Objective To establish a monitoring and evaluation indicator framework in the context of malaria elimination in pilot areas in China,so as to further assess the malaria elimination work in the future. Methods Based on the consultancy, and according to the government documents such as Action Plan for Malaria Elimination in China (2010-2020),Technical Guidance for Malaria Elimination,Programme Evaluation on Malaria Elimination,the indicators were set up at both provincial and county levels and their application was conducted in Yunnan and Anhui provinces to assess the accountability,accessibility and applicability. Results An indicator framework was built up including four key components,which were input,process, output and impact indicators,in which 95 were provincial indicators and 98 were county indicators. The completion rate of the indicators of Yunnan and Anhui provinces were 94.7%(90/95)and 95.8%(91/95)respectively;and the completion rate of in?dicators of Tengchong and Feidong counties were 93.9%(92/98)and 92.9%(91/98)respectively. Conclusion The estab?lished indicator framework is reliable and applicable,which could effectively help to track the malaria elimination progress and identify gaps.

This report presented the endemic status of schistosomiasis in the People’s Republic of China at a national level in 2015,and analyzed the data collected from the national schistosomiasis prevention and control system and 457 national schis?tosomiasis surveillance sites. Among the 12 provinces(municipality,autonomous region)endemic for schistosomiasis japonica in P. R. China,5 provinces(municipality,autonomous region),i.e.,Shanghai,Zhejiang,Fujian,Guangdong and Guangxi, had achieved transmission interruption,and 7 provinces of Sichuan,Yunnan,Jiangsu,Hubei,Anhui,Jiangxi and Hunan had achieved transmission control by the end of 2015. There were 453 endemic counties(city,district)covering 252 million peo?ple,specifically including 29 980 endemic villages of 68.61 million people at risk of infection. Among the 453 endemic counties (city,district),75.72%(343/453)and 24.28%(110/453)reached the criteria of transmission interruption and transmission control,respectively. By the end of 2015,it was estimated of 77 194 cases of schistosomiasis,which were decreased by 33.23%compared with 115 614 cases in 2014. No acute schistosomiasis cases were reported in 2015. There were 30 843 advanced schis?tosomiasis cases documented in 2015. A total of 8 736 036 individuals received schistosomiasis examinations and 3 606 individu?als were parasitologically diagnosed,which were decreased by 56.40%compared with 8 270 cases in 2014. An Oncomelania hu?pensis snail survey was performed in 19 965 endemic villages and the snails were found in 5 609 villages,accounting for 28.09%of total villages,with 31 newly detected villages with snails. The snail survey covered an area of 593 572.66 hm2 and snails were found in an area of 173 462.50 hm2,including a newly detected area of 666.04 hm2. No infected snails were found in 2015. A to?tal of 879 373 bovines were raised in the schistosomiasis endemic regions. Of them,526 062 bovines received stool examina?tions,resulting in 315 infected bovines. There were 170 438 schistosomiasis cases receiving drug treatment in 2015,with 2 449 696 individuals undergoing expanded chemotherapy. There were 318 bovines with schistosomiasis receiving drug treatment,with 483 213 bovines undergoing expanded chemotherapy. A total of 144 305.52 hm2 area was subject to snail control by using mollus?cicides,with an actual molluscicide?treated area of 69 221.57 hm2,and 4 572.06 hm2 snail habitats were treated by environmen?tal modification. Based on the data from the 457 national schistosomiasis surveillance sites,the mean Schistosoma japonicum in?fection rate was 0.05% and 0.04% in humans and bovines,respectively. No infected snails were found in all the surveillance sites. The results demonstrate a decline in the endemicity of schistosomiasis in P. R. China and the country reached the criteria of transmission control at the national level. However,the endemic situation of schistosomiasis is unstable in some regions with newly?reached transmission control,and further control and effective surveillance should be strengthened to consolidate the achievements and reduce the endemic situation of schistosomiasis in P. R. China.

Objective To determine the key interventions transferring from the control to elimination of malaria in China so as to provide the basic information for achieving malaria elimination. Methods Based on the data collected from the document entitled of The National Annual Report on Schistosomiasis,Malaria and Echinococcosis,published by the National Institute of Parasitic Diseases of Chinese Center for Disease Control and Prevention,the malaria incidence and intervention data were se?lected only in the typical endemic provinces during the period of 2004-2010. The correlation between the incidence and interven?tions in the target provinces was analyzed based on the Panel Data Regression Model,and the key interventions were deter?mined. Results Four provinces namely Anhui,Yunnan,Hainan and Henan were targeted with 87.56%of the national malaria figures from 2004 to 2010. When Y was given as vivax malaria incidence,X1 as the log of the number of historical cases receiving radical treatment in the pre?transmission stage(RTPT)(F=14.53,P<0.01,R2=0.72),X2 as the log of risk population receiv?ing RTPR(F=15.90,P<0.01,R2=0.71)and X3 as the number of technicians trained in microscopy(F=11.53,P<0.01,R2=0.61),three space?fixed effect models were established respectively,and X1,X2,as well as X3 had negative effects on Y value. When Y was given as falciparum malaria incidence,X1 as the accumulated technicians trained in microscopy(F=11.06,P<0.01,R2=0.87),X2 as the log of technicians trained in entomology(F=15.28,P<0.01,R2=0.89),two two?way(space and time)fixed effect models were established respectively,and both X1 and X2 had negative effects on Y value. Conclusion RTPT among historical patients and at?risk populations as well as microscopy training influences the variation of vivax malaria inci? dence,while the significant interventions of microscopy training and vector control training indicate that the integrated measures with strengthened capacity in diagnosis and vector control are of importance in the control of falciparum malaria transmission.

ObjectiveTo elucidate the association between aquaporins (AQPs) expression in kidney tissue and edema of nephrotic syndrome(NS) patients.MethodsNS patients were divided into edema group (14 cases) and non-edema group (8 cases).Ten patients without NS were used as control group.Expressions of AQP1,AQP2,and AQP4 in renal tissues of 3 groups were detectedbyimmunohistochemistrywithstandardtechniquesandsemi-quantitativeanalysis.Association between AQPs expression and edema was examined.ResultsThe positive index of AQP1 expression in proximal tubules in edema group was 0.0373±0.0110,which was significantly lower as compared to non-edema group (0.0510±0.0120) and control group 0.0574±0.0100),while the difference between non-edema and control groups was not significant.The positive index of AQP1 expression in glomerulus was 0.0106±0.0037 in edema group,which was significantly higher than that in non-edema group(0.0021±0.0013) and control group(0.0020±0.0012),while no significant difference was found between the last two groups.AQP2 mainly localized in the collecting duct system.The positive indexes of AQP2 expression were 0.0498±0.0081,0.0370± 0.0072 and 0.0255±0.0103 in edema group,non-edema group and control group,respectively.The differences were significant among 3 groups.AQP4 expression was not found in the renal cortex and collecting duct system.ConclusionsAQPs expression is different in renal tissues of NS patients.AQP2 may play an important role in the edema of NS patients,and AQP1 may involve in the occurrence of edema.

Objective Based on active monitoring MRSA carriage for hospitalized patients, the relationship between colonization pressure and MRSA cross transmission in wards without rigorous contactisolation measures was analyzed, and the role of colonization pressure in predicting MRSA cross transmission was further evaluated. Methods From March to December 2009, active MRSA colonization screening was performed for 240 hospitalized patients in emergency ward and 94 cases in RICU in our hospital. rep-PCR method was employed to do homology analysis on MRSA strains obtained in this study. MRSA weekly colonization pressure, threshold colonization pressure ,cross transmission rate were calculated respectively. RR of MRSA cross transmission under higher level of colonization pressure and lower level of colonization pressure was analyzed. Results MRSA carriage rates on admission for patients in emergency wards and RICU were 6. 25% (15/2A0) and 13. 83 % (13/94) ,and MRSA cross transmission occurred in 13 weeks and 14 weeks in above two units, respectively. Threshold colonization pressures for above two units were 6. 49%and 17. 66%, respectively. For emergency ward, the MRSA cross transmission rate under higher level of colonization pressure was significantly higher than that under lower level of colonization pressure (x2 = 7. 10,P＜0. 01), the RR of MRSA transmission was 9. 61 (95% CI:1. 25-74.00). For RICU, the MRSA cross transmission rate under higher level of colonization pressure was significantly higher than that under lower level of colonization pressure(x2 = 12. 60, P＜0. 01 ), the RR of MRSA transmission was 15.87 (95% CI:2. 06-122. 10). Conclusions Higher level of colonization pressure is an important risk factor for MRSA transmission, and average colonization pressure can be used as a prediction index for MRSA transmission and strengthening prevention and control measures.

Objective To compare the prevalence and correlation factors of chronic kidney disease (CKD) in urban and rural areas in Minhang district of Shanghai through the social economic and clinical data of the elderly population.Methods Jiangchuan Street and Pujiang town were randomly selected to represent the urban and rural population in Minhang district of Shanghai,respectively.Based on the over-60-year old people health examination program,6151 objectives with complete clinical-epidemiological data and bio-chemical index were investigated.The prevalence of CKD in urban and rural areas was compared,and the correlation factors for the urban and rural CKD were evaluated by multiple logistic regression analysis.Results (1) The survey objectives with an average age of (69.57+7.04) years,including 4345 cases of the city residents and 1806 cases of rural residents,were enrolled.The age structures of urban and rural showed differences,population over 80 years old account for 13.1％ of the rural total,significantly higher than 7.4％ in the urban population (P ＜ 0.001).(2) The prevalence rates of diabetes,hyperuricemia,hyperlipidemia and hyperlipidemia in urban residents were higher than those in rural residents,which were 26.4％ vs 13.7％,9.9％ vs 2.3％,53.7％ vs 37.4％,51.4％ vs 15.6％ (all P＜ 0.01).The awareness rates of kidney disease and hyperlipidemia showed significant differences in urban and rural areas,which were 32.9％ vs 44.2％,84.6％ vs 62.8％ (all P ＜ 0.01).Compared with those in rural areas,the treatment rates of hypertension and high blood lipids in urban residents were increased (all P ＜ 0.01).(3) The prevalence of CKD was 23.4％.Female CKD prevalence was higher than male,respectively 26.3％ and 18.5％ (P ＜ 0.01).In urban CKD prevalence was 22.2％,lower than 25.2％ in rural.The prevalence rate of hematuria in urban areas was lower than in rural areas,but the prevalence rate of decline in renal function was higher (all P ＜ 0.05).With the increase of age,the prevalence rate of CKD was increased (P ＜ 0.01).(4) Age (OR=1.072),smoking history (OR=1.543),previous history of kidney disease (OR=1.351),diabetes (OR=1.373),hyperuricemia (OR=2.498),obesity (OR=1.364),history of interventional therapy (OR=1.896) had positive correlation with CKD in city elderly population,while the higher education (OR=0.676,OR=0.604) and drinking (OR=0.585) had negative correlation (all P ＜ 0.05).Age (OR=1.032),female (OR=1.860) had positive correlation with CKD in rural elderly population (all P ＜ 0.05).Conclusions CKD has been a common chronic progressive disease of the aged in Minhang district.The prevalence of CKD is higher in urban areas than in rural.Age is a common factor for CKD in urban and rural.Previous smoking,history of kidney disease,diabetes,hyperuricemia,obesity,history of interventional therapy,education and drinking have correlation with urban CKD patients.Female has correlation with rural CKD population.

Objective To investigate the therapeutic effect of the microdissected thin fibular skin flap of the great toe to repair the finger pulp defect,and to discuss the operation and outcome of the flap for finger pulp defect.Methods From September,2012 to January,2016,12 cases of finger pulp defect were treated with the thin fibular skin flap of great toe removed partially subcutaneous fat under the microscope.One case for index finger,3 cases for middle finger,4 cases for ring finger,and 4 cases for little finger.Among them,5 cases were crush injury,6 cases were stamping injury,1 case was avulsion injury.The flap area was 3.0 cm×1.5 cm-3.2 cm×2.2 cm.The donor site was closed directly or covered with flap.Results All the 12 flaps survived completely without blood supply crisis,and the primary healing was achieved in donor site.Ten cases were followed-up from 6 months to 36 months.The blood-supply,texture and elasticity of transferred flaps and the shape of fingers pulp were excellent.Function recovery of the fingers was good.Pain and temperature sense were regained without hypersensitivity,two-point discrimination of finger pulp was 5-8 mm.Conclusion It is a reliable approrach for the repare of the finger pulp defects using the microdissected thin fibular skin flap of the great toe,especillay in repare finger pulp defect of ring and little finger.

Objective To investigate a anatomy research and clinic application of defect of thumb by reverse dorsoradial thumb flap of different rotation point.Methods The origin,course,distribution and vascular chain of the first metacarpal dorsoradial artery of thumb from 11 adult cadaveric hand specimens perfused by red latex were explored from September,2012 to December,2016.There were 3 different rotation points:the proximal of the metacarpophalangeal joint,proximal basal of the first proximal phalanx and distal of the first proximal phalanx.Each could be used as reverse flow flap to repair the defect of thumb.Results The first metacarpal dorsoradial artery of thumb originated from the radial artery and the initial diameter was (0.68±0.26) mm,diagonally across the extensor pollicis brevis tendon and then along the radialis part and terminated in the proximal of the first proximal phalanx of the vascular chain.There was a constant communicating branch among the proximal metacarpophalangeal joint,proximal basal of the first proximal phalanx and digital arterial dorsal branch.All the proximal of the metacarpophalangeal joint 4.3 mm to 10.2 mm and proximal basal of the first proximal phalanx 4.9 mm to 7.2 mm could be used as the rotation point of the flap.The flap of the first promixal phalanx blood supply was based on the vascular chain of neurocutaneous.There was a constant dorsal branch of the pollical artery,which was 8.6 mm to 10.3 mm far from the interphalangeal joint,could be used as the rotation point of the flap.Twenty-four cases with soft tissue defects of thumb were repaired by reverse dorsoradial flap.The flap size ranged from 2.0 cm×1.5 cm to 3.5 cm×2.8 cm.The follow-up period was 3 months to 12 months,protective sensations were restored,and skin flap two-point discrimination were 9.0 mm to 12.0 mm.The appearance of the thumbs was satisfactory.Conclusion Different rotation point of reverse dorsoradial flap can successfully repair the defect of thumb.The operation has advantages of simple,reliable blood supply,high success rate and is an ideal option for reconstruction the defect of thumb.

Objective To explore the anatomic basis of the thinning of the free posterior tibial artery perforator flaps and the clinical effect of repairing wound on hand or foot due to trauma.Methods From November,2016 to December,2017,10 cases of lower extremity cadaver specimens perfused with red ralex were dissected,which were perfused through the amputated femoral artery.Five of them were left and the rest were right.All cases were males.The number,diameter,branches and distribution of the perforator was observed.From September,2012 to September,2017,there were 13 cases of clinical application,which were 5 cases of hand wound and 8 cases of foot wound.The size of the wound was 3.0 cm × 2.0 cm to 6.0 cm × 4.0 cm,and the flap area was 3.5 cm × 2.2 cm to 6.5 cm × 4.5 cm.The repairing procedure was suitable for the wound associated with tendon,bone,joint capsule exposure.Results The number of posterior tibial artery perforating branches that more than 0.50 mm in diameter was 4 to 6,and the mean diameter was (0.87±0.26) mm.The perforating branch penetrated into the fat layer and was divided into 3 layers of vascular network:deep fat vascular network,superficial fat vascular network and subdermal vascular network.The perforating branch was located according to the positional relationship from deep to shallow,and vessel diameter become smaller step by step.The perforating branch trunk gave off branches to the deep vascular network,and the superficial vascular network had the same origin or shared with the deep blood vessels.The subdermal vascular network issued from the superficial vascular network or directly from the perforating branch trunk.There was no or few communicating branch between the deep vascular network and superficial ones,besides the vessel pedicle.So trimming deep fat layer will not affect the blood supply of superficial vascular network and neither will affect the flap blood supply.Most of the deep fat tissue was trimmed in 13 cases.The superficial and subdermal fat vascular network was preserved,and the same to the trunk and branches of the pedicle.All the flaps survived.Of which,1 appeared arterial crisis on the 2nd day after operation,and relieved by the local injection of papaverine.There was 1 case of venous crisis on the 3rd day,and improved by stitches,local release of congestion.Followed-up time was ranged from 2 to 12 months.All flaps were soft with good blood supply and good appearance,and did not need a second thinning surgery.Flaps restored the protective feeling 6 months later.Conclusion The microdissection of perforator flap of posterior tibial artery provides a theoretical basis for the perforator flap thinning,and the thinning of perforator flap is a good method to repair the appearance and function of the wound after foot and hand injuries.

Autophagy can regulate liver physiology and balance liver metabolism. Autophagy activation has a double-sided and complex effect on liver injury, and it is regulated by many factors and is associated with many protein pathways. This article summarizes the role of mTOR in the regulation of autophagy, which can inhibit or enhance autophagy through the PI3K/Akt upstream signaling pathway and participate in the physiological and pathological changes of related liver diseases. Therefore, this article reviews the research advances in the mTOR/PI3K/Akt autophagy pathway in liver injury, in order to provide new therapeutic targets for related liver diseases.