[Analysis of application of herd immunity as a control strategy for COVID-19]

Novel coronavirus spreads very fast and is not easy to control. It has spread over 200 countries or territories. China has taken action to implement containment strategies, including active COVID-19 case finding, tracing, and 14-day quarantine of close contacts, and home isolation of 1.39 billion of people countrywide for at least 2 weeks, etc. The combination of these strategies has brought the epidemic under control in China. The United Kingdom had deliberately not implemented containment measures for a while, instead opting to allow herd immunity strategy to develop over time. This is a "do-nothing" strategy whereby the virus is allowed to move through communities naturally until certain proportion of people has been infected, and the epidemic ends without intervention. The author assesses containment strategies versus this herd immunity strategy in real-world application to the COVID-19 epidemic. The author suggests an innovative strategy to balance controlling the epidemic and preventing impediment to economic and social development.

[Contribution of asymptomatic and pre-symptomatic cases of COVID-19 in spreading virus and targeted control strategies]

The asymptomatic carrier state of COVID-19 has become a topic of concern for preventing the rebound of possible epidemic. This review describes and defines the COVID-19 asymptomatic carrier state and outlines the methods for identifying, counting and reporting of these cases. The author elaborates that the asymptomatic carrier state can be further divided into asymptomatic infection and pre-symptomatic infection after extended follow-up based on the nature of the disease progression. The author presents the limited available data about the infectivity of asymptomatic and pre-symptomatic cases and their possible contributions to the overall epidemic of COVID-19 observed so far in China. Challenges of a possible second epidemic wave of COVID-19 caused by asymptomatic and pre-symptomatic cases are discussed and suggestions for control strategies and scientific research are provided.

[Transjugular intrahepatic portosystemic shunt for the treatment cavernous transformation of the portal vein with vareceal bleeding]

Objective: To evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt(TIPS) for the treatment of patients with cavernous transformation of portal vein (CTPV) with vareceal bleeding. Methods: From September 2016 to June 2018, a total of 21 patients suffered CTPV complicated with vareceal bleeding were admitted to First Affiliated Hospital of Zhengzhou University. TIPS were performed combined with percutaneous transhepatic portal vein assist. There were 13 males and 8 females, with an average age of 27-67 (48±11) years. Blood routine examination, liver function test, blood ammonia and ultrasound Doppler were conducted 1,3,6 months after operation, and every 6 months during follow-up. Abdominal enhanced CT and digital substraction angiography were followed every year. Results: TIPS were successfully performed in 19 cases (90.5%), esophageal and gastric varices were embolized in 17 cases; 2 cases failed to selective catheterized, then endoscopic therapy was performed.All bleeding stopped after operation. The pressure of portal vein decreased from 25.0-44.0 (33.7±5.4) mmHg (1 mmHg=0.133 kPa) to 17.0-30.0 (24.5±3.1) mmHg, portosystemic pressure gradient decreased from 16.0-32.0 (23.5±4.6) mmHg to 9.0-15.0 (11.4±1.9) mmHg after TIPS (all P<0.05). During 3-24 months follow-up, 2 patients suffered from hepatic encephalopathy, 3 patients had recurrent upper gastrointestinal bleeding, including 1 duodenal ulcer and 2 esophageal varices. In-stent restenosis were found in 6 patients,in which 3 patients underwent shunt revision operation. At the end of the follow-up, the cumulative patency was 16/19. Conclusion: For patients with CTPV and vareceal bleeding, TIPS could reduce portal hypertension while embolizing varicose veins.It is a safe and effective treatment.

[The association between the whole blood riboflavin level and the occurrence, development and prognosis of esophageal squamous cell carcinoma]

Objective: To investigate the association between the whole blood riboflavin level and the occurrence, development and prognosis of esophageal squamous cell carcinoma (ESCC) in China. Methods: From March 2014 to September 2018, ESCC patients from three hospitals (the Affiliated Hospital of Medical College of Shantou University, Shantou Central Hospital in Southern Chaoshan area and First Affiliated Hospital of Zhengzhou University in Northern Taihang Mountain) were selected as a case group; non-esophageal patients who had a physical examination were selected as a control group. The case and control group were paired by age (±5 years) and a 1:1 ration. A total of 1 528 subjects were enrolled including 764 patients in the case group and 764 patients in the control group. About 3-5 ml venous blood samples were collected, and the erythrocyte glutathione reductase activity coefficient (GRAC) was measured to assess the whole blood riboflavin level. A multivariate conditional logistic regression model was used to analyze the association between the GRAC and the risk of ESCC. The association between the GRAC and the prognosis of ESCC was analyzed by using Cox proportional risk regression model based on 288 patients with complete survival data. They were divided into two groups, the high GRAC group (GRAC≥7.87) group and the low GRAC group (GRAC<7.87) according to the strongest correlation between the total survival time, survival outcome and GRAC (GRAC=7.87). Results: Among the 1 528 patients, 958 patients were from Southern Chaoshan area, including 479 patients in the case group with an average age about (59.90±9.34) years and 479 patients in the control group with an average age about (59.55±8.77) years. Other 570 patients were from Northern Taihang Mountain area, including 285 patients in the case group with an average age (58.39±5.19) years and 285 patients in the control group with an average age about (58.74±4.57) years. The multivariate conditional logistic regression showed that the OR (95%CI) of the GRAC and the risk of ESCC was 1.009 (0.998-1.019). The Cox proportional hazard regression model analysis showed that the HR (95%CI) of the high GRAC group was 1.712 (1.034-2.824) compared with the low GRAC group in the 50-70 years group. Conclusion: The whole blood riboflavin level might not be associated with the occurrence of ESCC. The high whole blood riboflavin level would be more beneficial to the prognosis of ESCC patients aged 50-70 years.

[Follow-up of community injecting drug user cohort, 2014-2017]

Objective: To explore the methods of establishing and maintaining community injecting drug user (IDU) cohort. Methods: From June 2014 to June 2017, a community survey was conducted on basis of local needle and syringe exchange site to recruit 200 HIV sero-negative IDU for a prospective cohort study in Longyang district of Baoshan city, Yunan province. Follow-up was carried out every six month to investigate high risk drug use behavior and sexual behavior, and blood samples were collected from them for the tests of HIV and HCV serum antibodies. The cohort would be opened every 12 months to replenish the cohort to 200 subjects. Results: The follow up was conducted for 3 years in 229 IDUs. Cohort follow-up rate was 93.0% (213/229) for 6 months, 92.1% (211/229) for 12 months, 91.7% (200/218) for 18 months, 87.2% (190/218) for 24 months, 86.0% (172/200) for 30 months and 86.0% (172/200) for 36 months. Conclusion: The community IDU cohort has a high follow-up rate.

[Quality of network direct reporting of information about intervention service in population at high risk for HIV infection in China, 2013-2014]

Objective: To analyze the problems in the network direct reporting of information about intervention service conducted in population at high risk for HIV infection in China during 2013-2014, and provide evidence for the improvement of the network direct reporting of the intervention information. Methods: The wrong records of the intervention service in population at high-risk were collected from national AIDS prevention and treatment information system. The wrong records, including those found at county (district) level and those found at state level, were analyzed with descriptive statistical method. Results: A total of 1 066 wrong records were found during 2013-2014, and average annual wrong record rate was <0.1%. Up to 71.3% (760/1 066) of wrong records occurred in the first half year. The wrong records in eastern, central and western areas accounted for 14.9% (159/1 066), 22.6% (241/1 066) and 62.5% (666/1 066) of the total respectively. More wrong records were found in the intervention information for men who have sex with men and injecting drug users than in those for female sex workers. Among the total wrong records, 86.4% (921/1 066) were found at county level and 13.6% (145/1 066) were found at state level. The wrong records were mainly"annual number of persons receiving the first HIV test"and"annual number of persons covered by intervention". Common causes of wrong records were underreporting and delay, staff fault, miscalculation and misunderstanding. Conclusion: In general, the wrong record rate in intervention information for population at high risk for HIV infection reported directly through network was low in China. It is necessary to strengthen the recording of the intervention service, the quality control of statistics and network direct reporting and staff training to improve the quality of reported data of intervention service.

[Effect of data missing on population based viral load survey in HIV infected men who have sex with men sampled in 16 large cities, China]

Objective: To analyze the effect of missing data in population based viral load (PVL) survey in HIV infected men who have sex with men (MSM) sampled in 16 cities in China. Methods: The database of 3 virus load sampling survey conducted consecutively in HIV infected MSM population in 16 large cities (Beijing, Shanghai, Nanjing, Hangzhou, Wuhan, Chongqing, Kunming, Xi'an, Guangzhou, Shenzhen, Nanning, Urumuqi, Harbin, Changchun, Chengdu and Tianjin) during 2013-2015 was used. SPSS 17.0 software was used to describe distribution of the missing data and analyze associated factors. Results: A total of 12 150 HIV infected MSM were randomly selected for the surveys, in whom, 9 141 (75.2%) received virus load tests, while 3 009 (24.8%) received no virus load tests, whose virus load data missed. The virus load data missing rates in MSM with or without access to antiretroviral therapy (ART) were 11.5% (765/6 675) and 39.4% (2 060/5 223) respectively, and the virus load data missing rates were 21.9% (1 866/8 523) and 28.4% (959/3 374), respectively, in local residents and non-local residents (migrants). Conclusions: The analysis indicated that the data missing occurred in the virus load survey in HIV infected MSM population. ART status and census registering status were the main influencing factors. Data missing could influence the accurate evaluation of community viral load (CVL) and population viral load(PVL) levels in HIV infected MSM in China.

[Acceptability of HIV testing using oral quick self-testing kit in men who have sex with men]

Objective: To evaluate the acceptability of oral quick HIV self-testing in men who have sex with men (MSM). Methods: From April 2013 to April 2014, MSM in Beijing and Nanning of China were recruited for an observational study including baseline survey and follow-up, including questionnaire survey, oral HIV self-testing and clinic-based HIV confirmation testing. The sensitivity and specificity of oral quick self-testing were evaluated through comparing the results of oral quick testing with blood testing. The acceptability and associated factors were evaluated by logistic model. Results: A total of 510 MSM were recruited at baseline survey and 279 accepted follow-up. The sensitivity of the oral self-test was 86.00% (43/50) and specificity was 98.23% (445/453) at baseline survey. At baseline survey, 78.63% (401/510) of the MSM showed willingness to use oral quick HIV self-testing. The associated factors included unprotected anal intercourse with a regular male partner in the past 6 months (aOR=0.30, 95%CI: 0.10-1.00) and preference of oral quick HIV self-testing (aOR=7.32, 95%CI: 1.61- 33.31). At baseline survey, 34.51% (176/510) of the MSM reported that oral quick HIV self-testing was the preferred testing method rather than blood testing, which was associated with their birth places-urban area. Conclusion: The acceptability of oral quick HIV self- testing in MSM in the two cities was high.

[Estimation of HIV diagnosis rate with CD4(+) T-lymphocyte level and infected-time model in Dehong Prefecture, Yunnan Province]

Objective: To estimate the total number of people infected with HIV and to calculate the diagnosis rate of HIV in Dehong Prefecture, Yunnan Province. Methods: Through the comprehensive AIDS prevention and treatment information system, we collected and analyzed the relevant information of the new diagnosis report of HIV in Dehong Prefecture, Yunnan Province in 2006-2015, mainly including age, sex, infected transmission, CD4(+) T-lymphocyte counts, diagnostic time and so on. The content of the study was to establish a model method for estimating the diagnosis rate of HIV in Dehong. First, used the first CD4(+) T-lymphocyte count after HIV diagnosis to estimate the date of infection. Then based on the estimated time from HIV infection to diagnosis we can estimate the diagnosis delay distribution which in turn can be used to account for individuals infected but not yet diagnosed and thus estimated the total number of HIV infections (diagnosed and undiagnosed). Finally, the number of new infections in each year was added to estimate the total number of infected people, and the number of people who had been diagnosed was divided by the total number of infected persons to obtain the proportion of HIV diagnosis rate. Results: There were 8 215 reported cases in Dehong from 2006 to 2015, of which 1 297 cases were reported in 2007 (15. 8%) and 361 cases (4.4%) in 2015. The diagnosis rate of newly infected persons were 88% in 2005 and before. And from 2006 to 2015, the diagnosis rate of newly infected persons were 75%, 71%, 68%, 66%, 61%, 58%, 53%, 45%, 40% and 33%, respectively. The total number of newly infected persons in 2005 and before was 11 197 cases. The annual new infected number from 2006 to 2015 was 653, 671, 723, 640, 509, 468, 369, 375, 285 and 224 cases. The total number of people infected with HIV in Dehong was 16 114 cases, and the diagnosis rate was 87.7%. Conclusion: The diagnosis rate of HIV in Dehong was at a high level. Since 2008, the annual number of new infections in Dehong has been declining.

[Qualitative study on unprotected sexual behaviors among male students who have sex with men in Beijing]

Objective: To investigate the related factors of unprotected sexual behaviors among male students who have sex with men in Beijing. Methods: Male students who have sex with men were recruited from May 2018 to July 2018 at two voluntary counseling and testing (VCT) clinics in Beijing by convenient sampling method. Information being collected during in-depth personal interviews with a semi-structured outline included ways to seek sexual partners, sexual partners characteristics, attitude of condom use, incidence and causes of unprotected sexual behaviors, rush poppers and alcohol use. The text information was summarized and analyzed by Nvivo 11.0 software. Results: A total of 35 male students who have sex with men were recruited and interviewed, the median of age was 22 years old (P(25)-P(75): 21-24 years old). We found that incomprehensive knowledge of condom use, low risk perception of non-anal sexual behaviors, rush poppers and alcohol use were risk factors of unprotected sexual behaviors on individual level. Besides, sex with regular sex partners, partners who were much older or not from campus, and insertive partners are more likely to be unprotected. Furthermore, refusal of condom use by sexual partners and low self-efficacy of decision-making on condom use were the main reasons for unprotected sexual behaviors among male student who have sex with men. Conclusion: Lack of condom use knowledge, low risk perception of non-anal sexual behaviors and insufficient ability to refuse non-condom requirements for regular sex partners, partners who were much older or not from campus, and insertive partners are related factors of unprotected sexual behaviors among male students who have sex with men.

[Risk of HIV infection and its factors among men who have sex with men: a geosocial networking application-based survey in Beijing of China, 2017]

Objective: To assess risk of HIV infection and its risk factors among men who have sex with men (MSM) in Beijing, China. Methods: We conducted a cross-sectional online survey in October, 2017. Inclusion criteria of participants were: aged 18 year or more; resided in Beijing; conducted homosexual activities in past six months; self-reported HIV status as negative or unclear. Demographic information, HIV test history, social media use, and high-risk sexual behaviors were collected by a self-reporting questionnaire, and a HIV risk assessment tool was used to assess HIV risk of MSM, 5 388 particpants were finally enrolled in the study. Logistic regression model was used to analyze factors associated with risk of HIV infection. Results: Of the total 5 388 participants, most were 18-29 years old (64.35%), and the proportion of medium and high HIV risk score was 40.36%. The odds of medium and high HIV risk score among MSM who logged onto the app 1-20 times per week and>20 times per week were higher comparing with those who logged onto the app<1 time per week (OR=1.22, 95%CI: 1.02-1.46; OR=1.69, 95%CI: 1.38-2.06, respectively); MSM who completed college or higher education had lower probability of medium and high HIV infection risk, comparing with those who only had high school education level (OR=1.25, 95%CI:1.09-1.43) or junior or below education level (OR: 1.27, 95%CI: 1.05-1.53); MSM who did not conduct HIV test in past year had lower risk of medium and high HIV infection risk comparing with MSM who conducted HIV test in past year (OR=0.87, 95%CI: 0.77-0.99), and those who reported their HIV infection status unclear had higher probability of medium and high HIV infection risk than MSM who reported their HIV infection status negative (OR: 1.63, 95%CI: 1.44-1.86). Conclusion: The proportion of MSM who were in medium and high HIV infection risk score was high in Beijing. Lower level of education, high frequency of social media use, conducted HIV test in past year, and unclear of their own HIV infection status were associated with medium and high level of HIV infection risk.

[HIV and syphilis infection and related medical treatment status of low-fee female sex workers in three provinces of China, 2012-2015]

Objective: To understand the HIV and syphilis infection and related treatment status of low-fee female sex workers (FSWs) in 3 provinces of China. Methods: Four cross-sectional survey data of low-fee FSWs from six cities (counties) in Guangxi, Yunnan and Hunan Province between October 2012 and July 2015 were obtained from the national science and technology major special project intervention study for reducing sexually transmitted diseases (STDs) and acquired immunodeficiency syndrome (AIDS) in low-fee FSWs' database, which included social demographic characteristics, sexual service characteristics and related medical care seeking behaviors, etc. A total of 2 050 subjects were included in the database. Results: The age of the subjects was (35.16±9.76) years old, with a minimum age of 15 and a maximum age of 67. Those who use condoms every time in commercial sex accounted for 58.9% (n=1 206). Among the reasons of not using condom, the proportion of client reluctant to use was the highest (81.0% (n=682)). Only 38.1% (n=782) was tested for HIV in the last six months. HIV confirmed positive rate was 6.8% (n=139), previous positive accounts for 76.3% (n=106). Rate of antiviral therapy was 55.4% (n=77). By the end of 2015, the loss rate of antivirus treatment was 18.2% (n=14). Those who self-reported symptoms of sexually transmitted diseases in the last 6 months accounted for 9.4% (n=191). 50.3% (n=96) of reporters chose to go to formal hospitals, 23.0% (n=44) chose to go to private clinics and 20.4% (n=39) chose their own medication. The syphilis infection rate was 13.5% (n=277), among them, 91.3% (n=253) were asymptomatic. Conclusion: Among low-fee FSWs, the rates of HIV and syphilis infection are higher, the condom consistent use rate, HIV antibodies and syphilis test rate are lower. In this group, active seeking medical idea is poor, the rate of anti-virus treatment and the rate of seeking medical treatment in formal medical institutions is low.

[Changes of proportion regarding consistent condom use and syphilis infection among low-fee female sex workers aged 35 and above]

Objective: To investigate the changes of proportion on both consistent condom use and syphilis infection among low-fee female sex workers aged 35 and above (LFSW), in order to provide evidence for targeted intervention strategies. Methods: A total of six cities-Liuzhou city and Pingnan couty of Guigang city of Guangxi Zhuang Autonomous Region, Jinghong city of Xishuangbanna Dai autonomous prefecture and Dali city of Dali Bai autonomous prefecture of Yunnan province, Zhangjiajie city and Jianghua Yao autonomous county of Yongzhou city Hunan province were involved in this study, with 60 eligible participants needed in each city, estimated through a pre-study. The first cross-sectional survey was completed from October 2012 to January 2013. Face-to-face questionnaire interview was carried out to collect information on socio-demography, work-related information and condom use situation. Blood was collected for syphilis testing. The second cross-sectional survey was carried out from June to September, 2015 under the same procedure. Results: A total of 371 and 403 eligible participants were included in the first and second survey, respectively. When comparing the two surveys, we noticed that the average age showed a slight change, from 42.4 years to 43.8 years old (t=3.537, P<0.001) and the average price for every commercial sex exchange increased from 36.8 RMB to 49.5 RMB (t=11.961, P<0.001). In the first survey, 46.9% (174/371) of the participants had more than two years of experience working as LFSW, compared to 61.3% (247/403) in the second survey (χ(2)=16.125, P<0.001). Also, 46.9% (174/371) of the participants consistently used condoms with clients in the past month in the first survey versus 64.3% (259/403) (χ(2)=23.641, P<0.001) in the second one. Rates of syphilis infection were found from 15.9% (59/371) in the first survey reduced to 7.2% (29/403) in the second survey (χ(2)=14.533, P<0.001). Conclusion: Compared with the first survey, the proportion of consistent condoms use showed an increase. Although the proportion of syphilis infection decreased in the second survey, the scope did not meet the criteria on syphilis, set by the government. Targeted intervention strategies on condom promotion and syphilis control should be implemented consistently in this population.

[Characteristics of HIV sexually transmission and challenges for controlling the epidemic in China]

Sexual transmission became the major mode of HIV infection in this country and accounted for 95% of the newly diagnosed cases, 67% and 28% of heterosexual and male homosexual infections, respectively, in 2016. Heterosexual transmission was mostly reported in South-west while male homosexual transmission in North-east and major metropolitan areas. Elderly and young students became the two special groups of people with increased reported HIV cases in the past years, with major modes of transmission as both heterosexual and homosexual. HIV testing and treatment of all HIV infections have been national control strategies and implemented and have significantly reduced HIV sexual transmission among sero-discordant couples. However, about one-third HIV infections remained undiagnosed. HIV infection through sexual transmission will remain a challenge in the years to come.

Patient-derived iPSCs show premature neural differentiation and neuron type-specific phenotypes relevant to neurodevelopment

Ras/MAPK pathway signaling is a major participant in neurodevelopment, and evidence suggests that BRAF, a key Ras signal mediator, influences human behavior. We studied the role of the mutation BRAFQ257R, the most common cause of cardiofaciocutaneous syndrome (CFC), in an induced pluripotent stem cell (iPSC)-derived model of human neurodevelopment. In iPSC-derived neuronal cultures from CFC subjects, we observed decreased p-AKT and p-ERK1/2 compared to controls, as well as a depleted neural progenitor pool and rapid neuronal maturation. Pharmacological PI3K/AKT pathway manipulation recapitulated cellular phenotypes in control cells and attenuated them in CFC cells. CFC cultures displayed altered cellular subtype ratios and increased intrinsic excitability. Moreover, in CFC cells, Ras/MAPK pathway activation and morphological abnormalities exhibited cell subtype-specific differences. Our results highlight the importance of exploring specific cellular subtypes and of using iPSC models to reveal relevant human-specific neurodevelopmental events.

[Data distribution and transformation in population based sampling survey of viral load in HIV positive men who have sex with men in China]

Objective: To understand the distribution of population viral load (PVL) data in HIV infected men who have sex with men (MSM), fit distribution function and explore the appropriate estimating parameter of PVL. Methods: The detection limit of viral load (VL) was ≤ 50 copies/ml. Box-Cox transformation and normal distribution tests were used to describe the general distribution characteristics of the original and transformed data of PVL, then the stable distribution function was fitted with test of goodness of fit. Results: The original PVL data fitted a skewed distribution with the variation coefficient of 622.24%, and had a multimodal distribution after Box-Cox transformation with optimal parameter (λ) of-0.11. The distribution of PVL data over the detection limit was skewed and heavy tailed when transformed by Box-Cox with optimal λ=0. By fitting the distribution function of the transformed data over the detection limit, it matched the stable distribution (SD) function (α=1.70, β=-1.00, γ=0.78, δ=4.03). Conclusions: The original PVL data had some censored data below the detection limit, and the data over the detection limit had abnormal distribution with large degree of variation. When proportion of the censored data was large, it was inappropriate to use half-value of detection limit to replace the censored ones. The log-transformed data over the detection limit fitted the SD. The median (M) and inter-quartile ranger (IQR) of log-transformed data can be used to describe the centralized tendency and dispersion tendency of the data over the detection limit.

[Comparison of different methods in dealing with HIV viral load data with diversified missing value mechanism on HIV positive MSM]

Objective: To compare results of different methods: in organizing HIV viral load (VL) data with missing values mechanism. Methods We used software SPSS 17.0 to simulate complete and missing data with different missing value mechanism from HIV viral loading data collected from MSM in 16 cities in China in 2013. Maximum Likelihood Methods Using the Expectation and Maximization Algorithm (EM), regressive method, mean imputation, delete method, and Markov Chain Monte Carlo (MCMC) were used to supplement missing data respectively. The results: of different methods were compared according to distribution characteristics, accuracy and precision. Results HIV VL data could not be transferred into a normal distribution. All the methods showed good results in iterating data which is Missing Completely at Random Mechanism (MCAR). For the other types of missing data, regressive and MCMC methods were used to keep the main characteristic of the original data. The means of iterating database with different methods were all close to the original one. The EM, regressive method, mean imputation, and delete method under-estimate VL while MCMC overestimates it. Conclusion: MCMC can be used as the main imputation method for HIV virus loading missing data. The iterated data can be used as a reference for mean HIV VL estimation among the investigated population.

[Effect of laboratory referencing on data analysis of community viral load in HIV positive MSM from 15 cities, China]

Objective: To compare the community viral load (CVL) among MSM in 15 cities in China using standardized national reference sources. Methods: The study analyzed the existing database of National Major Science and Technology Project of China. The database was established with serial random survey of MSM HIV CVL among MSM in 15 cities from 2013 to 2015. VL tests were conducted in 15 laboratories with different equipment and methods, including RT-PCR, nucleic acid sequence based amplification (NASBA), branched DNA testing (bDNA) and Abbott M2000 RealTime system (M2000). Based on proficiency test for 15 laboratories conducted by National HIV Reference Laboratory, VL test values detected with EasyQ, bDNA and M2000 were converted and standardized into resultant values of TaqMan 2.0. Software SPSS 17.0 was used to produce descriptive statistics for the dataset. Results: From 2014 to 2015, the 15 testing sites were found to use a number of different viral load detection techniques. In 2014, the community viral load values were (2.38±1.47) and (2.99±1.31) in 15 testing sites, while in 2015 these values were found to be (2.07±1.34) and (2.72±1.19). The measurement of community VL was done using standard benchmarks of ≤200 copies/ml, ≤400 copies/ml and ≤1 000 copies/ml, that were used for reference for now. Conclusion: It is necessary to use standard detection method to improve the comparability of annual results. Using a standardized rate of ≤400 copies/ml or ≤1 000 copies/ml for successful control of VL was found with high stability for the result comparison among different areas.

[The situation and associated factors of facility-based HIV testing among men who sex with men in Beijing]

Objective: To understand the prevalence of facility-based HIV testing and its associated factors among men who have sex with men (MSM) in Beijing city. Methods: An application-based cross-sectional survey was employed to understand HIV site test situation and associated factors. The survey was carried out from May 14(th) to 21(st), 2016. Users of a smart phone application for gay dating were recruited and those eligible for this survey were investigated with an online self-administered questionnaire. Information of demographics, sexual behaviors, facility-based HIV testing history and recreational drug abuses were collected. The multivariate logistic regression was used to make comparison among different groups and assess associated factors. Results: A total of 7 494 participants were enrolled in the survey with mean age of (28.81 ± 7.38) years, 87.14% (6 530/7 494) sought sexual partners through internet. The proportion of facility-based HIV testing in 1 year was 42.55% (3 189/7 494), MSM who were 25-29 years had higher proportion of facility-based HIV testing in 1 year, the proportion was 45.56%(1 104/2 423). Among MSM who could insist in using condom during anal sex (50.46% (1 539/3 050)), the proportion of HIV site testing in 1 year was higher. The MSM who reported seeking healthcare for symptoms of a sexually transmitted infections (STIs) in the past year or ever using recreational drug had higher proportion of facility-based HIV testing, the proportions were 56.81% (409/720) and 52.00% (1 340/4 917), respectively. Compared with alone cohabitation, cohabitating was associated with decreased odds of HIV facility-based testing in past 1 year(odds ratio (OR)= 0.79, P<0.001). Compared with homosexual sexual orientation, bisexual sexual orientation was associated with decreased odds of facility-based HIV testing (OR=0.83, P=0.004). With the increasing of number of male anal sex partners, the odds of HIV facility-based testing was increasing (OR=1.31, P<0.001) But with the decreasing of the frequency of condom using with male anal sex partners, the odds of facility-based HIV testing was decreasing (OR=0.85, P=0.014). Using recreational drugs (OR=1.36, P<0.001) and seeking healthcare for symptoms of a STI in the past 1 year (OR=1.73, P<0.001) were associated with decreased odds of HIV site testing. Conclusion: MSM in Beijing had lower proportion of facility-based HIV testing in past 1 year. Multiple anal sex partners, using recreational drugs, seeking healthcare for symptoms of a STI in the past year, cohabitating, bisexual sexual orientation, and lower frequency of condom using with male anal sex partners were associated with the odds of HIV facility-based testing in past 1 year.

[Mobile internet based survey of current status of HIV test and related factors in men who have sex with men in college students in China]

Objective: To assess the current status of HIV test during the past year and related factors in men who have sex with men (MSM) in college students in China. Methods: Based on a MSM website, a cross-sectional study was conducted in 500 MSM in college students aged 18-25 years, who were selected based on the estimated HIV detection rate of 50% in this population, by means of mobile phone questionnaire survey. χ(2) test and non-conditional multivariate logistic regression analysis were conducted to identify the factors related with HIV test, respectively. Results: The mean age of MSM in college students was 20.99 (±0.04) years and the HIV test rate during the past year was 47.1%(652/1 384). Multivariate logistic regression analysis indicated that active factors associated with HIV test included awareness of HIV test (OR=6.37, 95%CI: 3.592-11.300), willing to receive regular HIV testing (OR=2.64, 95%CI: 1.191-2.631) well-knowing or not knowing of the HIV infection statues of their regular sex partners (OR=3.58, 95%CI: 2.138-5.996), (OR=2.25, 95%CI: 1.479-3.422), respectively. The negative factors associated with HIV test included believing their regular sex partners not being infected with HIV (OR=0.65, 95%CI: 0.445-0.938), having only one regular sex partner during the past year (OR=0.37, 95%CI: 0.232-0.589). Conclusion: The survey indicated that the HIV test rate in MSM in college students during the past year was low. The MSM in college students are usually sexual active, but less of them received HIV test due to the trust between them and less number of sexual partners. Close attention should be paid to the AIDS intervention in this population.

Clinical diagnostic value of free body of reduced iron protoporphyrin in uterus epithelial cells on cervical carcinoma and precancerous lesion

OBJECTIVE

Cervical cancer is a common malignant tumor in women with increased incidence and younger onset age. As a curable tumor, timely diagnosis and early intervention are critical. Based on the golden standard of cervical tissues pathology examination, we investigated the value of free body of reduced iron protoporphyrin (FH) in uterus epithelial cells for the diagnosis of cervical cancer and precancerous lesions, aiming to provide novel methods for early screening of cervical cancer.

PATIENTS AND METHODS

A total of 574 women who were screened for cervical cancer according to golden standard of pathology as the reference, were recruited for the analysis of authenticity, reliability, and predictive values of FH. The diagnostic value of FH on cervical carcinoma and precancerous lesion diagnosis was further analyzed.

RESULTS

340 individuals had normal cervical or benign lesion by pathology examination, while 155 people had precancerous lesion, among which 79 cases presented early infiltration and infiltrative cancer. In FH screening, 361 and 213 people had negative and positive results, respectively. No significant differences in the results were observed between the two methods in screening cancer and precancerous lesion (p>0.05). FH showed 93.55% sensitivity and 81.94% specificity in diagnosing precancerous lesion, while the sensitivity and specificity for cervical cancer diagnosis were 93.53% and 81.01%, respectively.

CONCLUSIONS

FH assay was demonstrated to have advantages of high diagnostic value for cervical cancer and precancerous lesion, and might be used for early screening.

[Clinical and electrophysiological studies of oxaliplatin-induced peripheral neuropathy]

OBJECTIVE

To identify the sensitive scales and the early change of nerve conduction for chronic oxaliplatin-induced peripheral neuropathy (OXLIPN), and to investigate correlation between the symptoms of acute OXLIPN and chronic OXLIPN.

METHODS

Between December 2014 and August 2015, 16 colorectal cancer patients confirmed by pathology, from department of Oncology, Chinese PLA General Hospital, scheduled to receive XELOX, completed the acute neurotoxic symptoms questionnaire at the end of 1 cycles and the scales of TNSc and NCI-CTC at the baseline and the end of 4 cycles. Nerve conduction studies (bilateral peroneal nerves and sural nerves) were performed in 11 patients at the baseline and the end of 4 cycles.

RESULTS

After chemotherapy, TNSc increased 1-9 points for all cases, while NCI-CTC increased 1 point for only 9 cases, the remaining 7 cases had the same NCI-CTC score before and after chemotherapy, where TNSc increased 1-6 points. Left sural nerve a-SNAP (amplitude of sensory nerve action potential) was (15.3±5.8)μV before chemotherapy and(12.3±5.0)μV after chemotherapy. Right sural nerve a-SNAP was (17.4±8.6)μV before chemotherapy and (13.3±6.7)μV after chemotherapy. After chemotherapy, these datum were significantly reduced for left peroneal nerve distal and proximal a-CMAP (amplitude of compound muscle action potential), bilateral sural nerve a-SNAP and left sural nerve SCV (sensory conduction velocity) (P<0.05). After chemotherapy, TNSc was correlated significantly with the acute neurotoxic symptoms questionnaire (Spearman r=0.698, P=0.003).

CONCLUSIONS

TNSc is more sensitive to the severity and changes in chronic OXLIPN than NCI-CTC. Sural nerve a-SNAP has a higher sensitivity for the early changes of nerve conduction studies in chronic OXLIPN. Patients who have more symptoms of acute OXLIPN are those who eventually develop more severe chronic OXLIPN.

Impact of human activities on subaqueous topographic change in Lingding Bay of the Pearl River estuary, China, during 1955-2013

Estuaries have been sites of intensive human activities during the past century. Tracing the evolution of subaqueous topography in estuaries on a decadal timescale enables us to understand the effects of human activities on estuaries. Bathymetric data from 1955 to 2010 show that land reclamation decreased the subaqueous area of Lingding Bay, in the Pearl River estuary, by ~170 km² and decreased its water volume by 615 × 10⁶ m³, representing a net decrease of 11.2 × 10⁶m³ per year and indicating the deposition of approximately 14.5 Mt/yr of sediment in Lingding Bay during that period. Whereas Lingding Bay was mainly governed by natural processes with slight net deposition before 1980, subsequent dredging and large port engineering projects changed the subaqueous topography of the bay by shallowing its shoals and deepening its troughs. Between 2012 and 2013, continuous dredging and a surge of sand excavation resulted in local changes in water depth of ± 5 m/yr, far exceeding the magnitude of natural topographic evolution in Lingding Bay. Reclamation, dredging, and navigation-channel projects removed 8.4 Mt/yr of sediment from Lingding Bay, representing 29% of the sediment input to the bay, and these activities have increased recently.

Label-free detection of fibrillar collagen deposition associated with vascular elements in glioblastoma multiforme by using multiphoton microscopy

Glioblastoma multiforme (GBM-WHO grade IV) is the most common and the most aggressive form of brain tumors in adults with the median survival of 10-12 months. The diagnostic detection of extracellular matrix (ECM) component in the tumour microenvironment is of prognostic value. In this paper, the fibrillar collagen deposition associated with vascular elements in GBM were investigated in the fresh specimens and unstained histological slices by using multiphoton microscopy (MPM) based on two-photon excited fluorescence (TPEF) and second harmonic generation (SHG). Our study revealed the existence of fibrillar collagen deposition in the adventitia of remodelled large blood vessels and in glomeruloid vascular structures in GBM. The degree of fibrillar collagen deposition can be quantitatively evaluated by measuring the adventitial thickness of blood vessels or calculating the ratio of SHG pixel to the whole pixel of glomeruloid vascular structure in MPM images. These results indicated that MPM can not only be employed to perform a retrospective study in unstained histological slices but also has the potential to apply for in vivo brain imaging to understand correlations between malignancy of gliomas and fibrillar collagen deposition.