Evaluation of electromagnetic scattering characteristics of construction solid waste-A theoretical study of solid waste identification.

The surge in urban development has resulted in a substantial accumulation of construction solid waste (CSW). However, prevailing identification methods of CSW remain predominantly two-dimensional in scope and need to be more efficient. This study employs an approach, combining simulation and experimental analyses, to delve into the factors influencing the electromagnetic scattering characteristics of CSW, investigating the feasibility of employing Synthetic Aperture Radar (SAR) to recognize CSW. The findings show that the computational time of MLFMM and PO is only 3.28 % and 0.029 % of MM among different simulation methods. The results underscore the collective impact of material types, surface structures, and curvature on the scattering characteristics of CSW. The difference in average intensity between different materials can reach up to 13 dB. Exploiting these distinctions in scattering enables the precise identification of high-value waste components, such as intact bricks and steel bars, within the intricate landscape of CSW.

From CNN to Transformer: A Review of Medical Image Segmentation Models.

Medical image segmentation is an important step in medical image analysis, especially as a crucial prerequisite for efficient disease diagnosis and treatment. The use of deep learning for image segmentation has become a prevalent trend. The widely adopted approach currently is U-Net and its variants. Moreover, with the remarkable success of pre-trained models in natural language processing tasks, transformer-based models like TransUNet have achieved desirable performance on multiple medical image segmentation datasets. Recently, the Segment Anything Model (SAM) and its variants have also been attempted for medical image segmentation. In this paper, we conduct a survey of the most representative seven medical image segmentation models in recent years. We theoretically analyze the characteristics of these models and quantitatively evaluate their performance on Tuberculosis Chest X-rays, Ovarian Tumors, and Liver Segmentation datasets. Finally, we discuss the main challenges and future trends in medical image segmentation. Our work can assist researchers in the related field to quickly establish medical segmentation models tailored to specific regions.

Distribution of hepatitis C virus in eastern China from 2011 to 2020: a Bayesian spatiotemporal analysis.

Objective: This study aimed to evaluate the spatiotemporal distribution of patients with hepatitis C virus (HCV) and the factors influencing this distribution in Jiangsu Province, China, from 2011 to 2020. Methods: The incidence of reported HCV in Jiangsu Province from 2011 to 2020 was obtained from the Chinese Information System for Disease Control and Prevention (CISDCP). R and GeoDa software were used to visualize the spatiotemporal distribution and the spatial autocorrelation of HCV. A Bayesian spatiotemporal model was constructed to explore the spatiotemporal distribution of HCV in Jiangsu Province and to further analyze the factors related to HCV. Results: A total of 31,778 HCV patients were registered in Jiangsu Province. The registered incidence rate of HCV increased from 2.60/100,000 people in 2011 to 4.96/100,000 people in 2020, an increase of 190.77%. Moran's I ranged from 0.099 to 0.354 (P < 0.05) from 2011 to 2019, indicating a positive spatial correlation overall. The relative risk (RR) of the urbanization rate, the most important factor affecting the spread of HCV in Jiangsu Province, was 1.254 (95% confidence interval: 1.141-1.376), while other factors had no significance. Conclusion: The reported HCV incidence rate integrally increased in the whole Jiangsu Province, whereas the spatial aggregation of HCV incidence was gradually weakening. Our study highlighted the importance of health education for the floating population and reasonable allocation of medical resources in the future health work.

HIV Services Uptake Among People Living with HIV in Jiangsu Province, China: A Cross-Sectional Study.

Healthcare disparities are common among people living with HIV (PLWH) in China and likely impact access to HIV services. This study aimed to assess the current status of access to HIV services among PLWH and explore the correlates of service uptake using baseline data from a prospective cohort study among PLWH in Jiangsu Province. Guided by Andersen's behavioral model, univariable and multivariable logistic regressions were conducted to identify factors associated with access to HIV services. Out of 8989 eligible PLWH included in this study, 46.4% perceived difficulty in seeing a healthcare professional for HIV treatment services in 2021-2022. PLWH aged 18-34 years (adjusted odds ratio [AOR] = 1.69, 95% CI 1.32-2.15), 35-39 years (AOR = 1.33, 95% CI 1.08-1.65), identified as a bisexual/other (AOR = 1.14, 95% CI 1.01-1.29), had a college and above education (AOR = 1.32, 95% CI 1.07-1.63), and perceived moderate (AOR = 1.70, 95% CI 1.51-1.91) and severe (AOR = 2.20, 95% CI 1.94-2.49) levels of HIV stigma were more likely to perceive difficulty in seeing healthcare professionals for HIV treatment in 2021-2022. Living in northern Jiangsu was also associated with increased odds of perceiving difficulty in seeing healthcare professionals for HIV treatment (AOR = 1.12, 95% CI 1.00-1.26). These findings underscore the need for innovative solutions to eliminate the practical barriers to HIV services utilization among PLWH who are bisexual, well-educated, and effective HIV-related stigma reduction interventions.

Sustained high HIV incidence among men who have sex with men in Jiangsu province, China: based on the limiting-antigen avidity EIA method and six consecutive surveys, 2016-2021.

Background: The epidemic of HIV infection among men who have sex with men (MSM) is a major public health concern in some parts of China, but data on trends in HIV incidence are limited. This study aimed to examine the trends in HIV incidence and factors associated with recent HIV infection among MSM in Jiangsu province, China, based on the limiting-antigen avidity enzyme immunoassay (LAg-Avidity-EIA) method. Methods: Six consecutive surveys were implemented among MSM throughout Jiangsu province from 2016 to 2021. Participants were recruited in three ways. Socio-demographic and behavioral information were collected through face-to-face interviews. Venous blood samples were taken to test for HIV and syphilis. HIV incidence was estimated using the LAg-Avidity-EIA method. Chi-square trend tests were used to observe trends over the years. Multivariate regression analyses were used to identify factors associated with recent HIV infection. Results: A total of 15,401 participants were enrolled in the study. The prevalence of HIV infection ranged from 8.0 to 9.8%, with no consistent rise or fall over the years (P = 0.189). HIV incidence ranged from 5.0 to 9.0%, and no uptrend or downtrend was shown (P = 0.418). MSM who lived locally for more than 2 years (aOR = 1.366, P = 0.019), had a lack of comprehensive HIV knowledge (aOR = 1.643, P = 0.031), had engaged in unprotected anal intercourse (UAI) in the past 6 months (aOR = 7.373, P < 0.001), had been tested for HIV within 12 months (aOR = 1.292, P = 0.035), and tested positive for syphilis (aOR = 2.840, P < 0.001) were likely to be recently infected with HIV. Conclusions: HIV incidence among MSM has remained at a high level in Jiangsu province. In China, health education, condom use, and HIV/syphilis testing should continue to be top priorities for HIV prevention among MSM to reduce HIV transmission.

Efficacy of aquatic exercise in chronic musculoskeletal disorders: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Aquatic exercise (AE) is becoming ever more popular as a physical therapy, while it is unclear what precise improvements it will produce and how effective it will be in comparison with other non-surgical therapies. The study aimed to assess whether AE positively impacts chronic musculoskeletal disorder patients in terms of pain, physical function, and quality of life. METHODS: PRISMA guidelines were followed, and our study protocol was published online at PROSPERO under registration number CRD42023417411. We searched PubMed, Embase, Web of Science, and Cochrane library databases for English-language articles published before April 11, 2023, including studies from all relevant randomized controlled trials (RCTs). After screening, we ultimately included 32 RCTs with a total of 2,200 participants. We also performed subgroup analyses for all included studies. This meta-analysis calculated standardized mean difference (SMD) with 95% confidence interval (CI), and the variance was estimated using a random-effects model. The quality of the included studies was assessed by using the Cochrane collaborative "risk of bias" assessment tool (version 2.0). Thus ensuring that the literature included is of high quality. RESULTS: This meta-analysis included 32 trials with 2,200 participants; these patients were all between the ages of 38-80. The study showed that compared to the no exercise (NE) group, patients in the AE group experienced a remarkable reduction in pain (SMD: -0.64, P < 0.001), a significant increase in physical function (SMD: 0.62, P < 0.001), and a statistically significant improvement in quality of life (SMD: -0.64, P < 0.001). When compared to land-based exercise (LE), AE significantly relieves patients' pain (SMD: -0.35, P = 0.03). CONCLUSIONS: This is the first systematic review and meta-analysis to study whether AE could improve chronic musculoskeletal disorders. The evidence suggests that AE benefits pain, physical function, and quality of life in adults with chronic musculoskeletal conditions compared to NE. Furthermore, when compared to LE, AE continues to provide a better improvement in patient pain. More long-term clinical trials are needed to confirm AE's positive effects and improvement mechanisms and the more existential advantages compared to LE.

Designing Metasurfaces for Efficient Solar Energy Conversion.

Metasurfaces have recently emerged as a promising technological platform, offering unprecedented control over light by structuring materials at the nanoscale using two-dimensional arrays of subwavelength nanoresonators. These metasurfaces possess exceptional optical properties, enabling a wide variety of applications in imaging, sensing, telecommunication, and energy-related fields. One significant advantage of metasurfaces lies in their ability to manipulate the optical spectrum by precisely engineering the geometry and material composition of the nanoresonators' array. Consequently, they hold tremendous potential for efficient solar light harvesting and conversion. In this Review, we delve into the current state-of-the-art in solar energy conversion devices based on metasurfaces. First, we provide an overview of the fundamental processes involved in solar energy conversion, alongside an introduction to the primary classes of metasurfaces, namely, plasmonic and dielectric metasurfaces. Subsequently, we explore the numerical tools used that guide the design of metasurfaces, focusing particularly on inverse design methods that facilitate an optimized optical response. To showcase the practical applications of metasurfaces, we present selected examples across various domains such as photovoltaics, photoelectrochemistry, photocatalysis, solar-thermal and photothermal routes, and radiative cooling. These examples highlight the ways in which metasurfaces can be leveraged to harness solar energy effectively. By tailoring the optical properties of metasurfaces, significant advancements can be expected in solar energy harvesting technologies, offering new practical solutions to support an emerging sustainable society.

Strategies to support substance use disorder care transitions from acute-care to community-based settings: a scoping review and typology.

BACKGROUND: Acute-care interventions that identify patients with substance use disorders (SUDs), initiate treatment, and link patients to community-based services, have proliferated in recent years. Yet, much is unknown about the specific strategies being used to support continuity of care from emergency department (ED) or inpatient hospital settings to community-based SUD treatment. In this scoping review, we synthesize the existing literature on patient transition interventions, and form an initial typology of reported strategies. METHODS: We searched Pubmed, Embase, CINAHL and PsychINFO for peer-reviewed articles published between 2000 and 2021 that studied interventions linking patients with SUD from ED or inpatient hospital settings to community-based SUD services. Eligible articles measured at least one post-discharge treatment outcome and included a description of the strategy used to promote linkage to community care. Detailed information was extracted on the components of the transition strategies and a thematic coding process was used to categorize strategies into a typology based on shared characteristics. Facilitators and barriers to transitions of care were synthesized using the Consolidated Framework for Implementation Research. RESULTS: Forty-five articles met inclusion criteria. 62% included ED interventions and 44% inpatient interventions. The majority focused on patients with opioid (71%) or alcohol (31%) use disorder. The transition strategies reported across studies were heterogeneous and often not well described. An initial typology of ten transition strategies, including five pre- and five post-discharge transition strategies is proposed. The most common strategy was scheduling an appointment with a community-based treatment provider prior to discharge. A range of facilitators and barriers were described, which can inform efforts to improve hospital-to-community transitions of care. CONCLUSIONS: Strategies to support transitions from acute-care to community-based SUD services, although critical for ensuring continuity of care, vary greatly across interventions and are inconsistently measured and described. More research is needed to classify SUD care transition strategies, understand their components, and explore which lead to the best patient outcomes.

Rice GA3ox1 modulates pollen starch granule accumulation and pollen wall development.

The rice GA biosynthetic gene OsGA3ox1 has been proposed to regulate pollen development through the gametophytic manner, but cellular characterization of its mutant pollen is lacking. In this study, three heterozygotic biallelic variants, "-3/-19", "-3/-2" and "-3/-10", each containing one null and one 3bp-deletion allele, were obtained by the CRISPR/Cas9 technique for the functional study of OsGA3ox1. The three homozygotes, "-19/-19", "-2/-2" and "-10/-10", derived from heterozygotic variants, did not affect the development of most vegetative and floral organs but showed a significant reduction in seed-setting rate and in pollen viability. Anatomic characterizations of these mutated osga3ox1 pollens revealed defects in starch granule accumulation and pollen wall development. Additional molecular characterization suggests that abnormal pollen development in the osga3ox1 mutants might be linked to the regulation of transcription factors OsGAMYB, OsTDR and OsbHLH142 during late pollen development. In brief, the rice GA3ox1 is a crucial gene that modulates pollen starch granule accumulation and pollen wall development at the gametophytic phase.

Geographical patterns and determinants in plant reproductive phenology duration.

Biodiversity is and always has been an important issue in ecological research. Biodiversity can reflect niche partitioning among species at several spatial and temporal scales and is generally highest in the tropics. One theory to explain it is that low-latitude tropical ecosystems are dominated by species that are generally only distributed over a narrow area. This principle is known as Rapoport's rule. One previously unconsidered extension of Rapoport's rule may be reproductive phenology, where variation in flowering and fruiting length may reflect a temporal range. Herein, we collected reproductive phenology data for more than 20,000 species covering almost all angiosperm species in China. We used a random forest model to quantify the relative role of seven environmental factors on the duration of reproductive phenology. Our results showed that the duration of reproductive phenology decreased with latitude, although there was no obvious change across longitudes. Latitude explained more of the variation in the duration of flowering and fruiting phases in woody plants than in herbaceous plants. Mean annual temperature and the length of the growing season strongly influenced the phenology of herbaceous plants, and average winter temperature and temperature seasonality were important drivers of woody plant phenology. Our result suggests the flowering period of woody plants is sensitive to temperature seasonality, while it does not influence herbaceous plants. By extending Rapoport's rule to consider the distribution of species in time as well as space, we have provided a novel insight into the mechanisms of maintaining high levels of diversity in low-latitude forests.

Strategies to support substance use disorder care transitions from acute-care to community-based settings: A Scoping review and typology.

Background: Acute-care interventions that identify patients with substance use disorders (SUDs), initiate treatment, and link patients to community-based services, have proliferated in recent years. Yet, much is unknown about the specific strategies being used to support continuity of care from emergency department (ED) or inpatient hospital settings to community-based SUD treatment. In this scoping review, we synthesize the existing literature on patient transition interventions, and form an initial typology of reported strategies. Methods: We searched Pubmed, Embase, CINAHL and PsychINFO for peer-reviewed articles published between 2000-2021 that studied interventions linking SUD patients from ED or inpatient hospital settings to community-based SUD services. Eligible articles measured at least one post-discharge treatment outcome and included a description of the strategy used to promote linkage to community care. Detailed information was extracted on the components of the transition strategies and a thematic coding process was used to categorize strategies into a typology based on shared characteristics. Facilitators and barriers to transitions of care were synthesized using the Consolidated Framework for Implementation Research. Results: Forty-five articles met inclusion criteria. 62% included ED interventions and 44% inpatient interventions. The majority focused on patients with opioid (71%) followed by alcohol (31%) use disorder. The transition strategies reported across studies were heterogeneous and often not well described. An initial typology of ten transition strategies, including five pre- and five post-discharge transition strategies is proposed. The most common strategy was scheduling an appointment with a community-based treatment provider prior to discharge. A range of facilitators and barriers were described, which can inform efforts to improve hospital-to-community transitions of care. Conclusions: Strategies to support transitions from acute-care to community-based SUD services, although critical for ensuring continuity of care, vary greatly across interventions and are inconsistently measured and described. More research is needed to classify SUD care transition strategies, understand their components, and explore which lead to the best patient outcomes.

Ambient noise-based weakly supervised manhole localization methods over deployed fiber networks.

We present a manhole localization method based on distributed fiber optic sensing and weakly supervised machine learning techniques. For the first time to our knowledge, ambient environment data is used for underground cable mapping with the promise of enhancing operational efficiency and reducing field work. To effectively accommodate the weak informativeness of ambient data, a selective data sampling scheme and an attention-based deep multiple instance classification model are adopted, which only requires weakly annotated data. The proposed approach is validated on field data collected by a fiber sensing system over multiple existing fiber networks.

Three-Dimensional Printed Titanium Prosthesis for Mandibular Condyle Reconstruction After Extensive Resection of Chondrosarcoma: A 6-year Follow-Up.

Chondrosarcomas (CHS) are malignant mesenchymal tumors arising from cartilage. Chondrosarcomas arising in the temporomandibular joint are especially rare. Herein, the authors report an unusual case of a 50-year-old female who presented with a progressive swelling in the left preauricular region. Computed tomography and magnetic resonance imaging revealed an osteolytic and expansive lesion in the left condyle. The diagnosis tended to be a malignant tumor. A resection guide and 3-dimensional printed titanium prosthesis for condyle reconstruction were designed. Extended resection of the left condyle and reconstruction were performed. The pathologic diagnosis was consistent with CHS (grade II). There was no tumor recurrence or distant metastasis at the 6-year follow-up, and good occlusion and satisfactory function of the temporomandibular joint were regained.

Development and validation of robust metabolism-related gene signature in the prognostic prediction of hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is one of the most common malignant tumours worldwide. Given metabolic reprogramming in tumours was a crucial hallmark, several studies have demonstrated its value in the diagnostics and surveillance of malignant tumours. The present study aimed to identify a cluster of metabolism-related genes to construct a prediction model for the prognosis of HCC. Multiple cohorts of HCC cases (466 cases) from public datasets were included in the present analysis. (GEO cohort) After identifying a list of metabolism-related genes associated with prognosis, a risk score based on metabolism-related genes was formulated via the LASSO-Cox and LASSO-pcvl algorithms. According to the risk score, patients were stratified into low- and high-risk groups, and further analysis and validation were accordingly conducted. The results revealed that high-risk patients had a significantly worse 5-year overall survival (OS) than low-risk patients in the GEO cohort. (30.0% vs. 57.8%; hazard ratio [HR], 0.411; 95% confidence interval [95% CI], 0.302-0.651; p < 0.001) This observation was confirmed in the external TCGA-LIHC cohort. (34.5% vs. 54.4%; HR 0.452; 95% CI, 0.299-0.681; p < 0.001) To promote the predictive ability of the model, risk score, age, gender and tumour stage were integrated into a nomogram. According to the results of receiver operating characteristic curves and decision curves analysis, the nomogram score possessed a superior predictive ability than conventional factors, which indicate that the risk score combined with clinicopathological features was able to achieve a robust prediction for OS and improve the individualized clinical decision making of HCC patients. In conclusion, the metabolic genes related to OS were identified and developed a metabolism-based predictive model for HCC. Through a series of bioinformatics and statistical analyses, the predictive ability of the model was approved.

Remote Blood Pressure Estimation via the Spatiotemporal Mapping of Facial Videos.

Blood pressure (BP) monitoring is vital in daily healthcare, especially for cardiovascular diseases. However, BP values are mainly acquired through a contact-sensing method, which is inconvenient and unfriendly for BP monitoring. This paper proposes an efficient end-to-end network for estimating BP values from a facial video to achieve remote BP estimation in daily life. The network first derives a spatiotemporal map of a facial video. Then, it regresses the BP ranges with a designed blood pressure classifier and simultaneously calculates the specific value with a blood pressure calculator in each BP range based on the spatiotemporal map. In addition, an innovative oversampling training strategy was developed to handle the problem of unbalanced data distribution. Finally, we trained the proposed blood pressure estimation network on a private dataset, MPM-BP, and tested it on a popular public dataset, MMSE-HR. As a result, the proposed network achieved a mean absolute error (MAE) and root mean square error (RMSE) of 12.35 mmHg and 16.55 mmHg on systolic BP estimations, and those for diastolic BP were 9.54 mmHg and 12.22 mmHg, which were better than the values obtained in recent works. It can be concluded that the proposed method has excellent potential for camera-based BP monitoring in the indoor scenarios in the real world.

Modifications to microplastics by potassium ferrate(VI): impacts on sorption and sinking capability in water treatment.

Pre-treatment (oxidation) may induce potential modifications to microplastics (MPs), further affecting their behaviors and removal efficiency in drinking water treatment plants. Herein, potassium ferrate(VI) oxidation was tested as a pre-treatment for MPs with four polymer types and three sizes each. Surface oxidation occurred with morphology destruction and oxidized bond generation, which were prosperous under low acid conditions (pH 3). As pH increased, the generation and attachment of nascent state ferric oxides (FexOx) gradually became dominant, making MP-FexOx complexes. These FexOx were identified as Fe(III) compounds, including Fe2O3 and FeOOH, firmly attaching to the MP surface. Using ciprofloxacin as the targeted organic contaminant, the presence of FexOx enhanced MP sorption dramatically, e.g., the kinetic constant Kf of ciprofloxacin raised from 0.206 (6.5 µm polystyrene) to 1.062 L g-1 (polystyrene-FexOx) after oxidation at pH 6. The sinking performance of MPs was enhanced, especially for small MPs (< 10 µm), which could be attributed to the increasing density and hydrophilicity. For instance, the sinking ratio of 6.5 µm polystyrene increased by 70% after pH 6 oxidation. In general, ferrate pre-oxidation possesses multiple enhanced removals of MPs and organic contaminants through adsorption and sinking, reducing the potential risk of MPs.

Epimedii Folium and Ligustri Lucidi Fructus Promote Osteoblastogenesis and Inhibit Osteoclastogenesis against Osteoporosis via Acting on Osteoblast-Osteoclast Communication.

Osteoblast (OB) and osteoclast (OC) play important roles in bone formation and bone resorption, which can communicate with each other through cytokine paracrine. Previous studies have confirmed that Epimedii Folium (EF) and Ligustri Lucidi Fructus (LLF) used alone or in combination can treat osteoporosis (OP) through regulating bone remodeling, but the effects of EF and LLF on osteoblastogenesis, osteoclastogenesis, and OB-OC communication are unclear. In this study, we investigated the direct and indirect effects of EF and LLF on OBs and OCs via monoculture and coculture (transwell) models of OBs and OCs. We found that the combination of EF and LLF (EF&LLF) could promote osteoblastogenesis and inhibit osteoclastogenesis directly and indirectly. In order to study the mechanisms of EF&LLF on indirectly regulating osteoblastogenesis and osteoclastogenesis, we detected the expression of cytokines by which OBs and OCs could communicate with each other. We found that EF&LLF could downregulate the expression of RANKL and M-CSF and the protein ratio of RANKL/OPG of OBs and Atp6v0d2 expression of OCs and upregulate the expression of OPG and TGF-ß1 of OBs and the expression of TGF-ß1, BMP-2, and IGF-1 of OCs, indicating that EF&LLF could regulate cytokine expressions of OBs/OCs to affect OB-OC communication. In addition, EF&LLF had a better effect on regulating cytokines of OBs and OCs than EF or LLF in single use. This study suggested that EF&LLF exhibited the effects of promoting osteoblastogenesis and inhibiting osteoclastogenesis via acting on OB-OC communication and provided some scientific evidences for EF&LLF against OP.

Volatile organic compounds generation pathways and mechanisms from microplastics in water: Ultraviolet, chlorine and ultraviolet/chlorine disinfection.

Disinfection in water treatments induces microplastics (MPs) to produce various derivative products, among which the volatile organic compounds (VOCs) are still poorly understood. Ultraviolet (UV), chlorine and UV/chlorine disinfections were used to treat polypropylene (PP), polystyrene (PS) and polyvinylchloride (PVC) in this study. Modifications were observed on the MP surfaces, including melting, cracks, folds, and even forming oxygen-containing structures, resulting in the release of a diversity of VOCs. The polymer types of MPs influenced the VOCs characteristics. PP released alkanes, alkenes and aldehydes, while PVC released alkanes, alkenes and halogenated hydrocarbons. VOCs from PS were dominated by unique aromatic alkanes, alkenes and aldehydes. These derived VOCs are generated during different disinfections with distinct mechanisms. UV-C at 254 nm induced direct scission and radical oxidation on MPs. The derived VOCs were mainly bond-breaking fragments. Chlorination relied on HOCl/OCl- electrophilic reactions, resulting fewer VOCs since C-C skeleton MPs have strong resistance to electrophilic reactions. UV/chlorination promotes the generation of chlorine radicals and hydroxyl radicals, thereby causing oxidative damage. Various oxidized VOCs, such as benzaldehyde and acetophenone, were formed. The disinfection reactions can produce various VOCs from MPs, posing potential risks to the ecological environment and human beings.

Evaluating the effect of the plan of national syphilis control in controlling the syphilis epidemic in Jiangsu, China 2010-2020.

Background: Starting in 2010, the Chinese government initiated a 10-year syphilis control plan, called the national syphilis control plan (NSCP), to address the emerging threat of syphilis. We aimed to evaluate the effect of the NSCP plan on syphilis control in Jiangsu, China. Methods: The temporal trends of syphilis incidence, prevalence and rate of condom use were estimated by Joinpoint regression with average annual percent change (APC) and average annual percentage (APPC). A Chi-square test was conducted to analyze the outcomes in different subgroups. ArcGIS was used to analyze the spatiotemporal distribution of syphilis incidence. Results: Geographically, early and congenital syphilis incidence decreased significantly in all areas of the province during the period of NSCP. Early syphilis incidence decreased from 21.1 to 8.8 (APC: -7.5, 95%CI: -8.6, -6.5, p < 0.001) per 100,000 people, and congenital syphilis decreased from 63.6 to 4.1 (APC: -14.8, 95%CI: -20.8, -8.4, p < 0.01) per 100,000 newborns from 2010 to 2020. Also, syphilis prevalence reduced from 13.4 to 3.8% (APC: -8.7, 95%CI: -12.1, -5.0, p = 0.001) among men who have sex with men, from 5.3 to 1.7% (APC: -7.9, 95%CI: -11.7, -3.8, p = 0.002) among female sex workers and remained under 1.0% with slight variations among pregnant women (APC: 0.3, 95%CI: -4.3, 5.1, p = 0.877) from 2010 to 2020. 0.2% (2,436) of pregnant women who received free syphilis testing during pregnancy were diagnosed with current syphilis infection, and 97.0% (2,555) of newborns in the province were delivered to women diagnosed with syphilis. 91.8% (2,346) of live babies and about 90% of diagnosed patients received complete standard syphilis diagnosis and treatment services. Conclusion: Trends of early syphilis incidence and syphilis prevalence show a considerable decreasing trend among almost all the key populations after implementing NSCP. Congenital syphilis has significantly decreased as well and hence, the NSCP program should be sustained and strengthened to control the syphilis epidemic in China further.

Trends of late HIV presentation and advance HIV disease among newly diagnosed HIV cases in Jiangsu, China: A serial cross-sectional study from 2008 to 2020.

Background: This study aimed to assess the trends and determine the factors associated with late presentation (LP) and advanced HIV disease (AHD) among newly diagnosed people living with HIV (PLWH) from 2008 to 2020 in Jiangsu, China. Methods: Newly diagnosed PLWH registered in the HIV surveillance system from 2008 to 2020 were included. Multivariable logistic regression models were used to analyze the factors associated with LP and AHD. The LP and AHD trends were assessed using Joint-point analysis. Results: Of 37,251 newly diagnosed PLWH identified, 30,251(81.2%) patients met the inclusion criteria. Among those, 16,672 (55.1%) were considered LP, and 8,691 (28.7%) had AHD. LP trends steadily increased from 2008 (39.0%) to 2020 (59.4%), but AHD trends decreased visibly from 2016 (32.3%) to 2020 (23.4%). The overall median CD4 trends decreased slowly from 389 to 305 cells/mm3 between 2008 and 2020. Married patients and those older than 35 years were more likely to be LP and have AHD. Patients infected via heterosexual transmission had a higher risk of being classified as AHD (aOR: 1.13, 95%CI: 1.06-1.21) than patients infected via homosexual transmission. Patients that were diagnosed at sexually transmitted infections (STIs) clinics (aOR: 1.10, 95%CI: 1.01-1.20) and in hospitals (aOR: 1.69, 95%CI: 1.59-1.79) were more likely to be classified as LP compared with patients diagnosed at voluntary counseling and testing (VCT) centers. Similar, patients diagnosed at STIs clinics (aOR: 1.23, 95%CI: 1.11-1.36) and hospitals (aOR: 2.27, 95%CI: 2.12-2.43) were more likely to have AHD than patients diagnosed in VCT. Conclusion: Our findings indicate an alarming burden of LP in Jiangsu, suggesting the need for more attention toward HIV diagnosis at early CD4 stages. National HIV control programs must strengthen comprehensive interventions for HIV prevention and promote HIV services. Also, strategies for HIV prevention (PrEP and PEP), testing, and treatment must be extended, especially among the general population.