[Survey on the awareness rate of mpox knowledge and related factors among men who have sex with men in China]

Objective: To understand the awareness rate of mpox knowledge and related factors among men who have sex with men (MSM) in China. Methods: The survey was conducted among men aged ≥18 years who had sex with men in the past year, using the convenience sampling method. The estimated sample size was 4 312. With the assistance of social organizations of MSM in 30 provinces in China, an online questionnaire survey was conducted using anonymous self-designed questionnaires powered by www.wjx.cn during 10-14 August 2023 to collect information on socio-demographic characteristics, awareness of mpox knowledge, travel history, and sexual behaviors of the respondents. The software SAS 9.4 was used for statistical analysis. Results: There were 7 725 respondents, and the age of the respondents was (31.6±9.0) years. The results revealed that the awareness rate of mpox knowledge was 50.1% (3 872/7 725). The main routes to acquire mpox knowledge were mainly new media, including WeChat, Weibo, TikTok, and Blued social software (88.4%,6 827/7 725), while official media report was the most trusted way to acquire related knowledge (79.3%,6 129/7 725). Multivariate logistic regression analysis revealed that the factors indicated a higher awareness rate of mpox knowledge, including living in the western region or the eastern region, people were over 26 years old in early adulthood and midlife, college-educated or with higher degrees, living in towns or urban periphery, being in homosexual or in bisexual relationships, 1-5 homosexual times/months in the past 3 months, knowing their HIV infection status, paying attention to mpox knowledge very often, occasionally or rarely, and convenient ways to acquire mpox knowledge from new media and social organizations. Conclusions: The awareness rate of mpox knowledge was low among MSM in China. Efforts should be made to improve the awareness rate of mpox knowledge among those who are young, less educated, or sexually active, with targeted health education via new media and social organizations.

[Progress on influencing factors of late diagnosis in HIV-infected patients]

At present, the late diagnosis of HIV-infected patients is not optimistic, which has a significant impact on the efficacy, cost, and prognosis of HIV antiretroviral therapy and HIV transmission. Late diagnosis is an important indicator for evaluating HIV testing. This article reviews the influencing factors of late diagnosis of HIV-infected patients and provides a reference for formulating and improving HIV testing strategies and measures in China.

[Survey on monkeypox knowledge awareness, risk perception and vaccination intention in men who have sex with men in five cities in northeast China]

Objective: To understand the monkeypox knowledge awareness, risk perception and vaccination intention in men who have sex with men (MSM) in five cities in northeast China. Methods: A cross-sectional study was conducted by using electronic questionnaire in MSM selected by convenience sampling in five cities in northeast China (Shenyang, Panjin, Changchun, Harbin and Jiamusi) from June 28 to July 8, 2023 by local centers for disease control and prevention and MSM communities. The sample size was estimated to be 220. Information about their demographics, monkeypox-related knowledge awareness, perceived concern about epidemic risk perception, and monkeypox vaccination intention were collected. Logistic regression model was used to analyze related factors for MSM's monkeypox vaccination intention. Results: In 355 MSM, 63.9% (227/355) had monkeypox vaccination intentions, and 55.5% (197/355) had high awareness of monkeypox related knowledge with a mean knowledge awareness score of 3.7±1.5. MSM with education level of high-school and above (aOR=1.93, 95%CI:1.01-3.69), higher knowledge awareness score (aOR=1.19, 95%CI:1.02-1.40) and higher risk perception of monkeypox infection (aOR=1.82, 95%CI:1.15-2.88), were more willing to receive monkeypox vaccination. The main reasons for willingness to receive monkeypox vaccine were preventing monkeypox (86.3%, 196/227) and worrying about appearance being affected (62.1%, 141/227). The main reasons for unwillingness for the vaccination included concerns about vaccine safety (53.1%, 68/128), clinical progression of AIDS being affected (46.1%, 59/128) and efficacy of antiretroviral therapy being affected (44.5%, 57/128). Conclusions: The levels of knowledge awareness and vaccine intentions still need to be improved among MSM in five cities of northeast China. It is necessary to improve the awareness of monkeypox and intention of monkeypox vaccination, promote protected sex behavior and self-assessment of infection risk, reduce vaccine hesitancy and increase monkeypox vaccination intention in MSM in 5 cities in northeast China.

[A cohort study of HIV infection in club drug abusers among men who have sex with men in Qingdao]

Objective: To understand and analyze the incidence of HIV infection in club drug abusers among men who have sex with men (MSM) in Qingdao and provide a reference for the prevention and intervention of this population. Methods: From March 2017 to July 2022, club drug abusers among MSM who are HIV-negative were recruited by snowball sampling of MSM social organizations in Qingdao, a prospective cohort was established, and a follow-up survey was conducted every six months, with the sample size estimated to be 436. The survey contents included demographic characteristics, sexual characteristics, AIDS knowledge awareness, club drug abuse, HIV testing, and other information. HIV infection was the outcome-dependent variable, and the interval between the recruitment into the cohort and the HIV infection was the time-dependent variable. Cox proportional hazards regression analysis was conducted to identify the related factors for HIV infection. Results: A total of 987 participants of club drug abusers among MSM were recruited during the baseline survey and 826 eligible participants were enrolled in this cohort. A total of 46 HIV infection cases were found, and the cumulative follow-up time was 1 960.68 person-years. The incidence of HIV infection was 2.35/100 person-years. The multivariate Cox regression analysis showed that <30 (aHR=3.04, 95%CI: 1.62-5.71) non-Shandong residents (aHR=2.29,95%CI:1.20-4.39) found their partners through offline (aHR=4.62,95%CI:2.05-10.41), homosexual sexual partners >4 (aHR=3.06,95%CI:1.59-5.88), condom broken during sex (aHR=2.24,95%CI:1.21-4.17) and hemorrhage sexual intercourse (aHR=2.56,95%CI:1.31-5.03) were significantly associated with HIV infection in this cohort. Conclusions: The incidence of HIV infection in club drug abusers among MSM in Qingdao is generally low, but knowledge and practice have separated, and the risk of HIV infection is high. The related factors of HIV infection included younger age, non-Shandong residents, finding their partners offline, multiple sexual partners, condom break during sex, and hemorrhage sexual intercourse; HIV-related behavioral intervention should be strengthened.

[A clustered epidemic investigation of non-marital non-commercial heterosexual contact of HIV in Zhejiang Province]

Objective: To identify the transmission relationship between HIV infection cases the non-marital non-commercial heterosexual contact in Zhejiang Province. Methods: When HIV positive was informed during January 2020 to January 2022, the staff conducted an epidemiological investigation to collect cases information on sociodemographic characteristics, mobility information, past HIV testing history, high-risk sexual behaviors, sexual partners, and etcetera. At the same time, 6-8 ml of blood from the new diagnosis of people infected with HIV before antiviral treatment was collected to separate the bleeding plasma. pol gene was amplified by nucleic acid extraction and PCR, sequenced by Sequencer 5.0 software, and Cytoscape 3.6.0 software was used to draw HIV molecular transmission network. Results: From January 2020 to January 2022, 88 HIV infected individuals were found in Pujiang County, of which 74 were transmitted through heterosexual transmission, of which 31 were infected through non-marital non-commercial heterosexual contact. Preliminary case studies have found that three female cases have engaged in unprotected non-marital non-commercial heterosexual contact with one male case. Among the 4 infected individuals, 2 of their spouses tested positive for HIV antibodies. Molecular transmission network monitoring was carried out on 65 newly diagnosed cases of heterosexual transmission with acquired sequences, forming 9 transmission clusters. The largest cluster contained 10 cases. A total of 11 HIV-infected individuals were involved in this HIV cluster epidemic. They were 3 males and 8 females, all over 50 years old and were farmers or rural housewives. They were traced to 7 sexual partners (6 negatives of HIV, 1 undetected). Among the 18 respondents' sexual social network relationships, there were 6 couples, 8 permanent partners, and 3 temporary partners. Among 11 HIV infected individuals, there were 9 cases of non-marital non-commercial heterosexual transmission and 2 cases of intramarital transmission. The epidemiological association between 7 non-married non-commercial heterosexual partners and case 2 (56-year-old male farmer), 3 cases confirmed by epidemiological investigation and molecular transmission cluster results, 3 cases confirmed by molecular transmission cluster and epidemiological investigation results, and 1 case confirmed by epidemiological investigation results. Conclusions: The transmission mode of this cluster epidemic was to spread HIV through heterosexual sex with a male case as the core, then cause the transmission within marriage and between fixed sexual partners. The combination of epidemiological investigation and molecular transmission network traceability survey supports the conclusion of this study.

[HIV self-testing and related factors in men who have sex with men in Shijiazhuang]

Objective: To understand HIV self-testing and related factors in men who have sex with men (MSM) in Shijiazhuang. Methods: From August to September 2020, convenient sampling was used to recruit MSM in Shijiazhuang. Online questionnaires were used to collect information about their demographic characteristics, sexual behaviors and HIV self-testing. logistic regression model was used to analyze the related factors associated with HIV self-testing. Results: In the 304 MSM respondents, 52.3% (159/304) had HIV self-testing in the past 6 months, and 95.0% (151/159) used fingertip blood HIV detection reagent. Self-purchase was the main way to obtain HIV testing reagents (45.9%, 73/159), followed by supply from MSM social organization (44.7%, 71/159). The reasons for having HIV self-testing were non-specific testing time (67.9%, 108/159) and privacy protection (62.9%,100/159), the reasons for having no HIV self-testing included inability of using (32.4%, 47/145), being unaware of HIV self-testing reagent (24.1%, 35/145), and worry about inaccurate self-testing results (19.3%, 28/145). Multivariate logistic regression analysis showed that being 18-29 years old (aOR=2.68, 95%CI: 1.20-5.94), obtaining free HIV self-testing kits in recent 6 months (aOR=8.61, 95%CI: 4.09-18.11) and making friends through Internet and social software (aOR=2.68, 95%CI: 1.48-4.88) were positive factors for having HIV self-testing. Conclusion: HIV self-testing is a more flexible and convenient way to detect HIV in MSM, and the promotion of HIV self-testing in MSM should be strengthened to further increase the HIV detection rate in this population.

[Analysis of on-demand adherence and related factors in men who have sex with men who access HIV pre-exposure prophylaxis services via the internet]

Objective: To understand the compliancy to on-demand HIV pre-exposure prophylaxis (PrEP) and related factors in men who have sex with men (MSM) accessing to PrEP service through an Internet platform. Methods: A cross-sectional study method was used to recruit survey respondents through the Heer Health platform from July 6 to August 30, 2022, and a questionnaire survey on the current status of medication use was conducted in MSM who use PrEP through the platform and take medication on demand. The MSM's information collected in the survey mainly included socio-demographic characteristics, behavioral characteristics, risk perception characteristics, PrEP awareness and the status of dose taking. Univariate and multivariate logistic regression analyses were used to evaluate factors related with compliancy to PrEP. Results: A total of 330 MSM who met the recruitment criteria were included during the survey period, with a valid response rate of 96.7% (319/330) to the questionnaire survey. The age of the 319 MSM was (32.5±7.3) years. Most of them had education level of junior college or college and above (94.7%, 302/319), most of them were unmarried (90.3%, 288/319), most of them had full-time works (95.9%, 306/319), and 40.8% of them had average monthly income ≥10 000 yuan (130/319). The proportion of the MSM with good compliancy to PrEP was 86.5% (276/319). The results of univariate and multivariate logistic analyses showed that the MSM with good awareness of PrEP had relatively better compliancy to PrEP compared with those with poor awareness of PrEP (aOR=2.43, 95%CI:1.11-5.32). Conclusions: The compliancy to on-demand PrEP was good in MSM who accessed to the services through Internet platform, but there is still a need to strengthen PrEP promotion in MSM for the further improvement of PrEP compliancy and reduction of the risk for HIV infection in this population.

[A survey on the current status of cognition of birth safety among married HIV-infected people aged 18-45 years]

Objective: To understand the current status of fertility safety cognition among married HIV-infected people aged 18-45 years and to provide evidence for fertility safety intervention in HIV-infected families. Methods: Six districts in Chongqing and Zigong City in Sichuan Province were selected. A questionnaire survey was conducted among married HIV-infected people aged 18-45 years who were followed up from November 2021 to April 2022 to collect their general demographic characteristics, histories of sex experience, fertility intention, and knowledge of birth safety. Unconditional logistic regression and Poisson regression were used to analyze the factors affecting the cognition of birth safety. Results: A total of 266 HIV-infected people were included in the study; 58.3% (155/266) were women, and 48.9% (130/266) had fertility desire. The cognition rate of knowledge of birth safety was 59.4% (158/266). The cognition rate of women's knowledge of birth safety was 2.14 (95%CI: 1.25-3.66) times that of men's. The cognition rate of knowledge of birth safety among HIV-infected persons with a high school education level or above was 1.88 (95%CI: 1.08-3.27) times that of those with a low education level. The cognition rate of knowledge of reproductive safety among HIV-infected people with fertility intention was 1.88 (95%CI: 1.10-3.22) times that of those without fertility intention. The cognition rate of knowledge of birth safety among HIV-infected persons who received AIDS knowledge promotion and education was 9.06 (95%CI: 2.46-33.32) times that of those who did not. The cognition rate of measures of birth safety was 5.3% (14/266). The Poisson regression analysis showed no significant difference in the cognition rate of specific measures among gender, age, education and other factors. Conclusions: HIV-infected people aged 18-45 years and married with a spouse have a low awareness of birth safety, and there are risks of HIV transmission between couples and mother-to-child in the family. Targeted birth safety education and intervention should be strengthened to reduce HIV transmission.

[Characteristics of mortality density of HIV/AIDS cases after diagnosis in Jiamusi of Heilongjiang province, 2010-2020]

Objective: To analyze characteristics of mortality density and the influencing factors of HIV/AIDS after diagnosis in Jiamusi of Heilongjiang province. Methods: The data were retrieved from HIV/AIDS Comprehensive Response Information System and selected cases diagnosed with HIV/AIDS in Jiamusi of Heilongjiang province during 2010-2020 and aged 15 years or older as the study objects. The method of retrospective cohort study was used to collect baseline and follow-up information, and characteristics of mortality density after HIV diagnosis were described. Death after HIV diagnosis was divided into 1-6 months, 7-12 months, and ≥13 months after HIV diagnosis. The Cox proportional hazards model was used to analyze the associated factors of mortality density within six months after HIV diagnosis. Excel 2019 and SPSS 22.0 software were used for data processing and statistical analysis. Results: A total of 953 HIV/AIDS with 173 deaths were included during the study period. Most HIV/AIDS were men (89.19%, 850/953), single or divorced or widowed (76.50%, 729/953), educated in middle school and lower level (51.84%, 494/953), and men who have sex with men (77.02%, 734/953). There was a cumulative follow-up of 3 944.59 person-years, with an overall mortality density of 4.39 (95%CI: 3.79-5.07)/100 person- years. The mortality density was highest in 21.60 (95%CI: 18.04-25.86) 100 person-years within the first six months after diagnosis, then decreased to 2.02 (95%CI: 1.59-2.58)/100 person-years over 13 months or more after HIV diagnosis. HIV/AIDS who died within the first six months after diagnosis had a higher proportion of first CD4⁺T lymphocytes (CD4) counts untested (51.61%, 48/93) and AIDS-related deaths (32.26%, 30/93). In the multivariate analysis of the Cox proportional hazards regression model, mortality density within the first six months after HIV diagnosis was greater among HIV/AIDS who were older at diagnosis, detected by medical institutions, with lower first CD4 counts or no testing, and never receiving antiretroviral therapy (ART). Conclusions: Mortality density was generally low in Jiamusi of Heilongjiang province during 2010-2020 and declined over the follow-up time. However, early diagnosis and immediate ART initiation should be strengthened. Attention should also be paid to follow-up care management and referral services for HIV/AIDS within the first six months after HIV diagnosis to reduce the risk of death after HIV diagnosis.

[Multi-state Markov model analysis of disease outcomes and influencing factors in HIV infected individuals receiving antiretroviral therapy in Luzhou of Sichuan province, 2010-2021]

Objective: To construct a multi-state Markov model and analyze the disease outcomes and its influencing factors in HIV infected individuals receiving antiretroviral therapy. Methods: A retrospective cohort analysis was conducted in HIV infected individuals receiving antiretroviral therapy in Luzhou of Sichuan province from 2010 to 2021. The disease status was divided into CD4⁺T lymphocytes (CD4) counts >500 cells/μl, 350-500 cells/μl, 200-349 cells/μl, ≤199 cells/μl and death indicated by S1-S5 in turn. A reversible continuous-time discrete-state multi-state Markov model was constructed for the analysis of disease progression features. Results: A total of 7 542 HIV infected individuals receiving antiretroviral therapy were included, and the median age (Q₁, Q₃) was 53.4 (41.2, 64.5) years old. The transition intensity of S3→S2 was higher. During follow-up, the transition probability of S4→S5 increased gradually. Influencing factors analysis of disease outcomes in HIV infected individuals receiving antiretroviral therapy showed that compared with individuals 15-24 years old, the transition intensities of S2→S1, S3→S2 and S4→S3 were lower and the transition intensity of S3→S4 was higher in individuals ≥45 years old. Compared with single individuals, the transition intensities of S3→S2 and S4→S3 were higher and the transition intensities of S3→S4 and S4→S5 were lower in married individuals. The transition intensity of S1→S2 was higher in individuals with baseline CD4 counts ≤500 cells/μl than in individuals with baseline CD4 counts >500 cells/μl. The transition intensity of S3→S4 in individuals diagnosed during 2011-2015 was lower than that in individuals diagnosed in 2010 and before. Conclusions: HIV infected individuals receiving antiretroviral therapy tended to shift to the previous disease status, suggesting that antiretroviral therapy was conducive to immune reconstitution. Older age (≥45 years old), being married, low baseline CD4 counts and being diagnosed in 2010 and before were the risk factors for disease progression.

[Survival analysis since diagnosis of HIV-positive injecting drug users aged 15 years and above in China]

Objective: To understand death's mortality and risk factors among HIV-positive injecting drug users (IDU) aged 15 or above in China and provide further reference to future prevention and treatment policies. Method: Retrospective cohort study was conducted to calculate the mortality rate of HIV-positive IDU based on HIV/AIDS Comprehensive Response Information Management System. Cox proportion hazards regression model was performed to assess the risk factors for deaths. The Excel 2019 and SPSS 22.0 software was used for data cleaning and statistical analysis. Results: Between 2001 and 2020, 119 209 HIV-positive IDU were reported with 59 094 deaths. The all-cause mortality rate was 6.96 per 100 person-years (py), and the AIDS-related mortality rate was 1.91 per 100 py, with a decreasing trend over the years. Multivariate Cox regression indicated for all-cause death risks of HIV-positive IDU, compared with those baseline T⁺ lymphocyte cells (CD4) counts above 500 cells/μl, the HR (95%CI) of those CD4 counts untested, between 0-199, 200-349, 350-500 cells/μl was 2.85 (2.78-2.93), 2.47 (2.40-2.54), 1.58 (1.53-1.62) and 1.24 (1.21-1.28) respectively. The HR (95%CI) of antiretroviral treatment (ART) naïve was 7.13 (6.99-7.27) compared with those under ART. The HR (95%CI) of methadone maintenance treatment (MMT) naïve was 1.07 (1.04-1.10) compared to those receiving MMT. As for AIDS-related death risks, compared with baseline T+ lymphocyte cell CD4 counts >500 cells/μl, the HR (95%CI) of those CD4 counts untested, between 0-199, 200-349, 350-500 cells/μl was 3.26 (3.08-3.46), 5.54 (5.24-5.85), 2.35 (2.21-2.50) and 1.41 (1.32-1.50). HR (95%CI) of ART naïve was 5.96(5.74-6.18) compared to those under ART. Conclusions: Further efforts should be made timely on diagnosis, treatment, and harm reduction programs such as MMT for improvement compliance to reduce mortality risks of HIV-positive IDU.

[Application of fuzzy analytic hierarchy process in risk assessment in medicine related fields]

Risks exist in medicine related fields, which cannot be defined and quantified precisely. It is necessary to adopt a method for the risk assessment of uncertain and fuzzy phenomenon. This paper summarizes the thinking, procedure, advantage and application of fuzzy analytic hierarchy process in the risk assessment in medicine related fields for the purpose of providing reference for its further application.

[A novel nomogram for individualized preoperative prediction of lymph node metastasis in patients with intrahepatic cholangiocarcinoma]

Objective: Constructing and validating a nomogram model for preoperative prediction of intrahepatic cholangiocarcinoma (ICC) lymph node metastasis to assist decision making during surgery. Methods: Retrospectively collecting the clinical and pathological data of 1 031 ICC patients who underwent partial hepatectomy at Eastern Hepatobiliary Surgery Hospital of Naval Military Medical University,General Hospital of Eastern Theater Command,or Zhongda Hospital Southeast University from January 2003 to January 2014. There were 682 males and 349 females; mean age was 54.7 years(range:18 to 82 years). There were 562 patients who underwent lymph node dissection and 469 patients who did not. Among the patients in the dissection group,Lasso regression method was used to filtrate preoperative variables related to lymph node metastasis and establish a nomogram. Bootstrap method was used to internally validate the discrimination of the nomogram,and the accuracy of the nomogram was assessed by using calibration curves. Patients were divided into low-moderate and high-risk groups based on model prediction probability. Propensity score matching(PSM) was used to analyze the overall survival (OS) and recurrence-free survival (RFS) of patients with and without lymph node dissection in the two groups,and to judge the importance of lymph node dissection in the two groups. Results: Six factors related to ICC lymph node metastasis were determined by Lasso regression,including hepatitis B surface antigen,CA19-9,age,lymphadenopathy,carcinoembryo antigen and maximum tumor diameter. These factors were integrated into a nomogram to predict ICC lymph node metastasis. The aera under curve value was 0.764,and the C-index was 0.754. Stratified analysis showed that OS and RFS in the high-risk group of lymph node metastasis were significantly lower than those in the low-medium risk group(median OS:14.6 months vs. 27.0 months,P<0.01; median RFS:9.1 months vs. 15.5 months,P<0.01). In the high-risk group,the median OS was 16.7 months and 6.3 months(Log-rank test: P=0.187;Wilcoxon test:P=0.046),and the median RFS was 11.0 months and 4.8 months(P=0.403),respectively in the lymph node dissection group and undissected group after PSM. In the low-medium-risk group,the median OS was 22.7 months and 26.7 months(P=0.288),and the median RFS was 13.0 months and 14.5 months(P=0.306),respectively in the lymph node dissection group and undissected group after PSM. Conclusions: The nomogram could be used for preoperative prediction of lymph node metastasis and prognostic stratification in patients with ICC. For patients with high risk of lymph node metastasis predicted by the model,active dissection should be performed. For patients predicted to be at low-moderate risk,lymph node dissection might be optional in some specific cases.

[A review of global and domestic HIV epidemic estimation]

Due to the latent characteristics of HIV infection, exceptionality of HIV high-risk population, social discrimination and insufficient awareness of AIDS prevention, timely testing and diagnosis of HIV infection is still a challenge worldwide. Until recently, it is difficult to exactly understand the overall HIV epidemic only using routine surveillance data. Therefore, epidemiological and statistical modeling is widely used to address this issue. Almost at the same time when AIDS was firstly discovered firstly, scientists also began to study the methods for the estimation and prediction of HIV infection epidemic. This article summarizes the development of global and domestic HIV epidemic estimation for the further understanding of its current performance and methods applied to provide reference for the future work.

[Epidemiological characteristics of newly reported HIV-infected adolescents aged 15-17 years outside school in China, 2011-2019]

Objective: To understand the epidemiological characteristics of HIV-infected adolescents outside school in China and provide reference to targeted prevention and control of HIV infection in this population. Methods: All the HIV-infected adolescents aged 15-17 years outside school reported during 2011-2019 were included this study. The information about their demographics, transmission routes and migration were collected from HIV/AIDS Comprehensive Response Information Management System. The χ² test was done for comparison among groups. The Joinpoint 4.9.0 software was applied to the annual percent change (APC) for time trends analysis using the Joinpoint regression model. The Excel 2019 and SPSS 22.0 software were used for data cleaning and statistical analysis. Results: A total of 4 919 HIV-infected adolescents aged 15-17 years outside school were reported accumulatively in China between 2011 and 2019, accounting for 63.4% (4 919/7 757) of total reported HIV-infected cases in this age group. Analysis on trend revealed that the new HIV infection diagnosis rate has become stable since 2016 (APC=2.5%, P=0.173) after the increase between 2011 and 2015 (APC=36.4%, P<0.001). The migration across provinces was discovered in 13.9% (684/4 919) of the HIV-infected adolescents outside school. Males, workers, and those diagnosed in detention centers or transmitted by injecting drugs or homosexual contacts accounted for a larger proportion in migrated cases compared with non-migrated cases. The adolescents outside school mainly got HIV infected by sexual contacts route, in which 66.5% (280/421) of the males were infected by homosexual contacts, while 97.8% (182/186) of the females were infected by heterosexual contacts in 2019. Conclusions: HIV-infected adolescents aged 15-17 years outside school were mainly infected by sexual contacts. However, adolescents outside school have low awareness of sexual health and high mobility, to whom close attention should be paid to improve their awareness of sexual health and to provide them with appropriate HIV infection prevention and treatment service.

[Cognition and related factors on the use of HIV non-occupational post-exposure prevention among men who have sex with men]

Objective: To understand the cognition and related factors on the use of HIV non-occupational post-exposure prophylaxis (nPEP) among men who have sex with men (MSM). Methods: The snowballing method was applied to recruit research subjects who were ≥18 years old, had sex with men in the past three months, and were aware of nPEP in MSM groups in Beijing, Shenzhen, and Kunming from March 15 to April 14, 2019. Data on social demographics, behavioral characteristics, basic knowledge of nPEP, consultation, and using nPEP were collected through "i guardian Platform". The logistic regression model was used to analyze the related factors affecting the use of nPEP. Results: Among 1 809 investigated, 39.8% (720 persons) were aware of the basic knowledge of nPEP, 33.4% (605 persons) had consulted nPEP, and 15.0% (271 persons) had used nPEP. In addition, multivariate logistic regression analysis showed that factors as whether to have sex with men infected with HIV in the last three months (OR=2.58, 95%CI: 1.64-4.07), the frequency of HIV testing in the past year (OR=2.47, 95%CI: 1.28-5.11), nPEP knowledge awareness (OR=0.70, 95%CI: 0.49-0.99), whether to consult nPEP (OR=70.98, 95%CI: 40.51-136.83) were related to the use of nPEP. Conclusions: MSM still have poor cognition of nPEP. It is necessary to strengthen the publicity and education of nPEP in MSM and promote the use of nPEP after HIV exposure as soon as possible.

[Tends on HIV and syphilis prevalence and sexual behaviors among young students in China, 2015-2019]

Objective: To analyze the tends on HIV/syphilis prevalence and sexual behaviors using the HIV/AIDS sentinel surveillance data of young students in China from 2015 to 2019 and provide evidence for the formulation of HIV/AIDS prevention and control measures among young students. Methods: From 2015 to 2019, a nationwide continuous cross-sectional survey was conducted in cities where colleges and technical schools were concentrated in each province. Multi-stage cluster sampling with the simple size 800, anonymous questionnaire, and blood sample collection were implemented to achieve general demographic information, sexual behavior, and serological information, analyze the trends and influence on HIV/syphilis infection and behaviors. Results: During 2015-2019, there was no linear trend on the antibody-positive rate of HIV[2019, 0.03% (17/54 110)], and there was a weak correlation on the antibody-positive rate of syphilis [2019, 0.08%(41/54 110)]. In 2019, the proportion of the respondents ever had sex was 8.71%(4 731/54 339), of those having regular sex partner in the last year was 3.96% (2 153/54 339), of those having a temporary partner was 1.81%(984/54 339), of a commercial sex partner was 0.19% (101/54 339), and of homosexual partners was 0.19% (101/54 339), who they were all stable. Multivariate logistic regression analysis showed that the young students who had male homosexual partners were most likely to be infected by HIV. The young students who had multiple sexual partners, including homosexual partners, were foreigners or minorities were most likely to be infected by syphilis (all P<0.05). Conclusions: The antibody-positive rates of HIV and syphilis remained low and stable among young students from 2015 to 2019 in China. However, the risk of sexual transmission of HIV and syphilis still remains among young students.

[Application of medical care cascade in hepatitis C prevention and treatment]

Medical care cascade, a population based method for tracking disease progression from diagnosis to cure, is a framework for monitoring gaps between current health service strategy and achievement of health goals. This paper summarizes the application of medical care cascade in hepatitis C prevention and treatment to facilitate the improvement in this field.

[Analysis on death trend in AIDS patients and related risk factors in China]

Objective: To understand the basic characteristics of death cases, analyze the death trends in AIDS patients and the risk factors in China and provide evidence for the development of AIDS prevention and control strategy. Methods: The data were collected from the national basic information system of HIV/AIDS. The information of the cases in AIDS phase were used. The death number and mortality trends in AIDS cases were described, and Cox Proportion Hazards Regression Model was constructed to assess hazard ratios (HR) for independent variables. Results: By the end of 2019, a total of 582 472 AIDS cases, including 168 391 deaths, had been reported in China. Among the death cases, males accounted for 76.8% (129 343/168 391), heterosexual contact was the main transmission route, accounting for 60.9% (102 516/168 391). The proportion of the death cases who had ever received ART was 54.0% (90 888/168 391). The inter-quartile (P₂₅, P₇₅) of first CD₄^＋T cells counts (CD₄) was 34 cells/μl, 240 cells/μl. Up to 43.5% (73 191/168 391) of the deaths occurred within one year after diagnosis. From 2007 to 2019, the annual death number increased from 5 485 to 18 737, the mortality rates decreased form 10.9%% to 4.3%. The average time interval from diagnosis to death ranged from 1.4 year to 4.0 years, showing increase trend by year. The results of Cox regression analysis showed that older age (50- years old: HR=1.50; ≥65 years old: HR=2.00), being male (HR=1.44)、being in minority ethnic group (HR=1.10), having lower first CD₄ levels (0- cells/μl, HR=2.73;200- cells/μl, HR=1.33; 350- cells/μl,HR=1.13), heterosexual transmission route (HR=1.64) and injecting drug use (HR=1.79) were the risk factors related to deaths in AIDS patients. The higher educational levels (junior middle school: HR=0.86, senior high school and above: HR=0.59) and receiving antiviral treatrment (HR=0.09) were protective factors. Conclusions: The number of death cases increased, meanwhile the mortality rates decrease year by year in AIDS patients in China during 2007-2019. It is necessary to strengthen the early detection and treatment of AIDS to reduce the mortality.

[Estimation of newly HIV infection trend by using the back-calculation method in Honghe Hani and Yi autonomous prefecture]

Objective: Using the changing patterns of CD(4)(+) lymphocytes (CD(4)) counts of HIV/AIDS cases, we tried to estimate the number of newly infected HIV in Honghe Hani and Yi autonomous prefecture (Honghe prefecture) Yunnan province, and to provide reference for evaluating the trend of local HIV epidemic. Methods: Among diagnosed HIV infections, those who were at ≥15 years old, having available initial CD(4) records of testing, initiating antiviral therapy before the end of 2018, were selected from the case reporting system of Honghe prefecture, Yunnan province. Both Depletion model of the square root on CD(4) and the time of infection were used to back-calculate the seroconversion time of each individual. Both direct probability distribution method and life table method were used to calculate the distribution rates of diagnosis and the weight of delay. The number of diagnoses over the years was used to reversely estimate the total number of newly HIV infections. Results: At the end of 2018, the total number of HIV infections was estimated 35 977 with the rate of diagnosis as 77.50% in Honghe prefecture of Yunnan province. The number of new HIV infections appeared as 23 792 in 2008-2018. Cumulatively, the number of new HIV infections was 12 185 up to 2007. The estimated number of new HIV infections decreased from 2 602 in 2008 to 1 480 in 2018. The weight of diagnostic delay decreased from 5.49 in one year to 1.00 in 20 years, and the diagnosis rate increased from 18.2% to 100.0% during 20 years. Conclusion: In Honghe prefecture of Yunnan province, the number of newly infection showed a declining trend but the diagnostic rate was still far from reaching the "first 90% target" . It is expected to expand the timeliness on detection and case-finding so as to reduce the risk of HIV transmission.

[Research progress of the impact of COVID-19 outbreak on people living with HIV]

The rapid spread of COVID-19 global outbreak will inevitably pose great challenges for public health and medical care, especially for major concerns of public health such as HIV. In the light of the COVID-19 pandemic, UNAIDS is urging countries to remain steadfast in their HIV prevention efforts. Few studies of COVID-19 have been focused on marginalized populations, especially those with HIV infection. This study aims to review the studies and researches of COVID-19 among people living with HIV, covering the impacts of COVID-19 on their disease progression, HIV-related medical services, HIV epidemics, and measures on relieving the above-mentioned impacts, which might provide references for targeted scientific research and prevention practice of COVID-19 in HIV population, and optimizing prevention and treatment services in the context of this pandemic.

[Characteristics and trends of newly reported HIV infection in young students in China, 2010-2019]

Objective: To analyze the characteristics and trends of newly reported HIV infection cases in young students in China between 2010 and 2019 and provide evidence for the formulation of AIDS prevention and control measures in young students. Methods: Data were collected from the Basic Web-based HIV/AIDS Case Reporting System. The HIV infection cases in students aged 15-24 years reported between 2010 and 2019 were selected. Their basic characteristics were described, and Joinpoint Regression Model was used to analyze the temporal trends of new diagnosis rates in different age groups. Results: A total of 23 307 HIV/AIDS cases were reported in young students, the male to female ratio was 33.9∶1 (22 640∶667), and the mean age was (19.9±2.05) years. The temporal trends of new diagnosis rates showed two stages, it increased rapidly between 2010 and 2015 (annual percentage changes, APC=32.1), and kept stable between 2015 and 2019 (APC=0.1, P>0.05). The new diagnosis rates in all age groups showed increasing trends between 2010 and 2015, and the APC of age group 15-17 years was highest (30.2). Between 2015 and 2019, the new diagnosis rates in age group 23-24 years showed decreasing trend (APC=-17.0). The transmission route was mainly homosexual contact for males, and heterosexual contact for females. For most heterosexual transmission cases, they were infected through non-marital or non-commercial heterosexual contact. The male cases mainly came from HIV voluntary counseling and testing clinics, but the female cases were mainly found in hospitals. The male cases had higher mean first CD(4)(+)T cells counts (CD(4)) compared with female cases (t=3.917, P=0.000). Conclusions: The overall increase trend of newly reported HIV infection in young students slowed slow down trend between 2010 and 2019, but the newly reported HIV infections in age group 15-17 years still showed an increase trend. It is necessary to carry out sex health education effectively in young students to reduce the high-risk sexual behavior and expand HIV test coverage in students.

Temperature and desorption mode matter in capacitive deionization process for water desalination

Literature reporting temperature and desorption mode as factors of capacitive deionization (CDI) process for water desalination is rare. This study explored the impacts of four water temperatures (15°C, 25°C, 35°C, and 45°C), three salt concentrations (350, 1260, and 3100 mg/L), and three desorption modes (potential removal, short circuit, and polarity reversal) on performance of a 'closed-loop' CDI system. Results showed that a higher temperature promoted adsorption and desorption rates but impaired adsorption capacity. Polarity reversal could greatly expedite the desorption process compared to short circuit and potential removal. A promotional impact of concentration on CDI desalination could be explained by the formation of electrical double layers. The research also noted the earlier occurrence of re-adsorption at higher temperatures during polarity-reversal desorption. Strategies of increasing water temperature on short adsorption cycles and using an adjustable combination mode of polarity reversal and short circuit for desorption are implied for improving desalination efficiency and water recovery of CDI systems.

[Bortezomib interferes with DNA repair and exerts synergistic anti-multiple myeloma activity with doxorubicin]

目的

探讨系统性免疫球蛋白轻链淀粉样变性（AL）初治患者的外周血免疫细胞表型特征及其与临床指标的相关性。

方法

采用流式细胞仪多参数免疫荧光分析技术，对36例AL初诊患者和28名健康供者的外周血单个核细胞的表面抗原CD3、CD56、CD4、CD8、CD25、CD45RA、CD28、CD57及核内抗原FOXP3进行检测和比较。根据梅奥2012分期对AL患者进行分期，比较Ⅰ~Ⅱ、Ⅲ~Ⅳ期患者的免疫细胞表型差异。分析λ轻链型AL患者T细胞亚群比例与多项临床指标的相关性。

结果

AL患者的外周血T（CD3⁺CD56⁻）和NKT（CD3⁺CD56⁺）细胞比例，T细胞中的CD4⁺CD8⁻、CD4⁻CD8⁺、Treg（CD4⁺CD25⁺FOXP3⁺）细胞比例与健康供者相比差异无统计学意义（P>0.05）。AL患者的CD4⁻CD8⁺细胞中，CD57⁺细胞的比例较健康供者显著降低（P<0.05），但CD45RA⁺和CD28⁺细胞的比例在AL和健康供者间差异无统计学意义。Ⅰ~Ⅱ期和Ⅲ~Ⅳ期AL患者T细胞及其亚群的比例差异无统计学意义（P>0.05）。在λ轻链型AL患者中，外周血CD4⁻CD8⁺细胞的比例与24 h尿蛋白和血肌酐呈正相关（P<0.05），与eGFR呈负相关（P<0.05），与其他临床指标无显著相关性。与此相反，CD4⁺CD8⁻细胞的比例与eGFR呈正相关，而与24 h尿蛋白和血肌酐呈负相关（P<0.05）。

结论

AL患者外周血的T细胞亚群与健康供者相比差异无统计学意义，但CD8⁺ T细胞的比例与肾脏损伤程度呈正相关，提示CD8⁺ T细胞的比例在评估AL患者肾脏预后中具有一定的价值。

[Follow-up of people living with HIV/AIDS by primary health care institutions in rural area of Jiangxi province]

Objective: To understand the current status of follow up of people living with HIV/AIDS by health service at grass root in rural area of Jiangxi province and related factors, and provide references for the promotion of the follow up by grass root health service. Methods: People living HIV/AIDS aged ≥18 years and diagnosed before 31 December 2017 in 6 townships of Xinjian, Yushan counties and Guixi city were included in the study in Jiangxi province. They had been followed up for more than one time after the first epidemiologic survey. The information about their demographic characteristics and HIV infection status were collected by using self-designed questionnaire. Univariate and multivariate logistic regression analyses were conducted to identify the factors that influencing the acceptance of follow up by grass root health service. Results: Of the 373 surveyed HIV infected subjects aged (53.06±16.15) years, 261 were males (70.0%, 261/373). Among the surveyed subjects, the illiteracy and people who received only primary school education accounted for 54.7% (204/373). The rate of follow up of the HIV infected subjects by grass root health service was 55.8% (208/373), and those through heterosexual contact were 58.5% (190/325). The multivariate regression analysis showed that the acceptance of follow up by grass root health service was higher in those who were farmers (OR=7.36, 95%CI: 2.52-21.45), had family support (OR=16.01, 95%CI: 2.25-49.73), didn't worry about discrimination (OR=12.97, 95%CI: 4.75-35.42), trusted health care provider (OR=5.07, 95%CI: 2.19-11.76) and showed AIDS symptoms (OR=10.58, 95%CI: 2.25- 49.73). Conclusions: The performance of follow up of people living with HIV/AIDS by grass root health service was well, suggesting it is a feasible management model. Being famer or not, family member supporting or not, worry about discrimination or not, trusting health care provider or not and showing AIDS symptoms or not were the main factors influencing the acceptance of follow up by grass root health service.

[Survival analysis of people living with HIV/AIDS in Sichuan province, 1991-2017]

Objective: To analyze the survival time of people living with HIV/AIDS and related influencing factors in Sichuan province during 1991-2017. Methods: A retrospective cohort study was conducted to analyze the data of 143 988 HIV/AIDS cases. The data were collected from Chinese HIV/AIDS Comprehensive Information Management System. Life table method was used to calculate the survival proportion of the cases, and Cox proportion hazard regression model was used to identify the factors related with survival time. Results: Among 143 988 HIV/AIDS cases a total of 30 420 cases died of AIDS related diseases (21.1%) and the average survival time was 11.51 years (95%CI: 11.39-11.64). Multivariate Cox regression analysis showed that the influencing factors for the survival of HIV/AIDS cases were gender (male vs. female, HR=1.35, 95%CI: 1.32-1.40), education level (primary school or below vs. junior middle school: HR=1.15, 95%CI: 1.12-1.18), ethnic group (Han vs. other ethnic groups, HR=1.46, 95%CI: 1.41-1.52), occupation (farmer vs. other occupations: HR=1.26, 95%CI: 1.22-1.29), age (≥55 years old vs. 15-24 years old: HR=3.18, 95%CI: 3.02- 3.36), disease phase (AIDS vs. HIV infection: HR=1.44, 95%CI: 1.39-1.48), antiretroviral therapy (ART) (receiving ART vs. receiving no ART: HR=0.20, 95%CI: 0.19-0.20), and CD(4)(+)T cell counts at diagnosis (>500 cells/μl vs.<200 cells/μl: HR=0.42, 95%CI: 0.40-0.45). Conclusions: The average survival time of HIV/AIDS cases was 11.51 years in Sichuan during 1991- 2017. The risk factors for the survival of the cases were male, education level of primary school or below, Han ethnic group, farmer, old age at diagnosis, disease phase, The protective factors for the survival of HIV/AIDS cases were receiving ART and higher CD(4)(+) T cell counts at diagnosis.

Variability of residual chlorine in swimming pool water and determination of chlorine consumption for maintaining hygienic safety of bathers with a simple mass balance model

Trial-and-error chlorination as a conventional practice for swimming pool water disinfection may fail to consistently maintain the pool's residual chlorine within regulatory limits. This study explored the variability of residual chlorine and other common water quality parameters of two sample swimming pools and examined the potential of using a mass balance model for proactive determination of chlorine consumption to better secure the hygienic safety of bathers. A lightly loaded Pool 1 with a normalized bather load of 0.038 bather/m³/day and a heavily loaded Pool 2 with a normalized bather load of 0.36 bather/m³/day showed great variances in residual free and combined chlorine control by trial-and-error methods due to dynamic pool uses. A mass balance model based on chemical and physical chlorine consumption mechanisms was found to be statistically valid using field data obtained from Pool 1. The chlorine consumption per capita coefficient was determined to be 4120 mg/bather. The predictive method based on chlorine demand has a potential to be used as a complementary approach to the existing trial-and-error chlorination practices for swimming pool water disinfection. The research is useful for pool maintenance to proactively determine the required chlorine dosage for compliance of pool regulations.

[An analysis of factors associated with timeliness of antiretroviral therapy initiation among newly diagnosed HIV/AIDS from 2010 to 2014 in China]

Objective: To analyze timeline of antiretroviral therapy (ART) initiation among newly diagnosed HIV/AIDS from 2010 to 2014, as well as influencing factors. Methods: Data from the Chinese HIV/AIDS Comprehensive Response Information Management System was used to collect newly diagnosed HIV/AIDS cases from January 1, 2010 to December 31, 2014. Inclusion criteria of HIV/AIDS were confirmed cases and clinically diagnosed HIV positive, Chinese mainland cases, 14 years old and above, the first CD4(+)T lymphocyte ≤350 cells/μl in the follow up period. A total of 177 971 HIV/AIDS cases were included in this study. The general demographic characteristics (gender, age, ethnicity, education, occupation, etc.), infection routes, sample sources, CD4(+)T lymphocyte level and other information were collected from the database. Chi square test was used to analyze univariate factor of the timeliness of ART initiation. Multivariate logistic regressions were used to analyze potential factors associated with timeliness of ART initiation. Results: Out of the 17 7971 cases, 130 679 (73.4%) were males. The proportion of the timeliness of ART initiation was 55% (97 915). The proportion of timeline of ART within 15 d increased from 26.4% (4 319/16 388) in 2010 to 39.7% (20 212/50 889) in 2014. The highest proportion was in the group of patients infected by illegal blood (plasma) donation, which was 38% (945). The proportion of timeline of ART within 30 d increased from 43.2% (7 077/16 388) in 2010 to 63% (32 070/50 889) in 2014.The highest proportion was in the group of patients infected by heterosexual transmission, which was 58.3% (73 098). Multivariate logistic regression analysis on timeliness of ART showed that the factors of timeliness of ART initiation of HIV/AIDS as follow. The possibility of timeliness of ART among patients who were female, education of junior high school and above, ethnic group of Han, farmers, married were higher, with OR values at 1.08, 1.09, 1.13, 1.05 and 1.12. The possibilities of timeliness of ART in group of patients aging 25-34, 35-44, 45-54 and ≥55 years old were higher than that of the group of patients aging 15-24 years old, with OR values at 1.13, 1.31, 1.46 and 1.51, respectively. The possibilities of timeliness of ART among the homosexuals, injection drug use and sexual contact plus injection drug use cases were lower than that of the heterosexuals, with OR values at 0.86, 0.59 and 0.72, respectively. The possibilities of timeliness of ART among patients whose HIV diagnosis from hospitals and detention centers were lower than that of patients whose HIV diagnosis from volunteer testing and counseling, with OR values at separately 0.90 and 0.29. The possibilities of timeliness of ART among patients whose CD4(+)T lymphocyte at 50-99, 100-199, 200-350 cells/μl were lower than that of the patients whose CD4(+)T lymphocyte count at 0-49 cells/μl, with OR values at 0.84, 0.64 and 0.40, respectively. All the P values above was<0.05. Conclusion: The proportion of timeliness of ART increased annually from 2010 to 2014. Those who were men, unmarried or divorced, at younger age, injection drug use, diagnosis from hospitals and detention centers and high CD4(+)T lymphocyte levels were related to the timeliness of ART.

Formation of disinfection by-products under influence of shale gas produced water

Accidental spills and surface discharges of shale gas produced water could contaminate water resources and generate health concerns. The study explored the formation and speciation of disinfection by-products (DBPs) during chlorination of natural waters under the influence of shale gas produced water. Results showed the presence of produced water as low as 0.005% changed the DBP profile measurably. A shift to a more bromine substitution direction for the formation of trihalomethanes, dihaloacetic acids, trihaloacetic acids, and dihaloacetonitriles was illustrated by exploring the individual DBP species levels, bromine substitution factors, and DBP species fractions, and the effect was attributable to the introduction of bromide from produced water. The ratio of dichloroacetic and trichloroacetic acids also increased, which was likely affected by different bromination degrees at elevated bromide concentrations. Increasing blend ratios of produced water enhanced the formation of DBPs, especially the brominated species, while such negative effects could be alleviated by pre-treating the produced water with ozone/air stripping to remove bromide. The study advances understandings about the impacts of produced water spills or surface discharges regarding potential violation of Stage 2 DBP rules at drinking water treatment facilities.

Impacts of shale gas production wastewater on disinfection byproduct formation: An investigation from a non-bromide perspective

The rapid rise of shale gas development has triggered environmental and human health concerns due to its impacts on water resources, especially on disinfection byproduct (DBP) formation upon chlorination. Despite the recently reported results on bromide, the effects of non-bromide ions in production wastewater at extremely high levels are vaguely defined. In this study, we investigated the effects of production wastewater, with bromide and non-bromide species, on the formation of DBPs when production wastewater was spiked into surface waters at various percentages. Results showed that the introduction of debrominated production wastewater led to increased formation of some chlorinated DBP species in selected surface water and wastewater. As the spiking percentage of debrominated production wastewater increased, the chlorinated DBP species increased. The contributions of individual cations to DBP formation followed a sequence of magnesium > calcium > barium at 0.10% spiking percentage due to the different catalytic effects of their chelates with organic precursors. The study of anions suggested that the discharge of treated production wastewater containing elevated sulfate may further enhance DBP formation. The significance of this study lies in the fact that in addition to bromide concerns from production wastewater, non-bromide species also contributed to DBP formation. The gas production wastewater management decision should consider the negative impacts from both bromide and non-bromide species to better protect the receiving water resources.

A feasibility study of disinfection by-product precursor removal from surface water by a membrane bioreactor acclimatized with wastewater organic matter

A membrane bioreactor (MBR) acclimatized with wastewater organic matter was employed for surface water treatment, and the feasibility of the MBR for the removal of disinfection by-product (DBP) precursors was studied. With a low pressure microfiltration hollow-fiber membrane module, a hydraulic retention time of 1.5 hours and a solids retention time of 180 days, the MBR was able to achieve 35% removal of trichloroacetic acid precursors and 21% removal of dichloroacetic acid precursors. The removal of trichloromethane (TCM) and brominated DBP precursors was unsatisfactory. The TCM yield and bromine substitution factors for trihalomethanes and dihaloacetic acids increased. The phenomena could be attributed to an extended treatment time for hydrophobic dissolved organic matter (DOM), production of soluble microbial products from biomass activities, and an increased Br/DOM ratio by the MBR. Since the MBR treatment would lead to the production of some new DBP precursors and a change of DOM composition, the toxic potency of the DBPs formed needs to be taken into consideration if this process is employed for surface water treatment.

Novel ZnFe2O4/TiO2/flake graphite composite as particle electrodes for efficient photoelectrocatalytic degradation of rhodamine B in water

A novel ZnFe₂O₄/TiO₂/flake graphite composite material was synthesized and used as particle electrodes in a photoelectrocatalytic (PEC) system to investigate the degradation of rhodamine B as a model dye pollutant in water. Results showed that a PEC process with the new composite evidently led to enhanced degradation of rhodamine B due to a synergistic effect of photocatalysis and electrocatalysis. Operating variables including electrolyte concentration, applied cell voltage, air flow, composite dosage, solution pH, and dye concentration were also found to play important roles in rhodamine B removal. A 99.0% removal efficiency was observed within 30 min of treatment under optimum conditions of 0.01 mol/L Na₂SO₄, applied cell voltage of 15 V, air flow of 20 mL/min, composite dosage of 10 g/L, solution pH of 2, and rhodamine B concentration of 20 mg/L, with a pseudo-first-order rate constant of 0.278 min^-1. These findings could provide new insights into the development of efficient PEC technologies on degradation of residual dyes in water.

[Survival time of newly diagnosed HIV/AIDS cases and related factors in China, 2010]

Objective: To analyze the survival time of newly diagnosed HIV/AIDS cases and related factors in China in 2010. Methods: The reporting cards and follow-up cards of HIV/AIDS cases reported as of 31 December 2015 were collected from national AIDS information system. The newly diagnosed HIV/AIDS cases in 2010 were selected. The information of follow-up intervention, CD(4+)T cells (CD(4)) testing, antiretroviral treatment and mortality of the cases from 2010 to 2015 were analyzed. Life table method was applied to calculate the survival probability. Kaplan-Meier was used to draw survival curve and Cox proportion hazard regression model were used to identify the factors related to survival time. Results: Of the 40 335 HIV/AIDS cases, 11 975(29.7%) died of AIDS related diseases. The median survival time was 63.1 months (95%CI: 63.0-63.2), and the survival rates in 1 year and 5 years were 81.2% and 69.9%. Multivariate Cox regression analysis showed that the risk factors for death in the HIV/AIDS cases were age (25-34 years old vs. 15-24 years old: HR=1.41, 95%CI: 1.29-1.54; 35-34 years old vs. 15-24 years old: HR=1.90, 95%CI: 1.74-2.07; 45-54 years old vs. 15-24 years old: HR=2.24, 95%CI: 2.04-2.46; ≥55 years old vs. 15-24 years old: HR=2.81, 95%CI: 2.57-3.08). The protective factors for death in the HIV/AIDS cases were level of baseline CD(4) counts (CD(4)≥500 cells/μl vs. CD(4)<200 cells/μl: HR=0.12, 95%CI: 0.11-0.13), receiving antiretroviral therapy (ART vs. no ART: HR=0.11,95%CI: 0.10-0.12). Conclusion: Survival time of HIV/AIDS cases might be influenced by age, baseline CD(4) count and access to antiretroviral therapy. The early diagnosed and early antiretroviral therapy could extend the survival time of HIV/AIDS cases.

[HIV transmission in newly reported HIV infected couples before diagnoses in five provinces, China, 2011-2014]

Objective: To understand the HIV transmission and associated factors in newly reported HIV infected couples before diagnosis. Methods: The information about newly reported HIV infected couples in Yunnan, Guangxi, Sichuan, Henan and Xinjiang provinces (autonomous region) were collected from National HIV/AIDS Information System from 2011 to 2014. The infection order of the sero-concordant couples were determined. Logistic regression model was used to analyze the HIV transmission between couples and identify the associated factors. Cochran-Armitage trend analysis was conducted to understand the annual sero-concordant couple proportion. Results: A total of 48 931 HIV cases in couples were included in this study, among whom 12 051(24.6%) were sero-concordant couples, indicating HIV transmissions occurred between them. Multivariate logistic regression analysis showed that those who were females (OR=1.98, 95%CI: 1.89-2.08), aged >45 years (45-59 yrs: OR=1.32, 95% CI: 1.23-1.42; >60 yrs: OR=1.72, 95% CI: 1.58-1.86), had educational level of middle school education or below (illiteracy and primary school: OR=1.33, 95%CI: 1.23-1.44; middle school: OR=1.19, 95% CI: 1.10-1.28), were farmers or migrate workers (OR=1.23, 95% CI: 1.17-1.30), were infected through injecting drug use or heterosexual intercourse (injecting drug use: OR=1.33, 95% CI: 1.03-1.72; heterosexual intercourse: OR=3.65, 95% CI: 2.89-4.61), had CD₄⁺T cells of <500 cells/μl (<200 cells/μl: OR=5.05, 95%CI: 4.62-5.52; 200-349 cells/μl: OR=3.58, 95%CI: 3.26-3.93; 350-500 cells/μl: OR=2.14, 95%CI: 1.94-2.36), reported unprotected sexual behaviors (OR=1.56, 95% CI: 1.49-1.64), were more likely to infect their couples before diagnosis. The HIV transmission proportion between couples before diagnosis decreased significantly from 28.9% (2 631/9 102) in 2011 to 25.5% (3 009/11 787) in 2014 among those infected through heterosexual intercourse. Conclusion: The proportion of HIV transmission between couples before diagnosis varied among different populations. Behavior intervention and early HIV test promoting are needed to prevent HIV transmission between couples before diagnosis in populations at high risk for HIV infection. HIV infection cases should be included in the HIV care system after diagnosis as early as possible.

[Factors associated with marital status among spouse after diagnosed in newly reported HIV cases in China, 2014]

Objective: To analyze the factors associated with divorce or separation when one of the spouse diagnosed and newly reported as HIV positive, in China. Methods: Data from the Chinese HIV/AIDS Comprehensive Response Information Management System, by December 31, 2015 were used for collection on newly reported HIV cases regarding their baseline information in 2014 and follow-up within one year, among couples and above 18 year olds. HIV cases were divided into divorce/separation group and married group according to their marriage dynamics in one year after being diagnosed as HIV positive. Multivariate logistic regressions were used to analyze potential factors associated with divorce or separation after the diagnoses made. Results: A total of 31 708 HIV cases were included in this study. 22.5% (7 134/31 708) of them got divorced or separated in one year after diagnose being made. 81.6% (25 864/31 708) of them had couples tested in one year after diagnose made and 10.0% (2 599/25 864) of them got divorced or separated. Among 18.4% (5 844/31 708) of the HIV cases who did not have their couples tested in one year after the diagnoses, 77.6% (4 535/5 844) got divorced or separated. For those who did not have their couples tested in one year after the diagnose. Data from the multivariate logistic regression analysis showed that factors as those who were older than 45 (46-60 yr.: OR=1.28, 95%CI: 1.03-1.58; ≥61 yr.: OR=1.83, 95%CI: 1.41-2.37), with Han ethnicity (OR=1.56, 95%CI: 1.34-1.83), with high school education or above (OR=1.55, 95%CI: 1.27-1.90), non-farmers or non-rural laborers (OR=1.34, 95%CI: 1.17-1.54), infected through injecting drug use (OR=1.33, 95% CI: 1.03-1.71), men who had sex with men (OR=1.49, 95% CI: 1.20-1.86), or with childless (OR=2.35, 95%CI: 1.78-3.09) etc. were more likely to be divorced or separated after the diagnoses being made, among those who had their couples tested in one year after the diagnoses. Results from the multivariate logistic regression analysis showed that factors as those who were above 60 year olds (OR=1.32, 95%CI: 1.12-1.56), with Han ethnicity (OR=1.27, 95%CI: 1.13-1.44), with high school education or above (OR=1.26, 95%CI: 1.11-1.43), non-farmers or non-rural labors (OR=1.37, 95%CI: 1.25-1.51), infected through having sex with men (OR=1.38, 95%CI: 1.25-1.54), or without a child (OR=1.48, 95% CI: 1.27-1.71), were more likely to be divorced or separated after the diagnoses. Conclusion: A certain proportion of HIV cases got divorced or separated in one year after the diagnosis was made. The proportions of divorce or separation were different among populations. Interventions targeting reducing divorce or separation in certain populations should be integrated into routine care system to reduce the HIV transmission.

[Effects of standardized follow-up program among newly diagnosed HIV/AIDS cases in 2010]

Objective: To analyze the effects of a follow-up program among newly diagnosed HIV/AIDS cases in 2010 in China. Methods: Database was downloaded on January, 2016 from both HIV/AIDS Case Reporting and Follow-up Cards. Information related to newly diagnosed HIV/AIDS cases in 2010 was extracted from the database. Information on follow-up intervention programs, CD₄ testing, antiretroviral treatment, sexual behavior and mortality from 2010 to 2015 were analyzed. Results: Of the newly diagnosed HIV/AIDS cases in 2010, 70.4% were men and 72.0% with Han ethnicity. Heterosexual transmission accounted for 65.8%. The proportion of having received standardized follow-up increased significantly, with an annually upward trend (trend χ²=3 749.77, P<0.01). The proportions of sexual risk behaviors decreased significantly, with safe sexual behaviors over 90%, and having yearly upward trend (trend χ²=16 971.98, P<0.01). Among those eligible for antiretroviral therapy, the proportion of initiation the therapy increased from 56.5% in 2010 to 83.2% in 2015, with significant upward trend, annually (trend χ²=2 504.86, P<0.01). Over the same period, the proportion of deaths decreased from 12.4% in 2010 to 2.4% in 2015, with significant annual downward trend (trend χ²=4 935.89, P<0.01). Conclusion: The standardized follow-up intervention program included the contents of: CD₄ testing; counseling and timely referrals to receive antiretroviral therapy etc., which were correlated to the reduction on both high risk sexual behaviors and deaths.

CYP4A in tumor-associated macrophages promotes pre-metastatic niche formation and metastasis

Tumor-associated macrophages (TAMs) play an essential role in metastasis. However, what enables TAMs to have a superior capacity to establish pre-metastatic microenvironment in distant organs is unclear. Here we have begun to uncover the effects of cytochrome P450 (CYP) 4A in TAMs on lung pre-metastatic niche formation and metastasis. CYP4A⁺ TAM infiltration was positively associated with metastasis, pre-metastatic niche formation and poor prognosis in breast cancer patients. The pharmacological inhibition of CYP4A reduced lung pre-metastatic niche formation (evidenced by a decrease in vascular endothelial growth factor receptor 1 positive (VEGFR1⁺) myeloid cell recruitment and pro-metastatic protein expression) and metastatic burden, accompanied with TAM polarization away from the M2 phenotype in spontaneous metastasis models of 4T1 breast cancer and B16F10 melanoma. Co-implantation of 4T1 cells with CYP4A10^high macrophages promoted lung pre-metastatic niche formation and metastasis. Depletion of TAMs disrupted lung pre-metastatic niches and thereby prevented metastasis. Treatment with the CM from CYP4A10^high M2 macrophages (M2) increased pre-metastatic niche formation and metastatic burden in the lungs, whereas CYP4A inhibition attenuated these effects. In vitro TAM polarization away from the M2 phenotype induced by CYP4A inhibition decreased VEGFR1⁺ myeloid cell migration and fibronectin expression, accompanied with downregulation of STAT3 signaling. Conversely, overexpression of CYP4A or exogenous addition of 20-hydroxyeicosatetraenoic acid promoted M2 polarization and cytokine production of macrophages and thereby enhanced migration of VEGFR1⁺ myeloid cells, which were reversed by siRNA or pharmacological inhibition of STAT3. Importantly, a combined blocking M2 macrophage-derived factors TGF-β, VEGF and SDF-1 abolished VEGFR1⁺ myeloid cell migration and fibroblast activation induced by CYP4A. In summary, CYP4A in TAMs is crucial for lung pre-metastatic niche formation and metastasis, and may serve as a potential therapeutic target in human cancer.

Lack of evidence for a harmful effect of sodium-glucose co-transporter 2 (SGLT2) inhibitors on fracture risk among type 2 diabetes patients: a network and cumulative meta-analysis of randomized controlled trials

AIM

To evaluate the comparative effects of sodium-glucose co-transporter 2 (SGLT2) inhibitors on risk of bone fracture in patients with type 2 diabetes mellitus (T2DM).

METHODS

PubMed, EMBASE, CENTRAL and ClinicalTrials.gov were systematically searched from inception to 27 January 2016 to identify randomized controlled trials (RCTs) reporting the outcome of fracture in patients with T2DM treated with SGLT2 inhibitors. Pairwise and network meta-analyses, as well as a cumulative meta-analysis, were performed to calculate odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

A total of 38 eligible RCTs (10 canagliflozin, 15 dapagliflozin and 13 empagliflozin) involving 30 384 patients, with follow-ups ranging from 24 to 160 weeks, were included. The fracture event rates were 1.59% in the SGLT2 inhibitor groups and 1.56% in the control groups. The incidence of fracture events was similar among these three SGLT2 inhibitor groups. Compared with placebo, canagliflozin (OR 1.15; 95% CI 0.71-1.88), dapagliflozin (OR 0.68; 95% CI 0.37-1.25) and empagliflozin (OR 0.93; 95% CI 0.74-1.18) were not significantly associated with an increased risk of fracture. Our cumulative meta-analysis indicated the robustness of the null findings with regard to SGLT2 inhibitors.

CONCLUSIONS

Our meta-analysis based on available RCT data does not support the harmful effect of SGLT2 inhibitors on fractures, although future safety monitoring from RCTs and real-world data with detailed information on bone health is warranted.

Effect of capacitive deionization on disinfection by-product precursors

Formation of brominated disinfection by-products (DBPs) from bromide and natural organic matter upon chlorination imposes health risks to drinking water users. In this study, capacitive deionization (CDI) was evaluated as a potential process for DBP precursor removal. Synthetic humic acid and bromide containing saline water was used as model water prior to CDI treatment. Batch experiments were conducted at cell voltages of 0.6-, 0.9-, and 1.2V to study the influence of CDI on the ratio of bromide and dissolved organic carbon, bromine substitution factor, and DBP formation potential (FP). Results showed beneficial aspects of CDI on reducing the levels of these parameters. A maximum DBPFP removal from 1510 to 1160μg/L was observed at the cell voltage of 0.6V. For the removed DBPFP, electro-adsorption played a greater role than physical adsorption. However, it is also noted that there could be electrochemical oxidations that led to reduction of humic content and formation of new dichloroacetic acid precursors at high cell voltages. Because of the potential of CDI on reducing health risks from the formation of less brominated DBPs upon subsequent chlorination, it can be considered as a potential technology for DBP control in drinking water treatment.

Biologically active carbon filtration for haloacetic acid removal from swimming pool water

A biologically activate carbon (BAC) filter was continuously operated on site for the treatment of haloacetic acids (HAAs) in an outdoor swimming pool at an average empty bed contact time (EBCT) of 5.8 min. Results showed that BAC filtration was a viable technology for direct removal of HAAs from the pool water with a nominal efficiency of 57.7% by the filter while the chlorine residuals were 1.71 ± 0.90 mg/L during the study. THMs and TOC were not removed and thus were not considered as indicators of the effectiveness of BAC filtration. Increased EBCT in the range of 4.5 and 6.4 min led to improved HAA removal performance, which could be best fit by a logarithmic regression model. BAC filtration also affected the HAA speciation by removing more dichloroacetic acid (DCAA) than trichloroacetic acid (TCAA), resulting in a lower ratio of DCAA/TCAA in the filtered effluent. However, the observation of an overall constant ratio could be attributable to a complex formation and degradation mechanism occurring in swimming pools.

Clinical research on dendritic cell vaccines to prevent postoperative recurrence and metastasis of liver cancer

We aimed to evaluate dendritic cell (DC) tumor vaccines for preventing liver cancer recurrence and metastasis. DCs were induced from mononuclear cells in the peripheral blood with recombinant human granulocyte macrophage colony stimulating factor (rhGM-CSF) and recombinant human interleukin 4 (rhIL-4), followed by sensitization with lysis of autologous liver cancer cells. One hundred and sixty patients with hepatocellular carcinoma were randomly divided into two groups of 80. One group was treated postoperatively with six cycles of the DC tumor vaccine. The other group was treated postoperatively with six cycles of FOLFOX 6, beginning 1 week after surgery. After treatment with DC tumor vaccines, the levels of CD3+, CD4+, and CD8+, the ratio of CD4+ to CD8+ DC, and the serum levels of IL-12 and IFN-γ were significantly increased both in comparison to the pre-treatment levels (P < 0.001) and to the chemotherapy group (P < 0.001). After a postoperative follow-up of 18 months, the metastatic recurrence rate in the DC tumor vaccine group was significantly lower than that in the chemotherapy group (17.50 vs 48.75%, P < 0.005), and the survival rate of the patients in the DC tumor vaccine group was higher than that of the chemotherapy treatment group (86.25 vs 52.50%, P < 0.005). Treatment with DC tumor vaccines was safe and feasible. It can enhance the immunity of the patients, reduce the rates of metastasis and recurrence, and improve survival rates. This is a promising treatment for the prevention of postoperative recurrence in patients with liver cancer.

Nitrification at full-scale municipal wastewater treatment plants: Evaluation of inhibition and bioaugmentation of nitrifiers

Batch nitrification tests were conducted with sludge and wastewater streams obtained from field implementations to evaluate nitrification inhibition and efficiency of a nitrifiers bioaugmentation technology at full-scale municipal wastewater treatment plants (WWTPs). The results showed that the substrate organic carbon and pH of wastewater streams were inhibitory factors to nitrification and the low pH was the cause of the WWTP experiencing poor nitrification. An ammonia-nitrogen removal rate of 0.21mg-N/gMLVSS-h was observed at pH 6.5, while the rate increased to 0.54mg-N/gMLVSS-h with an introduction of 6% bioaugmented nitrifiers, indicating that the integrated side-stream nitrifiers bioaugmentation process was beneficial in improving nitrification efficiency, even under low pH conditions not conducive to nitrification. The study provides new insights into effective upgrading of municipal WWTPs exposed to poor nitrification.

Novel VN/C nanocomposites as methanol-tolerant oxygen reduction electrocatalyst in alkaline electrolyte

A novel VN/C nanostructure consisting of VN nanoparticles and graphite-dominant carbon layers is synthesized by nitridation of V₂O₅ using melamine as reductant under inert atmosphere. High crystalline VN nanoparticles are observed to be uniformly distributed in carbon layers with an average size of ca13.45 nm. Moreover, the electrocatalytic performance of VN/C towards oxygen reduction reaction (ORR) in alkaline electrolyte is fascinating. The results show that VN/C has a considerable ORR activity, including a 75 percent value of the diffusion-limited current density and a 0.11 V smaller value about the onset potential with respect to Pt/C catalyst. Moreover, the excellent methanol-tolerance performance of VN/C has also been verified with 3 M methanol. Combined with the competitive prices, this VN/C nanocomposite can serve as an appropriate non-precious methanol-tolerant ORR catalyst for alkaline fuel cells.

Malondialdehyde and SOD-induced changes of gastric tissues in acute gastric mucosal injury under positive acceleration

The aim of this study was to investigate the impacts of positive acceleration (+Gz) on the gastric mucosal tissues in cases of acute gastric mucosal injury and to explore the role of oxygen free radicals. Thirty Sprague Dawley rats were randomly divided into the absolute ethanol control group (A group), absolute ethanol +5Gz group (B group), absolute ethanol +10Gz group (C group). Following centrifugation, the gastric tissues of each group were studied for the presence of gastric mucosal injuries and morphological changes. The concentrations of malondialdehyde (MDA) and superoxide dismutase (SOD) contents were simultaneously investigated. Degree of gastric mucosal injuries were as follows: C group (visually 49.080 ± 10.254, under light microscopy 9.400 ± 2.011) > B group (visually 23.654 ± 9.678, under light microscopy 5.000 ± 1.054) > A group (visually 11.410 ± 3.742, under light microscopy 3.800 ± 1.399). The gastric mucosal MDA content (0.376 ± 0.084 vs 0.235 ± 0.044) was significantly higher in the C group than in the A group, whereas the SOD content (8.852 ± 1.001 vs 10.694 ± 0.965) was lower than that in the A group. However, the MDA and SOD contents did not change much in the B group. Our results suggest that the +Gz exposure might aggravate the acute gastric mucosal injury, and changes in MDA and SOD contents in the gastric tissues indicated that the oxygen free radicals play an important role in this regard.

Essential versus accessory aspects of cell death: recommendations of the NCCD 2015

Cells exposed to extreme physicochemical or mechanical stimuli die in an uncontrollable manner, as a result of their immediate structural breakdown. Such an unavoidable variant of cellular demise is generally referred to as ‘accidental cell death' (ACD). In most settings, however, cell death is initiated by a genetically encoded apparatus, correlating with the fact that its course can be altered by pharmacologic or genetic interventions. ‘Regulated cell death' (RCD) can occur as part of physiologic programs or can be activated once adaptive responses to perturbations of the extracellular or intracellular microenvironment fail. The biochemical phenomena that accompany RCD may be harnessed to classify it into a few subtypes, which often (but not always) exhibit stereotyped morphologic features. Nonetheless, efficiently inhibiting the processes that are commonly thought to cause RCD, such as the activation of executioner caspases in the course of apoptosis, does not exert true cytoprotective effects in the mammalian system, but simply alters the kinetics of cellular demise as it shifts its morphologic and biochemical correlates. Conversely, bona fide cytoprotection can be achieved by inhibiting the transduction of lethal signals in the early phases of the process, when adaptive responses are still operational. Thus, the mechanisms that truly execute RCD may be less understood, less inhibitable and perhaps more homogeneous than previously thought. Here, the Nomenclature Committee on Cell Death formulates a set of recommendations to help scientists and researchers to discriminate between essential and accessory aspects of cell death.

Bone loss at subchondral plate in knee osteoarthritis patients with hypertension and type 2 diabetes mellitus

OBJECTIVES

This study aimed to characterize subchondral bone damages of knee osteoarthritis (OA) patients in presence of the comorbidities, i.e., hypertension and type 2 diabetes mellitus (T2DM).

METHODS

A total of 43 patients with advanced stage of primary knee OA were recruited, and tibial plateau specimens were collected during surgery with informed consent. The specimens were processed for micro-CT and histological examination to assess the severity of subchondral bone damages. The presence of the comorbid disease, e.g., hypertension and T2DM, and the data on covariates, such as the age, gender and body mass index (BMI), were taken into account in a multi-variable linear regression model to explore the potential effect of the comorbidities on subchondral bone damages in knee OA after adjusting the covariates.

RESULTS

As compared to 15 subjects without the comorbidities, significant bone loss was observed at subchondral plate in 28 knee OA patients with hypertension and T2DM, in terms of the lower bone mineral density (BMD) (P = 0.034) and higher porosity (P = 0.032) on the medial portion of tibial plateau. After adjusting the age, gender and BMI, the presence of hypertension or T2DM was included in a regression model to explain in part the decreased BMD (r(2) = 0.551, P = 0.004) and increased porosity (r(2) = 0.545, P = 0.003) at subchondral plate in knee OA.

CONCLUSION

Our findings suggest the biological link between bone loss at subchondral bone plate in knee OA and the comorbid diseases, i.e., hypertension and T2DM, which prompt the needs for a large-scale cohort study to confirm the causality.

Use of Bio-Amp, a commercial bio-additive for the treatment of grease trap wastewater containing fat, oil, and grease

This research investigated the application of Bio-Amp, a commercial bio-additive for the treatment of fat, oil, and grease (FOG) in a grease trap, and evaluated potential impacts of treated effluent on downstream collection system and treatment processes. Results show that after Bio-Amp treatment, FOG deposit formation was reduced by 40%, implicating a potential reduction of sewer line blockages. Chemical oxygen demand (COD), total nitrogen (TN), total phosphorus (TP) and total fatty acids were reduced by 39%, 33%, 56%, and 59%, respectively, which represents an overall loading reduction of 9% COD, 5% TN and 40% TP received by the treatment plant from all the dining halls. On the other hand, readily biodegradable COD fractions significantly increased, which implies a potential improvement on Bio-P removal. Overall, the results showed that application of Bio-Amp in grease trap provides potential reduction of sewer line blockages, and can also alleviate downstream treatment burden.