关节镜下关节外操作治疗顽固性网球肘

目的探究关节镜下关节外操作治疗顽固性网球肘的临床疗效。方法 2015年9月-2017年11月连续收治顽固性网球肘患者21例(21例肘)。其中,男8例,女13例,手术时患者年龄33~62岁,平均43岁;保守治疗时间为7~41个月,平均15.0个月。21例顽固性网球肘均采用关节镜下关节外操作手术治疗。结果 21例患者均获随访,随访时间6~26个月,平均17.3个月,无感染和神经损伤等严重并发症。21例在视觉模拟评分(VAS)、Mayo肘关节功能评分(MEPS)及外上髁压痛点压痛程度等方面术前术后有明显差异;19例对治疗结果非常满意,2例对治疗结果满意,无不满意病例。结论关节镜下关节外操作治疗顽固性网球肘,手术方式直观、安全,临床效果满意。

A multidisciplinary,integrated approach for the elimination of schistosomiasis:a longitudinal study in a historically hyperendemic region in the lower reaches of the Yangtze River,China from 2005 to 2014

Background:Although great success has been achieved,schistosomiasis remains a major public health concern in China,and the remaining core endemic regions are concentrated along the middle and lower reaches of the Yangtze River.In this longitudinal study,we evaluated the effectiveness of a multidisciplinary,integrated approach for schistosomiasis elimination in a historically hyper-endemic region in the lower reaches of the Yangtze River,China over the 10-year period from 2005 through 2014.Methods:A three-step roadmap for schistosomiasis elimination was designed in the study site,and multidisciplinary,integrated interventions were implemented by the health,agriculture,water resources development,land and resources,and forestry sectors from 2005 to 2014,including chemotherapy for infected individuals,health education,management of the source of Schistosoma japonicum infection,and intermediate host snail control.The annual number of schistosomiasis patients,S.japonicum infection in humans,bovines and Oncomelania hupensis snails,and water infectivity were observed to assess the effectiveness of the multidisciplinary,integrated approach for the elimination of schistosomiasis.Results:There was a tendency towards a gradual decline in both the number of schistosomiasis cases and the prevalence of S.japonicum human infection across the study period from 2005 through 2014.No S.japonicum human infection was detected since 2012,and no acute infection was seen since 2006.During the study period,no infection was found in bovines,and a 0.03%overall infection rate was observed in O.hupensis snails.Since 2009,no infected snails were identified,and the area of both snail habitats and infected snail habitats appeared a reduction over the study period.Following the 3-year multidisciplinary,integrated control,infection control was achieved,and transmission control was achieved after 6-year implementation,with all infected snails and water infectivity eliminated;in addition,the 10-year implementation resulted in interruption of schistosomiasis transmission in the study site in 2014.Conclusions:The results of the present 10-year longitudinal study demonstrate that the multidisciplinary,integrated approach is effective for the elimination of schistosomiasis as a public health problem in the lower reaches of the Yangtze River,China.

An integrated environmental improvement of marshlands:impact on control and elimination of schistosomiasis in marshland regions along the Yangtze River,China

Background:Schistosomiasis is a global snail-transmitted infectious disease of poverty.Transmission control had been achieved in China in 2015 after the control efforts for over 60 years.Currently,the remaining core regions endemic for Schistosoma japonicum are mainly located in the marshland and lake regions along the Yangtze River basin.Methods:During the period from 2001 through 2015,an integrated environmental improvement of the marshlands was carried out through the implementation of industrial,agricultural and resources development projects in Yizheng County along the Yangtze River.S.japonicum infection in humans,livestock and snails was estimated by serology,stool examination,hatching technique and microscopy during the 15-year study period to evaluate the effect of the integrated environmental improvement on control and elimination of schistosomiasis.Results:A 0.05%overall rate of S.japonicum infection was observed in snails during the 15-year study period,and no infected snails were detected since 2012.The overall prevalence of S.japonicum infection was 0.09%in humans during the study period,and no human infection was found since 2012.In addition,only 13 bovines were identified with S.japonicum infection in 2003 during the 15-year study period,and since 2004,no infection was found in livestock.Conclusion:The results of the present study demonstrate that the implementation of industrial,agricultural and water resources development projects,not only alters snail habitats in marshland regions,and promotes local economic development,which appears a win-to-win strategy to block the transmission of S.japonicum and accelerate socio-economic development along the Yangtze River.

Progress towards dog-mediated rabies elimination in PR China:a scoping review

Background Rabies continues to be a serious threat to global public health endangering people’s health and public health safety.In the People’s Republic of China,multi-sectoral and comprehensive prevention and control strategies have aimed to extensively curb human rabies transmission.Here,we examine the current state of rabies infection in China,explore strategic interventions put in place in response to WHO’s ambition of“Zero rabies deaths by 2030”and critically assess the constraints and feasibility of dog-mediated rabies elimination in China.Methods This study analyzed and evaluated the process towards dog-mediated rabies elimination in China from five perspectives:namely,human,dog,policy,challenge,and prospects.Evidence-based data on progress of dog-mediated rabies elimination in China was derived from a number of sources;a literature search was undertaken using PubMed,Web of Science and CNKI databases,distribution data for human rabies cases as derived from the Data-center of the China Public Health Science and policy and document data were obtained from official websites of the relevant China ministries and commissions.Results The incidence of human rabies cases in China have shown a downward trend year-on-year since 2007.Implementation of a government-led,multi-sectoral“One Health”approach to combating rabies has driven down the total number of rabies deaths nationwide to around 200 in 2020.The number of provincial-level administrative divisions(PLADs)reporting human cases of rabies has also decreased to 21 in 2020,13 of which reported less than 10 cases.Furthermore,the number of outpatient visits seeking rabies post-exposure prophylaxis has risen dramatically over the past two decades,with demand being 15 times higher than it was initially.There remain however,significant gaps in rabies elimination outcomes across the different regions of China.To date the target of achieving a canine rabies vaccination rate of>75%has not been met.The challenges of rabies immunization of dogs and dog management in underdeveloped cities and rural areas need to be addressed together with more effective animal surveillance and rabies risk from and too wildlife and livestock.Conclusions The Chinese government-led,multi-sectoral“One Health”approach to combating rabies and has made significant progress over the past decade.Development and adoption of more cost-effective One Health strategies can achieve more nationally beneficial rabies elimination outcomes.The ambitious target of“Zero rabies deaths by 2030”can be met through establishment of long-lasting herd immunity in dogs by means of dog mass vaccination campaigns,dog population management,epidemiological surveillance and the application of large-scale oral rabies vaccine to eliminate rabies in wild animals coupled with deployment of cost-effective human post-exposure prophylaxis,and community education.

The global epidemiology of clonorchiasis and its relation with cholangiocarcinoma

This paper reviews the epidemiological status and characteristics of clonorchiasis at global level and the etiological relationship between Clonorchis sinensis infection and cholangiocarcinoma(CCA).A conservative estimation was made that 15 million people were infected in the world in 2004,of which over 85%distributed in China.The epidemiology of clonorchiasis is characterized by rising trend in its prevalence,variability among sexes and age,as well as endemicity in different regions.More data indicate that C.sinensis infection is carcinogenic to human,and it is predicted that nearly 5000 CCA cases attributed to C.sinensis infection may occur annually in the world decades later,with its overall odds ratio of 4.47.Clonorchiasis is becoming one major public health problem in east Asia,and it is worthwhile to carry out further epidemiological studies.

Knowledge of, attitudes towards, and practice relating to schistosomiasis in two subtypes of a mountainous region of the People’s Republic of China

Background:Schistosomiasis japonica is still endemic in the People’s Republic of China(P.R.China)in five provinces of lake and marshland regions and in two provinces of mountainous regions.Studies elucidated that individual and community perception,attitudes towards schistosomiasis,and hygiene behaviors were crucial factors for preventing schistosomiasis.This study sought to assess the knowledge of,attitudes towards,and practices(KAP)relating to schistosomiasis in two subtypes of a mountainous region in Eryuan County,Yunnan Province,P.R.China.The study’s aim is to make suggestions for establishing more specific and effective control measures for disease transmission and interruption in two subtypes of a mountainous region with low-level infection rates.Methods:A cross-sectional study of 3,000 inhabitants was carried out in the Yongle(plateau basin)and Xinzhuang(plateau canyon)communities of Eryuan County,Yunnan Province in November and December 2011.Stratified cluster random sampling was undertaken using a uniform set of quantitative questionnaires administered by trained assistants.This was further supported with qualitative data from in-depth interviews(IDIs)conducted with ten farmers and ten students.All participants were examined for schistosomiasis using both a serological test(indirect hemagglutination assay[IHA])and a stool examination(Kato-Katz).Results:The total schistosomiasis knowledge rate in Yongle(83.4%)was significantly lower than that in Xinzhuang(95.5%).In both communities,among the respondents aged 15 years or below,more than one third didn’t know the name,endemic areas,and animal reservoirs of schistosomiasis.The majority of respondents in Eryuan acquired their schistosomiasis knowledge from doctors,followed by handouts and hearing from others.The infection rate was once the highest in Yongle,but is now the highest in Xinzhuang,where there are more risk factors for schistosomiasis,such as frequently grazing cattle,digging vegetables or cutting grass in the field,as well as raising cattle by free grazing.Conclusion:In short,Eryuan County’s overall knowledge rate of schistosomiasis was found to be high.Due to various dominating risk factors,different control strategies should be designed keeping in mind the two different subtypes of endemic areas for schistosomiasis in mountainous regions,namely plateau basins and plateau canyons.

Inferring the potential risks of H7N9 infection by spatiotemporally characterizing bird migration and poultry distribution in eastern China

Background:In view of the rapid geographic spread and the increasing number of confirmed cases of novel influenza A(H7N9)virus infections in eastern China,we developed a diffusion model to spatiotemporally characterize the impacts of bird migration and poultry distribution on the geographic spread of H7N9 infection.Methods:Three types of infection risks were estimated for 12 weeks,from February 4 to April 28,2013,including(i)the risk caused by bird migration,(ii)the risk caused by poultry distribution,and(iii)the integrated risk caused by both bird migration and poultry distribution.To achieve this,we first developed a method for estimating the likelihood of bird migration based on available environmental and meteorological data.Then,we adopted a computational mobility model to estimate poultry distribution based on annual poultry production and consumption of each province/municipality.Finally,the spatiotemporal risk maps were created based on the integrated impacts of both bird migration and poultry distribution.Results:In the study of risk estimation caused by bird migration,the likelihood matrix was estimated based on the 7-day temperature,from February 4 to April 28,2013.It was found the estimated migrant birds mainly appear in the southeastern provinces of Zhejiang,Shanghai and Jiangsu during Weeks 1 to 4,and Week 6,followed by appearing in central eastern provinces of Shandong,Hebei,Beijing,and Tianjin during Weeks 7 to 9,and finally in northeastern provinces of Liaoning,Jilin,and Heilongjiang during Weeks 10 to 12.In the study of risk caused by poultry distribution,poultry distribution matrix was created to show the probability of poultry distribution.In spite of the fact that the majority of the initial infections were reported in Shanghai and Jiangsu,the relative risk of H7N9 infection estimated based on the poultry distribution model predicted that Jiangsu may have a slightly higher likelihood of H7N9 infection than those in Zhejiang and Shanghai,if we only take the probability of poultry distribution into consideration.In the study of integrated risk caused by both bird migration and poultry distribution,the higher risk in southeastern provinces occurred during the first 8 weeks,and that in central eastern provinces appeared during Weeks 8 to 12,and that in northeastern provinces since Week 12.Therefore,it is necessary to regulate the poultry markets as long as the poultry-to-poultry transmission is not so well understood.Conclusion:With reference to the reported infection cases,the demonstrated risk mapping results will provide guidance in active surveillance and control of human H7N9 infections by taking intensive intervention in poultry markets.

Risk assessment of malaria transmission at the border area of China and Myanmar

Background:In order to achieve the goal of malaria elimination,the Chinese government launched the National Malaria Elimination Programme in 2010.However,as a result of increasing cross-border population movements,the risk of imported malaria cases still exists at the border areas of China,resulting in a potential threat of local transmission.The focus of this paper is to assess the Plasmodium vivax incidences in Tengchong,Yunnan Province,at the border areas of China and Myanmar.Methods:Time series of P.vivax incidences in Tengchong from 2006 to 2010 are collected from the web-based China Information System for Disease Control and Prevention,which are further separated into time series of imported and local cases.First,the seasonal and trend decomposition are performed on time series of imported cases using Loess method.Then,the impact of climatic factors on the local transmission of P.vivax is assessed using both linear regression models(LRM)and generalized additive models(GAM).Specifically,the notion of vectorial capacity(VCAP)is used to estimate the transmission potential of P.vivax at different locations,which is calculated based on temperature and rainfall collected from China Meteorological Administration.Results:Comparing with Ruili County,the seasonal pattern of imported cases in Tengchong is different:Tengchong has only one peak,while Ruili has two peaks during each year.This may be due to the different cross-border behaviors of peoples in two locations.The vectorial capacity together with the imported cases and the average humidity,can well explain the local incidences of P.vivax through both LRM and GAM methods.Moreover,the maximum daily temperature is verified to be more suitable to calculate VCAP than the minimal and average temperature in Tengchong County.Conclusion:To achieve malaria elimination in China,the assessment results in this paper will provide further guidance in active surveillance and control of malaria at the border areas of China and Myanmar.

Risk estimation and prediction of the transmission of coronavirus disease-2019(COVID-19)in the mainland of China excluding Hubei province

Background In December 2019,an outbreak of coronavirus disease(later named as COVID-19)was identified in Wuhan,China and,later on,detected in other parts of China.Our aim is to evaluate the effectiveness of the evolution of interventions and self-protection measures,estimate the risk of partial lifting control measures and predict the epidemic trend of the virus in the mainland of China excluding Hubei province based on the published data and a novel mathematical model.Methods A novel COVID-19 transmission dynamic model incorporating the intervention measures implemented in China is proposed.COVID-19 daily data of the mainland of China excluding Hubei province,including the cumulative confirmed cases,the cumulative deaths,newly confirmed cases and the cumulative recovered cases between 20 January and 3 March 2020,were archived from the National Health Commission of China(NHCC).We parameterize the model by using the Markov Chain Monte Carlo(MCMC)method and estimate the control reproduction number(Rc),as well as the effective daily reproduction ratio-Re(t),of the disease transmission in the mainland of China excluding Hubei province.Results The estimation outcomes indicate that Rc is 3.36(95%CI:3.20–3.64)and Re(t)has dropped below 1 since 31 January 2020,which implies that the containment strategies implemented by the Chinese government in the mainland of China are indeed effective and magnificently suppressed COVID-19 transmission.Moreover,our results show that relieving personal protection too early may lead to a prolonged disease transmission period and more people would be infected,and may even cause a second wave of epidemic or outbreaks.By calculating the effective reproduction ratio,we prove that the contact rate should be kept at least less than 30%of the normal level by April,2020.Conclusions To ensure the pandemic ending rapidly,it is necessary to maintain the current integrated restrict interventions and self-protection measures,including travel restriction,quarantine of entry,contact tracing followed by quarantine and isolation and reduction of contact,like wearing masks,keeping social distance,etc.People should be fully aware of the real-time epidemic situation and keep sufficient personal protection until April.If all the above conditions are met,the outbreak is expected to be ended by April in the mainland of China apart from Hubei province.

Identifying key bird species and geographical hotspots of avian influenza A(H7N9)virus in China

Background:In China since the first human infection of avian influenza A(H7N9)virus was identified in 2013,it has caused serious public health concerns due to its wide spread and high mortality rate.Evidence shows that bird migration plays an essential role in global spread of avian influenza viruses.Accordingly,in this paper,we aim to identify key bird species and geographical hotspots that are relevant to the transmission of avian influenza A(H7N9)virus in China.Methods:We first conducted phylogenetic analysis on 626 viral sequences of avian influenza A(H7N9)virus isolated in chicken,which were collected from the Global Initiative on Sharing All Influenza Data(GISAID),to reveal geographical spread and molecular evolution of the virus in China.Then,we adopted the cross correlation function(CCF)to explore the relationship between the identified influenza A(H7N9)cases and the spatiotemporal distribution of migratory birds.Here,the spatiotemporal distribution of bird species was generated based on bird observation data collected from China Bird Reports,which consists of 157272 observation records about 1145 bird species.Finally,we employed a kernel density estimator to identify geographical hotspots of bird habitat/stopover that are relevant to the influenza A(H7N9)infections.Results:Phylogenetic analysis reveals the evolutionary and geographical patterns of influenza A(H7N9)infections,where cases in the same or nearby municipality/provinces are clustered together with small evolutionary differences.Moreover,three epidemic waves in chicken along the East Asian-Australasian flyway in China are distinguished from the phylogenetic tree.The CCF analysis identifies possible migratory bird species that are relevant to the influenza A(H7N9)infections in Shanghai,Jiangsu,Zhejiang,Fujian,Jiangxi,and Guangdong in China,where the six municipality/provinces account for 91.2%of the total number of isolated H7N9 cases in chicken in GISAID.Based on the spatial distribution of identified bird species,geographical hotspots are further estimated and illustrated within these typical municipality/provinces.Conclusions:In this paper,we have identified key bird species and geographical hotspots that are relevant to the spread of influenza A(H7N9)virus.The results and findings could provide sentinel signal and evidence for active surveillance,as well as strategic control of influenza A(H7N9)transmission in China.

Estimation of disability weight for paragonimiasis:a systematic analysis

Background:Paragonimiasis,caused by helminths of the genus Paragonimus spp.,is a neglected tropical disease.Human suffering from paragonimiasis is often misunderstood and its quantification by the disability weight of the disability-adjusted life years largely varies in different global burden of disease(GBD)estimates.This paper is to systematically review clinical paragonimiasis cases and requantify the disability weight of human paragonimiasis.Methods:A systematic analysis was conducted using articles from the following databases:PubMed,Institute for Scientific Information Web of Science,China National Knowledge Infrastructure,the Chinese scientific journal databases Wanfang Data and CQVIP,Africa Journal Online,and the System for Information on Grey Literature in Europe.Search terms were the combination of“paragonim*”with“clinical”or“infection”.Only articles fulfilling the following conditions were recruited for this study:the occurrence of clinical signs and symptoms of paragonimiasis in human beings were reported;diagnosis was confirmed;no comorbidities were reported;the reviewed clinical cases or epidemiological findings were not already included in any other articles.The information and frequencies of paragonimiasis outcomes from included articles using predefined data fields were extracted two times by two separate individuals.Outcome disability weights were selected mainly from the GBD 2004 and GBD 2013 datasets.Frequencies and disability weights of paragonimiasis outcomes were modelled into a decision tree using the additive approach and multiplicative approach,respectively.Monte Carlo simulations were run 5000 times for an uncertainty analysis.Results:The disability weight estimates of paragonimiasis were simulated with 5302 clinical cases from 80 general articles.The overall disability weight was estimated at 0.1927(median 0.1956)with a 95%uncertainty interval(UI)of 0.1632-0.2378 using the additive approach,and 0.1791(median 0.1816)with a 95%UI of 0.1530-0.2182 using the multiplicative approach.The simulated disability weights of Paragonimus westermani cases were higher than that of P.skrjabini cases.Lung outcomes and headache were the top two contributors to disability weight for both species.Conclusions:The use of paragonimiasis disability weight needs to be reconsidered with regard to availability of morbidity data and species variation.Calculating the disease burden of paragonimiasis requires further modification and thus has considerable implications for public health prioritization in research,monitoring,and control.

Leveraging mathematical models of disease dynamics and machine learning to improve development of novel malaria interventions

Background:Substantial research is underway to develop next-generation interventions that address current malaria control challenges.As there is limited testing in their early development,it is difficult to predefine intervention properties such as efficacy that achieve target health goals,and therefore challenging to prioritize selection of novel candidate interventions.Here,we present a quantitative approach to guide intervention development using mathematical models of malaria dynamics coupled with machine learning.Our analysis identifies requirements of efficacy,coverage,and duration of effect for five novel malaria interventions to achieve targeted reductions in malaria prevalence.Methods:A mathematical model of malaria transmission dynamics is used to simulate deployment and predict potential impact of new malaria interventions by considering operational,health-system,population,and disease characteristics.Our method relies on consultation with product development stakeholders to define the putative space of novel intervention specifications.We couple the disease model with machine learning to search this multi-dimensional space and efficiently identify optimal intervention properties that achieve specified health goals.Results:We apply our approach to five malaria interventions under development.Aiming for malaria prevalence reduction,we identify and quantify key determinants of intervention impact along with their minimal properties required to achieve the desired health goals.While coverage is generally identified as the largest driver of impact,higher efficacy,longer protection duration or multiple deployments per year are needed to increase prevalence reduction.We show that interventions on multiple parasite or vector targets,as well as combinations the new interventions with drug treatment,lead to significant burden reductions and lower efficacy or duration requirements.Conclusions:Our approach uses disease dynamic models and machine learning to support decision-making and resource investment,facilitating development of new malaria interventions.By evaluating the intervention capabilities in relation to the targeted health goal,our analysis allows prioritization of interventions and of their specifications from an early stage in development,and subsequent investments to be channeled cost-effectively towards impact maximization.This study highlights the role of mathematical models to support intervention development.Although we focus on five malaria interventions,the analysis is generalizable to other new malaria interventions.

Research priorities in modeling the transmission risks of H7N9 bird flu

The epidemic of H7N9 bird flu in eastern China in early 2013 has caused much attention from researchers as well as public health workers.The issue on modeling the transmission risks is very interesting topic.In this article,this issue is debated and discussed in order to promote further researches on prediction and prevention of avian influenza viruses supported by better interdisciplinary datasets from the surveillance and response system.