Plasma D-dimer Can Effectively Predict the Prospective Occurrence of Ascites in Advanced Schistosomiasis Japonica Patients

China still has more than 30,000 patients of advanced schistosomiasis while new cases being reported consistently. D-dimer is a fibrin degradation product. As ascites being the dominating symptom in advanced schistosomiasis, the present study aimed to explore a prediction model of ascites with D-dimer and other clinical easy-achievable indicators. A case-control study nested in a prospective cohort was conducted in schistosomiasis-endemic area of southern China. A total of 291 patients of advanced schistosomiasis were first investigated in 2013 and further followed in 2014. Information on clinical history, physical examination, and abdominal ultrasonography, including the symptom of ascites was repeatedly collected. Result showed 44 patients having ascites. Most of the patients' ascites were confined in the kidney area with median area of 20 mm². The level of plasma D-dimer and pertinent liver function indicators were measured at the initial investigation in 2013. Compared with those without ascites, cases with ascites had significantly higher levels of D-dimer (0.71±2.44 μg/L vs 0.48±2.12 μg/L, P=0.005), as well ALB (44.5 vs 46.2, g/L) and Type IV collagen (50.04 vs 44.50 μg/L). Receiver operating characteristic curve analyses indicated a moderate predictive value of D-dimer by its own area under curve (AUC) of 0.64 (95% CI: 0.54–0.73) and the cutoff value as 0.81 μg/L. Dichotomized by the cutoff level, D-dimer along with other categorical variables generated a prediction model with AUC of 0.76 (95% CI: 0.68–0.89). Risks of patients with specific characteristics in the prediction model were summarized. Our study suggests that the plasma D-dimer level is a reliable predictor for incident ascites in advanced schistosomiasis japonica patients.

Study on cut-off value of IHA method for schistosomiasis diagnosis in differ-ent endemic areas / 中国血吸虫病防治杂志

Objective To explore the cut?off value of the indirect haemagglutination test(IHA)method for schistosomiasis japonica diagnosis in different endemic areas. Methods Totally 55 nature villages of the lake?type endemic counties,Yugan and Xinzi,in Poyang Lake Region of Jiangxi Province were chosen as the study fields,and all the villagers over 5 years old were parallelly examined by Kato?Katz method+miracidial hatching test and IHA method. The detection data were analyzed by the correlation analysis,and the threshold values of the IHA method in different endemic areas were decided by the receiver operat?ing characteristic(ROC)curve. Results The positive rate of stool examinations of the villagers was correlated with the distribu?tion trend of the antibody level of whole population(r=0.588,P0.05). The antibody level of stool?negative population during the period of 2008 to 2011 detect?ed by IHA method dropped year by year,and the annual difference was statistically significant(F=3.650,P0.05). When the positive rates were5%,the specificity of diagnosis could be improved when 1∶80,1∶20 and 1∶10 were used as the cut?off val? ues of IHA correspondingly. Conclusion The different threshold values for diagnosis of schistosomiasis japonica should be con?sidered while using IHA method to screen out patients in different endemic areas.

Clinical trials on preventive effect of artesunate against reinfection of Schistosoma japonicum / 中国血吸虫病防治杂志

Objective To assess the preventive effect of artesunate against reinfection of Schistosoma japonicum.Methods Volunteers were divided into 3 groups,Medication Group Ⅰ took artesunate 6 mg/kg ,once a week for 4 weeks,Medication Group Ⅱ took artesunate 6 mg/kg in the 1st and 3rd week,twice a week,and a control group was given a placebo.The 3 teams took praziquantel 40 mg/kg on the 4th weekend.The effects of artesunate in early treatment were observed at the 8th weekend,and the preventive effects of artesunate against reinfection were assessed at the 12th weekend.The positive rate of fecal examination was used as the indicator.Results In the stage of early treatment,the positive rates of fecal examination in Medication Group Ⅰ ,Ⅱdecreased significantly compared with the data before the study with all P values less than 0.05 ;in the stage of preventing reinfection,compared with the data before the study,the positive rates of the fecal examination declined significantly in Medication Group Ⅰ,Ⅱ ,with all P values less than 0.05.While in the control group,the positive rates of the fecal examination had no significant changes in the two stages.Conclusions Artesunate has a valid effect against schistosome infections in the early treatment and can prevent residents from reinfection,and the suitable dosage is 6 mg/kg,once a week for 4 weeks.

Analysis of epidemical pattern of schistosomiasis in Poyang Lake areas from 1960 to 2007 / 中国血吸虫病防治杂志

Objective To explore the epidemical pattern of acute schistosomiasis in Poyang Lake area so as to provide the scientific evidence for control-strategy-making. Methods The data of acute schistosomiasis in 12 counties along Poyang Lake from 1960 to 2007, including the data of 2 special investigations from 1982 to 1984 and from 1987 to 1989 were collected and analyzed with the retrospective investigation methods. Results There were 29 864 cases of acute schistosomiasis in 12 counties of Poyang Lake area from 1960 to 2007, accounting for 85.5% of the total acute schistosomiasis cases of Jiangxi Province. The largest number of cases existed in Yugan County, accounting for 18. 7%. The peak of acute schistosomiasis prevalence was in 1987 with 2 088 cases. However, the case of acute schistosomiasis declined significantly, keeping at a low level, since 1990. During the 2 special investigations, the people whose age were lower than 30 years old, were the susceptible populations of acute schistosomiasis (86. 1% and 82. 9% , respectively) , most of them were peasants and students, and the infection rates were 57. 4% and 21.2%, 61.7% and 21. 8%, respectively. Fishing and swimming were the main infection ways, with the infection rates of 43.0% and 44.9% , respectively. The peak season of infection was from April to October. Conclusions The river bank and continent of Poyang Lake are the main infection areas, the spring and autumn are the main epidemic seasons and the susceptible populations are the peasants, fishmen and young students. It is very important to enhance the comprehensive prevention and treatment measures in the key areas and population for schistosomiasis control.