Advanced Schistosomiasis Patients Research Articles

Impact of historical disease conditions on mortality and life expectancy in patients with advanced schistosomiasis in Hunan Province, China.

Although the prognosis of advanced schistosomiasis patients has significantly improved, the impact of historical disease conditions on life expectancy remains unclear. Utilizing data from an advanced schistosomiasis cohort (n=10 362) from 2008 to 2019 in Hunan, China, we examined five historical disease conditions: times of praziquantel treatment, the history of ascites, splenectomy, upper gastrointestinal bleeding (UGIB) and hepatic coma. Using latent class analysis, participants were categorized into three groups: Group 1 (characterized by no risk conditions), Group 2 (had ≤3 times of praziquantel treatment without UGIB history) and Group 3 (had UGIB history). Life expectancies were calculated using the life table method. At the age of 45 y, patients with ≤3 times of praziquantel treatment, a history of ascites, UGIB, hepatic coma and those without splenectomy exhibited lower life expectancies. Groups 1, 2 and 3 had estimated life expectancies of 32.32, 26.76 and 25.38 y, respectively. Compared with Group 1, women in Group 3 experienced greater life expectancy loss than those in Group 2, with the difference narrowing with age. Based on the consideration of overall physical conditions, tailored treatment and healthcare, along with public health interventions targeting diverse populations, could mitigate the prevalence of poor disease conditions and premature deaths.

Spatial distribution characteristics of the prevalence of advanced schistosomiasis and seroprevalence of anti-Schistosoma antibody in Hunan Province in 2020

To investigate the spatial distribution characteristics of the prevalence of advanced schistosomiasis and seroprevalence of anti-Schistosoma antibody, and to examine the correlation between the prevalence of advanced schistosomiasis and seroprevalence of anti-Schistosoma antibody in Hunan Province in 2020, so as to provide insights into advanced schistosomiais control in the province. The epidemiological data of schistosomiasis in Hunan Province in 2020 were collected, including number of permanent residents in survey villages, number of advanced schistosomiasis patients, number of residents receiving serological tests and number of residents seropositive for anti-Schistosoma antibody, and the prevalence advanced schistosomiasis and seroprevalence of anti-Schistosoma antibody were descriptively analyzed. Village-based spatial distribution characteristics of prevalence advanced schistosomiasis and seroprevalence of anti-Schistosoma antibody were identified in Hunan Province in 2020, and the correlation between the revalence advanced schistosomiasis and seroprevalence of anti-Schistosoma antibody was examined using Spearman correlation analysis. The prevalence of advanced schistosomiasis was 0 to 2.72% and the seroprevalence of anti-Schistosoma antibody was 0 to 20.25% in 1 153 schistosomiasis-endemic villages in Hunan Province in 2020. Spatial clusters were identified in both the prevalence of advanced schistosomiasis (global Moran's I = 0.416, P < 0.01) and the seroprevalence of anti-Schistosoma antibody (global Moran's I = 0.711, P < 0.01) in Hunan Province. Local spatial autocorrelation analysis identified 98 schistosomiasis-endemic villages with high-high clusters of the prevalence of advanced schistosomiasis, 134 endemic villages with high-high clusters of the seroprevalence of anti-Schistosoma antibody and 36 endemic villages with high-high clusters of both the prevalence of advanced schistosomiasis and seroprevalence of anti-Schistosoma antibody in Hunan Province. In addition, spearman correlation analysis showed a positive correlation between the prevalence of advanced schistosomiasis and seroprevalence of anti-Schistosoma antibody (rs = 0.235, P < 0.05). There were spatial clusters of the prevalence of advanced schistosomiasis and seroprevalence of anti-Schistosoma antibody in Hunan Province in 2020, which were predominantly located in areas neighboring the Dongting Lake. These clusters should be given a high priority in the schistosomiasis control programs.

Life expectancy and healthy life expectancy of patients with advanced schistosomiasis in Hunan Province, China

BackgroundFew studies have investigated the change in life expectancy (LE) and the healthy lifespan among patients with advanced schistosomiasis. This study was to evaluate the LE and healthy life expectancy (HLE) for patients and assess the mechanism responsible for the LE inequality.MethodsWe utilized data from a dynamic advanced schistosomiasis cohort (10,362 patients) for the period from January 2008 to December 2019 in Hunan Province, China, to calculate the LEs of patients, and made a comparison with that of general population (19,642 schistosomiasis-free individuals) in the schistosomiasis endemic areas. LEs were estimated from 15 years of age by constructing period life tables. Arriaga’s decomposition method was applied to quantify the influence of the age structure on the difference in LE. HLE for advanced schistosomiasis patients was calculated by using Sullivan method with age-specific disability weight. The LE and HLE were calculated for both males and females to perform further analyses on gender gap.ResultsThe estimated LE for advanced schistosomiasis patients aged 15–19 was 49.51 years (48.86 years for males and 51.07 years for females), which was 20.14 years lower compared with general population (69.65 years), and the LE gap between patients and general population decreased with age. The largest age-specific mortality contribution to the gap (32.06%) occurred at age 80–84 years. Women had a lower LE and HLE than men at age ≥ 60 years (both gender gaps in LE and HLE < 0). For advanced schistosomiasis patients, the gender gap in LE was largely attributed to the difference in mortality among those under the age of 55; the age-specific mortality in women exerted positive influence on the gap at age 25–64 and 75–79 years, with the contribution rate ranging from 0.59% to 57.02%, and made the negative contribution at other age groups.ConclusionsThe LE of advanced schistosomiasis patients was still much lower compared with general population. Strengthened prevention strategies and targeted treatments are needed to reduce morbidity and mortality due to advanced schistosomiasis, especially for younger population and elderly female patients.

Predicting the Occurrence of Advanced Schistosomiasis Based on FISHER Discriminant Analysis of Hematological Biomarkers.

We established a model that predicts the possibility of chronic schistosomiasis (CS) patients developing into advanced schistosomiasis (AS) patients using special biomarkers that were detected in human peripheral blood. Blood biomarkers from two cohorts (132 CS cases and 139 AS cases) were examined and data were collected and analyzed by univariate and multivariate logistic regression analysis. Fisher discriminant analysis (FDA) for advanced schistosomiasis was established based on specific predictive diagnostic indicators and its accuracy was assessed using data of 109 CS. The results showed that seven indicators including HGB, MON, GLB, GGT, APTT, VIII, and Fbg match the model. The accuracy of the FDA was assessed by cross-validation, and 86.7% of the participants were correctly classified into AS and CS groups. Blood biomarker data from 109 CS patients were converted into the discriminant function to determine the possibility of occurrence of AS. The results demonstrated that the possibility of occurrence of AS and CS was 62.1% and 89.0%, respectively, and the accuracy of the established model was 81.4%. Evidence displayed that Fisher discriminant analysis is a reliable predictive model in the clinical field. It’s an important guide to effectively control the occurrence of AS and lay a solid foundation for achieving the goal of schistosomiasis elimination.

Application of kNN and SVM to predict the prognosis of advanced schistosomiasis.

Predictive models for prognosis of small sample advanced schistosomiasis patients have not been well studied. We aimed to construct prognostic predictive models of small sample advanced schistosomiasis patients using two machine learning algorithms, k nearest neighbour (kNN) and support vector machine (SVM) utilising routinely available data under the government medical assistance programme. The predictive models were derived from 229 patients from Xiantao and externally validated by 77 patients of Jiayu, two county-level cities in Hubei province, China. Candidate predictors were selected according to expert opinions and literature reports, including clinical features, sociodemographic characteristics, and medical examinations results. An area under the receiver operating characteristic curve (AUC), sensitivity, and specificity were used to evaluate the models' predictive performances. The AUC values were 0.879 for the kNN model and 0.890 for the SVM model in the training set, 0.852 for the kNN model, and 0.785 for the SVM model in the external validation set. The kNN and SVM models can be used to improve the health services provided by healthcare planners, clinicians, and policymakers.

Analysis of causes of death among advanced schistosomiasis patients in Jiaxing City from 2010 to 2020

To analyze the cause of death among patients with advanced schistosomiasis in Jiaxing City of Zhejiang Province from 2000 to 2020. The medical records of 167 dead patients with advanced schistosomiasis that were registered in Jiaxing First Hospital and received national medical assistance program from 2010 to 2020 were collected, and compared with the data of advanced schistosomiasis patients without national medical assistance program in the same city from 1998 to 2008. Among the 167 advanced schistosomiasis patients in Jiaxing City during the period from 2010 to 2020, the four most common causes of death included liver failure (22.16%), upper gastrointestinal hemorrhage (17.37%), hepatic encephalopathy (14.97%) and liver cancer (14.37%), and the dead patients were predominantly at ages of 70 to 74 years, with a mean age of 74.8 years. The four most common causes of death included upper gastrointestinal bleeding (34.16%), hepatic encephalopathy (22.28%), unexplained causes (22.28%) and liver failure (4.46%) among advanced schistosomiasis patients without national medical assistance in Jiaxing City from 1998 to 2008, and the dead patients were predominantly at ages of 60 to 69 years, with a mean age of 69.3 years. There were significant differences between patients detected from 2010 to 2020 and from 1998 to 2008 in terms of causes of death (χ2 = 63.42, P = 0.00) and age of death (χ2 = 50.09, P = 0.00). There are significant changes in the cause of death among patients with advanced schistosomiasis in Jiaxing City from 2010-2020, which may be attributed to the implementation of the national medical assistance program.

Association between serum vitamin D level and immune imbalance in advanced schistosomiasis patients with liver fibrosis

To examine the relationship between serum vitamin D level and immune imbalance in advanced schistosomiasis patients with liver fibrosis. A total of 120 advanced schistosomiasis patients with liver fibrosis that were admitted to the Department of Schistosomiasis of The First Hospital of Jiaxing City from May 2016 to September 2018 were recruited as the observation group, and 50 healthy volunteers randomly sampled from the hospital during the same period served as the control group. The serum IgG antibody, IgA antibody, C3 complement, C4 complement, CD4+ cell proportion, CD8+ cell proportion, 25-hydroxyvitamin D [25(OH)D] levels were compared between the two groups. Liver fibrosis was classified into grade I, II and III according to the classification criteria of liver fibrosis by ultrasonography, and the serum IgG antibody, IgA antibody, C3 complement, C4 complement, CD4+ proportion, CD8+ proportion, 25(OH)D levels were compared among patients with grade I, II and III liver fibrosis. In addition, all patients were classified into the sufficient group, the insufficient group and the deficient group according to the serum vitamin D level, and the serum IgG antibody, IgA antibody, C3 complement, C4 complement, CD4+ proportion, CD8+ proportion, 25(OH)D levels were compared among these three groups. Moreover, the associations of the serum vitamin D level with these immune indicators were examined. The 120 advanced schistosomiasis patients with liver fibrosis included 58 men and 62 women, and had a mean age of (72.00 ± 3.00) years. There were 32 cases with grade I liver fibrosis, 46 cases with grade II liver fibrosis, and 42 cases with grade III liver fibrosis. There were no significant differences between the observation group and the control group in terms of serum D-dimer, total cholesterol (TC), triglyceride (TG), C3 complement or C4 complement levels (t = 2.467, 0.322, 0.790, -2.432 and -2.630, all P values > 0.05); however, there were significant differences seen in alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood calcium, blood phosphorus, IgG antibody, IgA antibody, CD4+ proportion, CD8+ proportion, and 25(OH)D levels (t = 5.130, 6.382, -1.341, 2.361, 8.708, 11.783, -2.995, -6.543 and -3.022, all P values < 0.05). In addition, there were significant differences in AST, ALT, blood phosphorus, IgA antibody, C3 complement, CD8+ cell proportion and 25(OH)D levels among patients with grades I, II and III liver fibrosis (F = 19.704, 16.254, 62.669, 49.347, 5.430, 5.434 and 5.783, all P values < 0.05). There were significant differences in ALT, blood phosphorus, IgA antibody, CD8+ cell proportion and 25(OH)D levels between patients with grades I and III liver fibrosis (all P values < 0.05), and significant differences were seen between patients with grades II and III liver fibrosis in terms of blood phosphorus, IgA antibody and CD8+ cell proportion (all P values < 0.05), while there was a significant difference in the CD8+ cell proportion between patients with grades I and II liver fibrosis (P < 0.05). Moreover, there were significant differences among the sufficient, insufficient and deficient groups in terms of IgG antibody, IgA antibody, C3 complement, CD4+ cell proportion and CD8+ cell proportion (F = 13.303, 59.623, 8.698, 9.969 and 12.805, all P values < 0.05), and there was a significant difference in the CD8+ cell proportion between the insufficient and deficient groups (P < 0.05). Pearson correlation analysis revealed that serum 25(OH)D level were negatively associated with IgG and IgA antibody levels (r = -0.754 and -0.773, both P values < 0.05), and positively associated with C3 complement, CD4+ cell proportion and CD8+ cell proportion in advanced schistosomiasis patients with liver fibrosis (r = 0.827, 0.850 and 0.830, all P values < 0.05). Immune imbalance occurs in advanced schistosomiasis patients with liver fibrosis, and serum vitamin D level may correlate with immune imbalance in advanced schistosomiasis patients with liver fibrosis.

Effect of rational emotive therapy on negative emotion in advanced schistosomiasis patients with repeated hospitalization

To examine the effect of rational emotive therapy on negative emotions among advanced schistosomiasis patients with repeated hospitalizations. A total of 97 advanced schistosomiasis patients with anxiety and depressive emotions that were hospitalized in Xiangyue Hospital of Hunan Institute of Schistosomiasis Control for three times or more were enrolled, and given rational emotive therapy for 4 weeks in addition to routine nursing care. The scores for anxiety, depression and quality of life were estimated in patients before and after the rational emotive therapy using the Self-Rating Anxiety Scale (SRS), the Self-Rating Depression Scale (SDS) and WHOQOL-BREF Form. The SAS and SDS scores were significantly lower 4 weeks following rational emotive therapy than before the intervention (SAS score, 45.40 ± 7.77 vs. 59.25 ± 9.29, t = 14.021, P < 0.01; 51.48 ± 8.01 vs. 63.93 ± 9.59, t = 12.991, P < 0.01). The percentages of patients with moderate and severe anxiety and depression were significantly lower 4 weeks following rational emotive therapy than before the intervention (P < 0.01), and the scores for each item in the quality of life were all significantly greater 4 weeks following rational emotive therapy than before the intervention (P < 0.01). Rational emotive therapy may improve the negative emotions and the quality of life of advanced schistosomiasis patients with repeated hospitalizations.

Serum vitamin D expression in advanced schistosomiasis patients with hepatic fibrosis and its association with disease progression

To compare the expression of serum vitamin D in advanced schistosomiasis patients with grade I and II hepatic fibrosis, and to preliminarily examine its associations with the internal diameter of the main portal vein and progression of hepatic fibrosis. The medical records of 126 advanced schistosomiasis patients with grade I and II hepatic fibrosis referred to Jiaxing First Hospital from March 2012 to September 2015 were retrospectively analyzed. The internal diameter of the main portal vein and serum 25-hydroxyvitamin D3 [25(OH)D3] level were measured. The progression of hepatic fibrosis was followed up, and the serum vitamin D level was compared between patient with disease progression and stable disease. The 126 advanced schistosomiasis patients included 72 men and 54 women, and had ages of 62 to 80 years. There were 58 cases with grade I hepatic fibrosis and 68 cases with grade II hepatic fibrosis. There were significant differences between patients with grade I and II hepatic fibrosis in terms of hemoglobin, white blood cell count, prothrombin time, international normalized ratio, activated partial thromboplastin time, fibrinogen or 25(OH)D3 level (all P > 0.05), and significant differences were seen in alanine aminotransferase, aspartate aminotransferase, blood calcium, blood phosphorus levels and the internal diameter of the main portal vein (all P values < 0.05). In addition, a lower serum 25(OH)D3 level was detected in patients with broadened internal diameter of the main portal vein than in those with normal internal diameter of the main portal vein [(19.08 ± 1.36) nmol/L vs. (25.61 ± 6.69) nmol/L, P < 0.05]. Following 3-year follow-up, there were 73 cases with progression of hepatic fibrosis, and a significantly lower serum vitamin D level was found in patients with disease progression than in those with stable disease [(20.00 ± 0.81) nmol/L vs. (25.47 ± 5.91) nmol/L, P < 0.05]. Vitamin D deficiency is common in advanced schistosomiasis patients with hepatic fibrosis, and it may be associated with the internal diameter of the main portal vein and the progression of hepatic fibrosis disease.

Investigation on current schistosomiasis cases in Sichuan Province

To understand the status of current schistosomiasis patients after the interruption of schistosomiasis transmission in Sichuan Province, so as to provide the reference for the development of specific rescue and treatment schemes and the implementation of dynamic management of the patients. The information of registered schistosomiasis patients in disease control and prevention institutions and medical institutions were reviewed in all schistosomiasis-endemic counties (districts) across Sichuan Province in 2018, and the data of all newly discovered schistosomiasis patients were collected and analyzed. A total of 1 558 current schistosomiasis cases were diagnosed in 11 endemic cities (prefectures) across Sichuan Province, and all were advanced cases. Megalosplenia and ascites were the predominant types of advanced schistosomiasis cases, and no age- (χ2 = 16.723, P > 0.05) or gender-specific difference (χ2 = 2.493, P > 0.05) was seen in the clinical types of current schistosomiasis cases. There were 9.3% of current schistosomiasis patients from poor households. There was a tendency towards a decline in the number of advanced schistosomiasis cases since 2012, and the number of schistosomiasis cases in 2018 reduced by 17.8% as compared to that in 2012. Currently, all current schistosomiasis patients are advanced cases in Sichuan Province. In the future, multidisciplinary collaboration should be implemented to search for a feasible financial subsidy pattern and establish an effective care system for advanced schistosomiasis patients.

Study on effect of clinical pathway implementation in advanced schistosomiasis with ascites

To evaluate the effect of clinical pathway (CP) on the implementation of advanced schistosomiasis patients with ascites. Totally 1 129 cases of advanced schistosomiasis patients with ascites but without other complications were selected randomly from the Performance Evaluation and Management System for Medical Treatment of Advanced Schistosomiasis Patients in Hubei Province from year 2011 to 2013. Among the patients, 754 cases were treated by CP (CP group), and 375 cases were treated with traditional methods (NCP group), and the hospitalization days, hospitalization expenses, medicine proportions, treatment outcomes and degrees of satisfaction and health knowledge rates of the two groups were compared. Meanwhile, the variation of CP was calculated. The average length of hospital days of the CP group and NCP group were (13.85 ± 5.60) d and (17.92 ± 5.80) d, respectively, and the average hospitalization costs of the two groups were (4 699.14 ± 1 520.59) Yuan and (5 692.01 ± 1 616.66) Yuan, respectively, both the differences were statistically significant (both P ＜ 0.05). Also the hospitalization cost structures of the two groups were remarkably different, the composition ratios of the inspection fee and accommodation fee in the CP group were lower than those in the NCP group, but the constituent ratios of the examination fee, diagnosis and treatment fee, drug charges and other expenses were higher than those in the NCP group (all P < 0.05). The awareness rate of health knowledge in the CP group was higher than that in the NCP group (P < 0.05), but there were no statistically significant differences in the treatment outcome and the degree of satisfaction between the two groups (both P > 0.05). The variation rate of CP was 9.02% (68/754). The implementation of CP can decrease the days of hospital stay and medical expenses, improve the awareness rate on health knowledge of the patients. The CP treatment with low variation rate is applicable to advanced schistosomiasis patients with ascites but without complications.

Disease burden of patients with advanced schistosomiasis in Jiangsu Province

To understand the disease burden of patients with advanced schistosomiasis in Jiangsu Province. Totally 450 patients with advanced schistosomiasis from southern, northern and central Jiangsu were chosen by the stratified sampling method, and surveyed by the self-designed economic burden questionnaire in 2015. The economic burden of the patients was analyzed by the descriptive analysis method, and its determinants were explored by the multiple linear regression analysis. A total of 450 subjects were surveyed and 434 valid questionnaires were recovered with the recovery rate of 96.44%. The per capita economic burden of advanced schistosomiasis patients was 10 217 Yuan in Jiangsu Province in 2015, including 7 221 Yuan in direct economic burden and 2 996 Yuan in indirect economic burden. The average lost labor force time was 140 days for the patients, and was 23 days for the family. The multiple linear regression analysis showed that the marital status, hospitalization health service utilization, and self-reported health score impacted on the disease economic burden. The disease burden of patients with advanced schistosomiasis in Jiangsu Province is heavy.

Clinical characteristics of 16 newly discovered advanced schistosomiasis patients in Dongpo District, Meishan City, Sichuan Province

To understand the clinical characteristics of newly discovered advanced schistosomiasis patients in Dongpo District, Meishan City, Sichuan Province, so as to provide the reference for enhancing the clinicians' awareness for diagnosis and treatment of this disease and improving the therapeutic effect. The data of medical records and schedule of case survey of 16 newly discovered advanced schistosomiasis patients in Dongpo District, Meishan City, Sichuan Province were collected and analyzed. The mean age of the 16 newly discovered advanced schistosomiasis patients was 63 years, and there were 10 cases at ages of over 60 years. The 16 cases included 8 men and 8 women, and 10 cases were detected in the historical hyper-endemic areas. There were 11 cases with an ascitic type of advanced schistosomiasis, 4 cases with a megalosplenia type, and one case with a colon proliferation type. The primary initial symptoms mainly included ascites, splenomegaly, hypersplenism and portal hypertension. Following inpatient treatments, 15 cases achieved clinical improvments. It is necessary to enhance the prevention and control of advanced schistosomiasis. If the patients with portal hypertension, hepatosplenomegaly, upper gastrointestinal hemorrhage visit a doctor, the clinicians should pay much attention to advanced schistosomiasis and they need to comprehensively analyze the clinical data in combination with the epidemiological information, clinical features and laboratory examinations, and make a correct diagnosis and give treatments timely.

Expression profiles of circulatingmicroRNAs in newly-developed advanced schistosomiasis patients

To study the expression profiles of circulating microRNAs (miRNAs) in newly-developed advanced schistosomiasis patients. Ten healthy controls (Group 1), ten patients with schistosomiasis history (without advanced schistosomiasis, Group 2) and ten patients with newly-developed advanced schistosomiasis (Group 3) were randomly selected from Jiangsu Province. The expression profiles of 570 human related circulatingmiRNAs were measured and analyzed with the Agilent Human microRNAs microarray Rel 12.0. Compared to the healthy controls, four miRNAs were up-regulated, while 16 miRNAs were down-regulated in the patients with newly-developed advanced schistosomiasis. Moreover, six miRNAs were up-regulated, while 21 miRNAs were down-regulated in the patients in Group 2. Among of them, the expression level of miR-383 was significantly decreased by 4.23 and 11.82 folds in Group 2 and Group 3, respectively. There are significant differences among the healthy controls, patients with schistosomiasis history (without advanced schistosomiasis) and the patients with newly-developed advanced schistosomiasisin the expression profiles of circulatingmiRNAs. Moreover, circulating miR-383 might be involved in the development of newly-developed advanced schistosomiasis.

Effectiveness of clinical pathway for treatment of advanced schistosomiasis hepatic fibrosis

Objective To assess the effectiveness of the clinical pathway for the treatment of advanced schistosomiasis hepatic fibrosis. Methods The duration of hospital stay, gross hospitalization expense, individual-paid expense, interior diameter of portal vein, levels of four serum hepatic fibrosis-related parameters (PIIIP, CIV, HA, and LN), and activities of ALT, AST and γ-GT were assessed and compared between the advanced schistosomiasis patients receiving the clinical pathway and ones receiving non-clinical pathway. Results There were 142 advanced schistosomiasis patients with hepatic fibrosis receiving the clinical pathway of anti-hepatic fibrosis. Compared with the patients receiving non-clinical pathway, the gross hospitalization expenses reduced by 11.2% (t = 6.310, P < 0.05), and the individual-paid expenses reduced by 16.1% (t = 4.326, P < 0.05). The mean HA level was twice higher than the normal range, with a positive rising from 70.4% to 83.1%, and the abnormal rates of CIV and γ-GT were 64.1% and 28.9% respectively. Conclusions The clinical pathway can drastically reduce the treatment expenses in advanced schistosomiasis patients with hepatic fibrosis. However, the patients have a trend towards the persistent disease progression. Therefore, the researches of more effective therapeutic methods for advanced schistosomiasis hepatic fibrosis are urgently needed.

Analysis of characteristics of medical assistance to advanced schistosomiasis patients in Hunan Province, 2015

To understand the current distribution and characteristics of advanced schistosomiasis patients who accepted medical assistance in Hunan Province in 2015, so as to provide the evidence for perfecting the policy and measures of the medical assistance to advanced schistosomiasis patients. The patients who had been diagnosed as advanced schistosomiasis were verified and confirmed according to the standard of the medical assistance to advanced schistosomiasis patients in Hunan Province in 2015. The epidemiological survey was conducted to investigate the demographic characteristics, history of diagnosis and treatment, and medical assistance to these persons. There were 3 850 advanced schistosomiasis patients who accepted the medical assistance in Hunan Province in 2015, and among them, 2 664 patients were male (69.19%), and 1 186 were female (30.81%). Most of them (92.82%) came from the main schistosomiasis endemic areas, such as Yueyang, Changde and Yiyang. There were 2 369 cases of ascites (61.53%), 1 466 cases of splenomegaly (38.08%), 15 cases of colon proliferation and dwarf (0.39%). The mean age of advanced schistosomiasis patients who accepted the medical assistance was (62.94 ± 11.67) years old, with 64.31% of them being more than 60 years old. The age of initial diagnosis of advanced schistosomiasis was (53.85 ± 21.32) years old, and it was concentrated in 40-60 years old (68.57%). The mean duration of advanced schistosomiasis was (9.58 ± 10.06) years, and it was mainly distributed in 10 years (75.95%). The mean duration from initial diagnosis of schistosomiasis to advanced schistosomiasis was (22.33 ± 14.20) years. The priority of the medical assistance to advanced schistosomiasis patients was given to the county hospitals (76.57%); and the effective rate of assistance was 94.46%. Totally 86.57% of the patients with advanced schistosomiasis got the medical insurance (rural cooperative medical care, urban medical care, etc.). The burden of the medical assistance to advanced schistosomiasis patients is still heavy because of many patients and low cure rate in Hunan Province. The ascites patients and high age patients should be the important objects of the medical assistance.

Schistosomiasis control progress and endemic situation in Sichuan Province

To understand the schistosomiasis control progress and endemic situation, so as to provide the evidence for formulating the strategy of schistosomiasis elimination in Sichuan Province. The schistosomiasis history data, working reports of schistosomiasis prevention and control, schistosomiasis surveillance data, and data of schistosomiasis prevention and control capacity were collected and analyzed for the schistosomiasis control progress and epidemic situation in Sichuan Province from 2004 to 2015. There were 63 schistosomiasis endemic districts in 11 cities in Sichuan Province, and the standard of schistosomiasis transmission interruption was achieved in the whole province in 2015. Currently, the area with Oncomelania hupensis snails was 2 537.54 hm2, and there were 1 769 advanced schistosomiasis patients. From 2004 to 2015, the accumulated survey area with snails was 433 065.80 hm2, and the area of snail control by molluscicides was 251 259 hm2. There were 26.017 144 million person-times of schistosomiasis blood tests and 7.89 million person-times of chemotherapy. There were 1.276 117 million head-times of cattle that received the schistosomiasis examinations. The schistosomiasis patients and livestock and the area with snails were decreased year by year. Since 2010, there were no local schistosome-infected residents and livestock and since 2004, there were no schistosome-infected snails. However, in some area, the professional personnel were less, the technology and hardware lagged behind, and the schistosomiasis prevention and control capacity was weak. Sichuan Province achieved the standard of schistosomiasis transmission interruption in 2015. In the future, the comprehensive schistosomiasis prevention and control strategy still should be strengthened, including the promotion of schistosomiasis prevention and control capacity, establishment of sensitive early-warning surveillance system, and implementation of accurate schistosomiasis prevention and control, in order to consolidate the control achievements and realize the aim of schistosomiasis elimination as soon as possible.

Application effect of pericardial devascularization plus gastric fundus transaction in advanced schistosomiasis

To discuss the effect of pericardial devascularization plus gastric fundus transaction in advance schistosomiasis patients with portal hypertension. Thirty-six advanced schistosomiasis patients with portal hypertension treated with devascularization plus gastric fundus transaction (a portal hypertension group), as well as 10 patients treated with modified Sugiura operation (a modified Sugiura operation group) in the Third People's Hospital of Yangxin County since 2006 were chosen as the observation objects, and the clinical effects of the two groups were observed and compared. The operation time, indwelling time of stomach tube, time to taking food after operation, drainage tube removal time of the portal hypertension group were all shorten than those of the modified Sugiura operation group (all P＜0.05). The hospitalization expenses of the two groups were (25 466.00 ± 2 888.48) Yuan and (34 517.10 ± 4 948.39) Yuan respectively, and the difference was also statistically significant (P＜0.05). The incidence rates of portal thrombosis of the portal hypertension group and modified Sugiura operation group were 33.33% (12/36) and 40.00% (4/10), respectively, and the incidence rates of rehaemorrhagia of the two groups 12 months after the operation were 16.67% (6/36) and 10.00% (1/10), respectively, but the differences had no statistically significance (both P ＞ 0.05). In addition, 1 case with delayed gastric emptying and 1 case with stomal leak of esophagus happened in the modified Sugiura operation group, while no corresponding complications happened in the portal hypertension group. Pericardial devascularization plus gastric fundus is a relatively easy procedure which has a good short-term clinical effect, and therefore it is suitable for application in primary hospitals. However, its long-term effect still needs further observation.

Clinical characteristics of 96 patients with advanced schistosomiasis in Yingcheng City

To understand the clinical characteristics of patients with advanced schistosomiasis in Yingcheng City, so as to provide evidences for the assistance work of advanced schistosomiasis. The clinical data of all the advanced schistosomiasis patients in Yingcheng City were collected and analyzed. Up to December 30, 2014, there were 96 advanced schistosomiasis patients in Yingcheng City, among which, 68 cases (70.8%) were male, 28 cases (29.2%) were female, and their average age was 64.2 years. Most of the patients (90.6%) were ascitic type, followed by splenomegaly type (5.2%), colon proliferation type (2.1%), and dwarf type (2.1%). Totally 48 cases (50.0%) were positive in immunological detections, among which 8 cases (8.3%) were positive in ELISA and 12 cases (12.5%) were positive in IHA. For all the 4 indexes of hepatic fibrosis (HA, LN, CIV and PCⅢ), only 15 cases (15.6%) were normal. Though Yingcheng City has reached the criteria of transmission control, the hepatic fibrosis of some patients continues to progress. Therefore, the intensity of the treatment and assistance could not be weakened, especially for those of the ascitic type patients.

Management strategy and technology of medical assistance to advanced schistosomiasis patients in Hunan Province

The medical assistance to advanced schistosomiasis patients established by the Chinese government is a major public facility for patients with advanced schistosomiasis. Since the medical assistance to advance schistosomiasis patients in Hunan Province started ten years ago, a set of mature and operable programs with whole program management and related technologies has been developed. The author investigated the data on medical assistance to advanced schistosomiasis patients in Hunan Province during the last 10 years (from 2006 to 2015) retrospectively, and found that the program had high therapeutic effect and high satisfaction degree of both patients and the society. In order to improve the management of the medical assistance to advanced schistosomiasis patients and share our experiences of the whole program management and related technologies with the colleagues of other provinces, this paper mainly illustrates the experiences of the program, as well as the existing problems and related strategies.