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Wang M.,Fudan University | You L.,Fudan University | Li H.,Fudan University | Lin Y.,Fudan University | And 4 more authors.
Clinical Journal of the American Society of Nephrology | Year: 2013

Background and objectives High serum levels of fibroblast growth factor-23 (FGF-23) are associated with mortality in patients with ESRD, but whether it still acts as a phosphaturic factor is unknown. This study aimed to explore the role of circulating FGF-23 on urinary phosphate excretion and phosphate balance in maintenance hemodialysis (MHD) patients with residual renal function (RRF). Design, setting, participants, & measurements There were 134 MHD patients enrolled in this cross-sectional study from June to July 2010. Demographics, laboratory data, and excretion capacity of phosphate were recorded. Multivariable linear regression was used to analyze the relationship of serum phosphate and the tubular reabsorption rate of phosphate with other factors. Results The median age of the patients was 61.0 years and 47.8% were male. Thirty percent of the patients had high urinary output (>200 ml/d) accompanied by lower serum levels of phosphate, calcium, intact parathyroid hormone, and FGF-23 compared with those with low urine output (≤200 ml/d). The independent predictors of serum phosphate were normalized protein nitrogen appearance, intact parathyroid hormone, and FGF-23 in the low urine output group and female sex and GFR in the high urine output group. The tubular reabsorption rate of phosphate decreased to 50% of the normal level in patients with RRF. Elevated circulating FGF-23 was significantly associated with lower tubular phosphate reabsorption after adjusting for GFR. Conclusions RRF is associated with significant capacity to excrete phosphate in MHD patients and high levels of serum FGF-23 may promote phosphate excretion by remnant nephrons. © 2013 by the American Society of Nephrology. Source

Jiang H.,Fudan University | Jiang H.,Key Laboratory of Public Health Safety | Xiong X.,Tulane University | Su Y.,Fudan University | And 5 more authors.
BMC Pregnancy and Childbirth | Year: 2013

Background: Evidence has suggested that periodontal disease is associated with an increased risk of various adverse pregnancy and birth outcomes. However, several large clinical randomized controlled trials failed to demonstrate periodontal therapy during pregnancy reduced the incidence of adverse pregnancy and birth outcomes. It has been suggested that the pre-conception period may be an optimal period for periodontal disease treatment rather than during pregnancy. To date, no randomized controlled trial (RCT) has examined if treating periodontal disease before pregnancy reduces adverse birth outcomes. This study aims to examine if the pre-conception treatment of periodontal disease will lead to improved periodontal status during late pregnancy and subsequent birth outcomes.Methods/Design: A sample of 470 (235 in each arm of the study) pre-conception women who plan to conceive within one year and with periodontal disease will be recruited for the study. All participants will be randomly allocated to the intervention or control group. The intervention group will receive free therapy including dental scaling and root planning (the standard therapy), supragingival prophylaxis, and oral hygiene education. The control group will only receive supragingival prophylaxis and oral hygiene education. Women will be followed throughout their pregnancy and then to childbirth. The main outcomes include periodontal disease status in late pregnancy and birth outcomes measured such as mean birth weight (grams), and mean gestational age (weeks). Periodontal disease will be diagnosed through a dental examination by measuring probing depth, clinical attachment loss and percentage of bleeding on probing (BOP) between gestational age of 32 and 36 weeks. Local and systemic inflammatory mediators are also included as main outcomes.Discussion: This will be the first RCT to test whether treating periodontal disease among pre-conception women reduces periodontal disease during pregnancy and prevents adverse birth outcomes. If the effect of pre-pregnancy periodontal treatment is confirmed, this intervention could be recommended for application in low- or middle-income countries to improve both oral health and maternal and child health.Trial registration: This trial is registered with Chinese Clinical Trial Registry (ChiCTR): ChiCTR-TRC-12001913. © 2013 Jiang et al.; licensee BioMed Central Ltd. Source

Zhang Z.,Fudan University | Zhang Z.,Key Laboratory of Public Health Safety | Zhu R.,National Institute of Parasitic Diseases | Ward M.P.,University of Sydney | And 6 more authors.
PLoS Neglected Tropical Diseases | Year: 2012

Background: The World Bank Loan Project (WBLP) for controlling schistosomiasis in China was implemented during 1992-2001. Its short-term impact has been assessed from non-spatial perspective, but its long-term impact remains unclear and a spatial evaluation has not previously been conducted. Here we compared the spatial distribution of schistosomiasis risk using national datasets in the lake and marshland regions from 1999-2001 and 2007-2008 to evaluate the long-term impact of WBLP strategy on China's schistosomiasis burden. Methodology/Principal Findings: A hierarchical Poisson regression model was developed in a Bayesian framework with spatially correlated and uncorrelated heterogeneities at the county-level, modeled using a conditional autoregressive prior structure and a spatially unstructured Gaussian distribution, respectively. There were two important findings from this study. The WBLP strategy was found to have a good short-term impact on schistosomiasis control, but its long-term impact was not ideal. It has successfully reduced the morbidity of schistosomiasis to a low level, but can not contribute further to China's schistosomiasis control because of the current low endemic level. A second finding is that the WBLP strategy could not effectively compress the spatial distribution of schistosomiasis risk. To achieve further reductions in schistosomiasis-affected areas, and for sustainable control, focusing on the intermediate host snail should become the next step to interrupt schistosomiasis transmission within the two most affected regions surrounding the Dongting and Poyang Lakes. Furthermore, in the lower reaches of the Yangtze River, the WBLP's morbidity control strategy may need to continue for some time until snails in the upriver provinces have been well controlled. Conclusion: It is difficult to further reduce morbidity due to schistosomiasis using a chemotherapy-based control strategy in the lake and marshland regions of China because of the current low endemic levels of infection. The future control strategy for schistosomiasis should instead focus on a snail-based integrated control strategy to maintain the program achievements and sustainably reduce the burden of schistosomiasis in China. © 2012 Zhang et al. Source

Zhang Z.,Fudan University | Zhang Z.,Key Laboratory of Public Health Safety | Chen D.,Queens University | Ward M.P.,University of Sydney | And 2 more authors.
Geospatial Health | Year: 2013

The highly pathogenic avian influenza virus (HPAIV), subtype H5N1 poses a serious threat not only to the poultry industry and wild birds but also to humans. Despite a large number of studies conducted on various aspects of this virus, its transmissibility is still poorly understood. This study quantifies the basic reproductive number (R0) of the global HPAIV H5N1 spread within domestic poultry during December 2003 to December 2009. Three different approaches were applied to estimate R0 for HPAIV H5N1: (i) epidemic doubling time; (ii) spatial distance-based nearest neighbour; and (iii) spatiotemporal distance-based nearest neighbour. These three approaches represent temporal (tR0), spatial (sR0) and spatio-temporal transmissibility (stR0), respectively. The joint application of these three approaches provides a more complete profile by characterising the transmissibility traits of infectious diseases from different perspectives. Estimates of tR0 gradually decreased over the six sequential epidemic waves (EWs) examined, suggesting that the implemented control measures were effective in reducing the number of outbreaks. However, sR0 and stR0 increased from EW1, peaked in EW3 and then gradually decreased during EW4-EW6, reflecting different aspects of disease transmissibility compared to tR0. The application of all three methods in the final EW6 showed R0 >1, suggesting that the control measures implemented did not completely interrupt the transmission cycle, and hence were insufficient to eliminate HPAIV H5N1. Close monitoring of HPAIV H5N1 outbreaks and enhanced control policies is advised. Source

Hu Y.,Fudan University | Hu Y.,Key Laboratory of Public Health Safety | Xiong C.,Fudan University | Zhang Z.,Fudan University | And 7 more authors.
Parasitology International | Year: 2014

The 10-year (1992-2001) World Bank Loan Project (WBLP) contributed greatly to schistosomiasis control in China. However, the re-emergence of schistosomiasis in recent years challenged the long-term progress of the WBLP strategy. In order to gain insight in the long-term progress of the WBLP, the spatial pattern of the epidemic was investigated in the Yangtze River Valley between 1999-2001 and 2007-2008. Two spatial cluster methods were jointly used to identify spatial clusters of cases. The magnitude and number of clusters varied during 1999-2001. It was found that prevalence of schistosomiasis had been greatly reduced and maintained at a low level during 2007-2008, with little change. Besides, spatial clusters most frequently occurred within 16 counties in the Dongting Lake region and within 5 counties in the Poyang Lake region. These findings precisely pointed out the prior places for future public health planning and resource allocation of schistosomiasis. © 2014 Elsevier Ireland Ltd. Source

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