[Application value of superb microvascular imaging for diagnosis of different size renal solid tumors].

Objective: To discuss the diagnostic value of superb microvacular imaging (SMI) in renal solid tumors of different sizes. Methods: A total of 142 patients with 146 renal tumors detected by ultrasound in Tianjin Medical University Cancer Institute and Hospital from September 2017 to March 2019 were retrospectively analyzed. The maximum diameter of lesions was 0.8-7.3 cm, and patients were divided into the maximum diameter ≤3.0 cm group (61 patients, 64 lesions) and the maximum diameter >3.0 cm group (61 patients, 82 lesions). All of the tumors were separately evaluated by SMI and color Doppler flow imaging (CDFI) with Adler grade, vascular morphology and peripheral blood flow. Results: In the group with maximum diameter ≤3.0 cm, 50 lesions were malignant and 14 were benign. In the group with maximum diameter >3.0 cm, 62 lesions were malignant and 20 were benign. In the group with maximum diameter ≤3.0 cm, there were no significant differences in location, boundary, echo, homogeneity and small cystic area between malignant tumors and benign tumors (P>0.05). In the group with maximum diameter >3.0 cm, there were significant differences in echo, homogeneity and small cystic area between malignant tumors and benign tumors (P<0.05). For all of the benign tumors, there were no significant difference between CDFI and SMI in evaluating Adler grade, vascular morphology and peripheral blood flow (P>0.05). For malignant tumors with maximum diameter ≤3.0 cm, 43 lesions with Adler grade 2-3 were detected by SMI, which was higher than CDFI (32, P<0.05). There were 38 lesions with dendritic and irregular vascular morphology detected by SMI, which was higher than CDFI (7, P<0.05). The detected rate of peripheral annular or semi-annular blood flow in lesions was 80.0% (40/50), higher than CDFI (18/50, P<0.05). While in malignant tumors with maximum diameter >3 cm, the lesion with peripheral annular or semi-annular blood flow detected by SMI was 38, higher than 22 of CDFI (P<0.05). The area under the receiver operating characteristic (ROC) curve for CDFI and SMI diagnosis of renal solid tumors with the maximum diameter ≤3.0 cm was 0.627 (sensitivity: 54.0%, specificity: 71.4%) and 0.791 (sensitivity: 94.0%, specificity: 64.3%), respectively, with statistically significant difference (P=0.039). The area under the ROC curve for CDFI and SMI diagnosis of renal solid tumors with the maximum diameter>3.0 cm was 0.852 (sensitivity: 85.5%, specificity: 85.0%) and 0.860 (sensitivity: 91.9%, specificity: 80.0%), respectively, without statistically significance (P=0.858). Conclusions: SMI is superior to CDFI in detecting low-velocity blood flow and microvessels in both malignant and benign renal tumors, and can effectively improve the display rate of peripheral blood flow in malignant tumors. Otherwise, SMI can provide better diagnostic efficiency for renal tumors with the maximum diameter ≤3.0 cm.

[Current status of nucleic acid testing for hepatitis C].

Nucleic acid testing is the gold standard for diagnosing HCV infection, and it is of great significance to guide the treatment of HCV patients and change the follow-up strategy. In recent years, its detection technology has become increasingly mature. This article summarizes the necessity and current status of nucleic acid testing for hepatitis C through the analysis of domestic and foreign literature, in order to provide reference for the formulation of relevant policies to eliminate hepatitis C in China.

[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.

[Comparative analysis of superb microvascular imaging and contrast-enhanced ultrasound in diagnosis of small renal masses].

Objective: To explore the value of superb microvascular imaging (SMI) and contrast- enhanced ultrasound (CEUS) in differential diagnosis of small renal masses. Methods: A total of 84 patients with 86 lesions of renal masses were collected from October 2016 to March 2018 in Tianjin Medical University Cancer Institute and Hospital. There were 56 males and 28 females,aged from 29 to 76 years old,with an average age of (54±10) years old. These tumors were all examined by using SMI and CEUS. And the imaging diagnostic results were compared based on the pathological results. Adler semi quantitative analysis of blood flow grading of the tumors were evaluated in SMI,and the evaluation standard was as follows:0-1 grade was benign, 2-3 grade was malignant. Besides,the patterns and enhancement of the small renal masses were observed in CEUS. The main diagnostic criteria of malignant tumors were "fast forward" , "rapid regression" and "high perfusion" . Some special types of renal cell carcinoma were diagnosed by "slow in" , "rapid regression" and "hypo-perfusion" . Benign tumors were diagnosed by "slow in" , "slow down" and "hypo-perfusion" . Results: Among 86 cases, 76 cases were confirmed as malignant masses and 10 cases were confirmed as benign masses by pathological diagnosis. By SMI, Adler grade of 89.5% (68/76) malignant tumors were 2-3, Adler grade of 6/10 benign tumors were 0-1. By CEUS, 77.6% (59/76) of malignant tumors were "fast forward" , 82.9% (63/76) were "rapid regression" , 76.3% (58/76) were "high perfusion" ; 7/10 of benign tumors were "slow in" , 5/10 were "slow down" and 6/10 were "low perfusion" . The accuracy, sensitivity, specificity, positive predictive value, negative predictive value and AUC of SMI were 86.0%,89.5%, 60.0%, 94.4%,42.9% and 0.747 respectively. The values for CEUS were 89.5%, 92.1%, 70.0%,95.9%, 53.8% and 0.811 respectively.There was no statistical difference in diagnostic efficacy between CEUS and SMI (P=0.288). Conclusions: Although there is no statistical significance between SMI and CEUS, the accuracy, sensitivity and positive predictive value of SMI in the diagnosis of small renal masses are higher,which can clearly show micro-vessels and exquisitely detect the low-velocity blood flow in small renal masses. In brief,SMI provides a new method in the differential diagnosis of small renal masses.

[The situation and related factors of satisfaction of HIV-infected people towards the follow-up management of primary medical and health care institutions in rural areas of Jiangxi Province].

The HIV-infected people were investigated for their satisfactory situation towards the follow-up management of primary medical and health care institutions in Xinjian County, Yushan County and Guixi City of Jiangxi Province from January to July 2018 and related factors were also analyzed. The total score of the Infected Patients' Follow-up Management Satisfaction Scale higher than 59 was defined as the satisfactory. 75.68% of 259 infected patients were satisfied with the follow-up management. Compared to farmers and other follow-up modes, non-farmers (OR=10.72, 95%CI: 2.07-55.63), and patients receiving follow-up service in responsible institutions (OR=6.44, 95%CI: 3.12-13.30) were more satisfied with follow-up management.

[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.

[Initial follow-up and CD(4)(+) T cell count test of newly reported students HIV cases in China, 2013-2017].

Objective: To analyze first follow-up and CD(4)(+) T (CD(4)) cell count test of newly reported students HIV cases in China from 2013 to 2017. Methods: Data were collected from both Case Reporting Cards and Follow-up Cards from China Information System for HIV/AIDS Control and Prevention between 1(s)t January 2013 and 31(st) December 2017. The inclusion criteria are 15-24 years old students who were newly diagnosed with HIV infection. Logistic regression model was used to analyze relevant factors of the first CD(4) test results less than 200 CD(4) cells/µl. Results: There were 12 037 newly diagnosed students HIV cases from 2013 to 2017. Most cases were male (97.7%), 19-22 years old (65.1%) and Han ethnicity (90.5%). At the time of diagnosis, the route of HIV infection was most frequently homosexual contact (82.2%). The majority of cases (46.9%) were diagnosed at HIV voluntary counseling and testing (VCT) location. About 2 465 (20.6%) students had unprotected intercourse in the past 3 months, of which 1 387 (56.8%) had 1 sexual partner, 610 (25.0%) with 2 sexual partners, 273 (11.2%) with 3 partners and 170 (7.0%) with more than 4 partners. 11.0% and 28.9% of cases had initial CD(4) counts less than 200 cells/µl and 200-349 cells/µl. Compared to the male, younger than 18 years old and diagnosed at VCT location, female (OR=2.09, 95%CI: 1.51-2.89), aged 21 to 22 years (OR=1.25, 95%CI: 1.06-1.47), diagnosed in hospital settings (OR=2.20, 95%CI: 1.89-2.57) and preoperative testing (OR=1.36, 95%CI: 1.07-1.73) had greater proportion of the first CD(4) test result less than 200 CD(4) cells/µl. Conclusion: The number of newly diagnosed students HIV cases significantly increased in past 5 years, and the proportion of late diagnosis was high. Female, aged 21 to 22 years, diagnosed in hospital settings and preoperative testing were related to the first CD(4) test result less than 200 CD(4) cells/µl.

[Programs on mobility, status of follow-up and CD(4)(+)T cell testing among people living with HIV/AIDS, in China 2011-2015].

Objective: To analyze the mobility, status of follow-up and CD(4)(+)T cell testing (CD(4) testing) programs among people living with HIV (PLHIV) between 2011 and 2015 and to improve the prevention program on HIV secondary transmission. Methods: Data were collected from both Case Reporting Cards and Follow-up Cards through the National HIV/AIDS Comprehensive Control and Prevention data system. Changes of residence among the newly reported cases and survival cases between 2011 and 2015 were analyzed by SPSS 24.0 software. Results: The number of newly reported inter-provincial mobile PLHIV had been increasing, with proportions of the total reported cases from 10.0% (5 576/55 805) in 2011 to 13.3% (15 348/115 231) in 2015. After adjusting for related confounders, percentages of follow-up and CD(4) testing were lower in inter-provincial and inter-prefectural mobile cases than those without. Conclusion: Service regarding the follow-up and CD(4) testing programs was affected by mobility of people living with HIV/AIDS. Programs on communication and personal contact should be strengthened in the follow-up management services for PLHIV. Information on potential mobility of PLHIV should be gathered timely by health workers during the subsequent follow-up period to avoid the loss of follow-up and CD(4) testing on patients.

[Application of Bernoulli Process Model fitting the effect of intervention measures on sexual transmission among HIV sero-discordant couples].

Objectives: To undersand the outcomes of major intervention measures on sexual transmission among HIV sero-discordant couples. Methods: Bernoulli Process Model was applied to model the major influencing factors of HIV transmission among HIV sero-discordant couples. The major influencing factors appeared as consistent condom use, antiretroviral therapy, frequency of sexual behavior. These parameters were from the HIV sero-discordant couples in 30 counties in 4 provinces (Guangxi Zhuang Autonomous Region, Yunnan Province, Xinjiang Uygur Autonomous Region and Henan provinces) from January 1, 2011 to December 31, 2012. According to the main factors, modeling-intervention strategies and measures on reduction HIV transmission among serodiscordant couples were formed. Results: Data from the present proportion of consistent condom use (85%) modeling and the coverage of antiretroviral treatment (60%) showed that, the proportion of cumulative seroconversion among the spouses was 1.76%. Results from the sensitivity analysis on modeling the consistent condom use and the antiretroviral treatment showed that, when the coverage of antiretroviral treatment was as 90% and the proportion of consistent condom use increased from 50% to 90%, with 80.7% of the risk of spouse seroconversion could be reduced. Or, when the proportion of consistent condom use was as 90% and the coverage of antiretroviral treatment increased from 50% to 90%, with 64.5% of the risk of spouse seroconversion could be reduced. Conclusions: With measures as consistent condom use plus provision of timely antiretroviral therapy to HIV positive index spouses, the risk of sexual transmission among sero-discordant couples could be greatly reduced.

[Situation and reasons for missed follow-up services among newly reported HIV/AIDS cases transmitted by homosexual behavior in China, 2008-2015].

Objective: To determine the prevalence and relative factors on those who missed the follow-up service among newly reported HIV/AIDS cases that were infected by homosexual behavior. Methods: Data were extracted from both HIV/AIDS case-reporting and follow-up cards on HIV/AIDS in the Comprehensive Response Information Management System, between December 2008 and December 2015. Data was analyzed, using the generalized estimating equations (GEE) to explore the relative factors of influence. Results: Among the newly reported HIV infection among MSM, the proportion of those who missed the follow-up services was 5.06% (6 037/119 358), and decreased dramatically, from 37.57% (1 261/3 356) to 0.84% (267/31 935) (trend χ(2)=103.43, P<0.01). In MSM population, the younger than 20-year olds (OR=1.30, 95%CI: 1.11-1.52), 20-year olds (OR=1.52, 95%CI: 1.36-1.69), 30-year olds (OR=1.22, 95%CI: 1.12-1.34), 40-year olds (OR=1.10, 95%CI: 1.01-1.20) were receiving less follow-up services than those 50-year olds. Those who had received either junior (OR=1.52, 95%CI: 1.37-1.69) or senior high school education (OR=1.35, 95%CI: 1.23-1.49) were receiving less follow-up service than those who were more educated. MSM with the following characteristics as unspecified occupation (OR=2.06, 95%CI: 1.49-2.87),unemployed (OR=1.54, 95%CI: 1.30-1.83), working in commercial service (OR=1.31, 95%CI: 1.15-1.49) or being student (OR=1.34, 95%CI: 1.18-1.52) were more difficult to be traced or followed than the cadres. Cases being identified on site (OR=2.99, 95%CI: 2.26-3.95) or under special investigation (OR=1.43, 95%CI: 1.29-1.59) had received less follow-up service than those being identified through voluntary counsel testing service. Floating population (OR=1.46, 95%CI: 1.28-1.66) were getting less follow-up service than local residents. Conclusions: The prevalence of those who had missed the follow-up services in the newly discovered MSM HIV cases declined dramatically. Among the MSM HIV cases, those having the following characteristics as: younger than 50-year old, with less school education, with unspecified occupation or unemployment, working in commercial service, being student, having history of incarceration, recruited from special investigation, and floating population were prone to miss the follow-up program, suggesting that the follow-up service should be targeting on these patients.

[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.

[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.

[Status of marriage and HIV transmission between couples in newly reported HIV cases before diagnosis was made, among men who have sex with men in China, 2014].

Objective: To analyze the status of marriage and HIV transmission between couples in newly reported HIV cases before diagnoses were made, among men who have sex with men (MSM) in China. Methods: Baseline and follow-up information related to newly reported cases in 2014 were collected from the Chinese HIV/AIDS Comprehensive Response Information Management System. Infected MSM who were older than 22 years of age were included in this study. HIV cases were divided into sero-concordant or sero-discordant group, according to the HIV status of the couple who were tested 180 days post-diagnosis. Multivariate logistic regression method was used to analyze the potential factors associated with HIV transmission between couples before diagnosis was made. Results: A total of 5 081 (22.7%) of the HIV infected MSM who had couples, were included in this study. A total of 3 715 cases had their couples tested 180 days after the diagnosis was made. 7.6% (282) had positive couples. Results from the multivariate logistic regression analysis showed that factors as: older than 60 (OR=2.64, 95% CI: 1.50-4.65) years of age, being minorities (OR=1.93, 95% CI: 1.13-3.29), having CD(4)(+)T cells less than 500 cells/µl (<200: OR=2.91, 95%CI: 1.82-4.65; 200-349: OR=1.98, 95%CI: 1.22-3.23; 350-500: OR=1.69, 95%CI: 1.00-2.86), with self-reported unsafe behaviors (OR=1.92, 95% CI: 1.44-2.58) etc., were more likely to transmit HIV to their couples before the diagnosis was made. Conclusion: Behavior interventions and early HIV testing should be promoted, especially among those MSM who had couples, to avoid inter-spousal transmission.

[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.

[Marital status and high-risk sexual behaviors among newly reported HIV infected men who have sex with men in China in 2012, one year follow up study].

OBJECTIVE: To analyze the changes of marital status and high-risk sexual behaviors in newly reported HIV infected men who have sex with men(MSM)and provide evidence for the targeted behavior intervention in this population and the prevention of secondary HIV infection. METHODS: Data collected from HIV/AIDS case reporting cards and follow-up cards between December 31(st), 2012 and December 31(st), 2013 were used and newly reported HIV infected MSM were recruited, their demographic characteristics, marital status, and high-risk sexual behaviors were analyzed. RESULTS: Of 15 768 newly reported HIV infected MSM in 2012, 10 426(66.1%)were unmarried and 10 970(69.6%)had educational level of ≥senior high school. Among the 15 049 HIV infected MSM receiving follow up in 2012, 14 451(96.0%)still received follow up in 2013. The number HIV infected MSM who had protected sexual behaviors increased from 9 779(67.7%)in 2012 to 13 277(91.1%)in 2013. Among the HIV infected MSM who had married, 64.1% remained their marital status in 2013. Among the HIV infected MSM, those who had educational level of ≥senior high school(OR=1.540, 95% CI: 1.138-2.085), workers(OR=1.430, 95% CI: 1.131-1.808), staff(OR=1.610, 95%CI: 1.236-2.098)or farmers(OR=1.661, 95%CI: 1.214-2.271)were more likely to have protected sexual behaviors than those who had educational level of primary school or were engaged in commercial services. Those who had never married,(OR=0.563, 95% CI: 0.439-0.722), divorced(OR=0.624, 95% CI: 0.448-0.870)or remarried(OR=0.444, 95% CI: 0.288-0.687)were more likely to have high-risk sexual behaviors. CONCLUSION: Standardized follow-up seemed helpful for the newly diagnosed HIV infected MSM to have protected sexual behaviors. Highly effective intervention should be focused on MSM who have no spouses or regular sexual partners, with low educational level, or are engaged in commercial services to prevent secondary HIV transmission.

[Analysis on the ' late diagnosis' (LD) phenomena among newly identified HIV/AIDS cases in China, 2010-2014].

OBJECTIVE: To analyze the 'late diagnoses' (LD) phenomena among newly identified HIV/AIDS cases in China from 2010 to 2014. METHODS: Newly identified HIV/AIDS cases from 2010 to 2014 were selected from the National HIV/AIDS comprehensive information system. Rates related to LD were stratified according to the demographic indicators. RESULTS: From 2010 to 2014, numbers of newly identified HIV/AIDS cases were reported as 64 338, 74 517, 82 434, 90 119 and 103 501 in China. Among them, proportions of LD were 41.8%, 42.1%, 38.1%, 36.8% and 35.5% respectively. LD proportions appeared high in medical settings, with the minimum proportion as 45% (χ(2)=5 174,P<0.000 1). Proportion of LD among patients who were heterosexually transmitted appeared over 40%, which was significantly higher than that seen among men who have sex with men or injecting drug users (χ(2)=3 066,P<0.000 1). Proportion of LD showed more than 39% in those newly identified cases, and was seen higher in permanent residents than in floating population (less than 30%) (χ(2)=5 265,P<0.000 1). CONCLUSION: With the expansion testing coverage on HIV, newly identified HIV/AIDS increased year by year. Among the newly identified cases, late diagnosis was high, especially in medical institutions. More effective strategies and measures are needed to promote the early detection of HIV in high risk population.

[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.

p53 inactivating mutations in chinese breast carcinomas.

While previous reports on breast cancers indicate that Caucasian women have a low frequency of p53 mutations, higher frequencies of mutations are reported in some Japanese populations. There are few reports regarding p53 mutations in Chinese breast carcinomas. Using a previously established sensitive p53 yeast functional assay, we screened 23 Chinese breast carcinomas for mutations. The p53 was mutated in 5/23 (21.7%) specimens. Two of these mutations were detected in exon 5 and one was detected in each of exons 6, 7 and 8. All of these mutations have previously been shown to be mutated in Caucasian and Japanese breast cancers, but two have not previously been observed in Chinese breast cancers and one has also not been observed in Japanese.