen of residents in a village and to evaluate the application of ultrasound on schistosomiasis epidemiology. Methods A total of 454 residents aged 5-65 years were examined by methods of Kato-Katz and ultrasound as well as disease history inquiry. Results The positive rate was 9.38% by stool examination, with no significant difference between males and females. The intensity of the infection among population was 5.70 eggs per gram of stool (EPG), with significant difference between males and females. The stool positive rate and EPG in farmers and students were the highest. Among 10.66% of the males and 8.10% of the females, as well as in 23.81% of the stool positive and 8.31% of the stool negative, the parenchyma of the liver was abnormal(≥GradeⅡ),with significant difference between males and females and between the stool positive and the stool negative. The abnormal rate of liver parenchyma went up with the age. Conclusion Ultrasound can evaluate the health status of inhabitants with schistosomiasis japonica and improve the compliance rate of residents to praziquantel chemotherapy.
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Objective To observe the effect of artemether in the control of prevalence and acute infection of Schistosoma japonicum in humans in high endemic areas. Methods During the transmission season (May-October), the residents in the pilot village took artemether with a 15- day interval to prevent the infection of S. japonicum. Results By the end of the transmission season, the egg positive rate was 0.83% and no acute case occurred in the artemether group, while 15.01% and 3 acute cases were observed in the placebo group. Conclusions Oral administration of artemether at a 15-day interval shows an effective protection from infection of S. japonicum, with a protection rate of 94.47% in residents of a high endemic area and it also shows marked effect to prevent acute schistosomiasis.
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Objective To understand endemic diversity on schistosomiasis transmission after reserving plain for flooding. Methods In two study pilots, Jicheng and Qingshanhu, epidemiological factors were investigated longitudinally, and the effectiveness of the interventions was evaluated. Results The infection rates of mobile people who engaged in activities in the discarded plain were increased year by year. The density of infected snails was high. The snail habitats increased significantly in Jicheng, but decreased in Qingshanhu. The infection rate and number of livestock pastured in the discarded plain increased. In the discarded plain, most of the mobile people came from the local areas, and main activities for water contact were fishing and pasturing. About 90% of local residents migrated into endemic areas, and the others into non-endemic areas. Conclusions The discarded plains were evolving to a serious transmission zone of schistosomiasis. Interventions combined with agriculture and fisher productions can decrease snail-spreading. Schistosomiasis examination and chemotherapy for the migrants to non-endemic areas are vital.