Zoonotic spillover and extreme weather events drive the global outbreaks of airborne viral emerging infectious diseases.

Outbreaks of airborne viral emerging infectious diseases (EIDs) cause an increasing burden on global public health, particularly with a backdrop of intensified climate change. However, infection sources and drivers for outbreaks of airborne viral EIDs remain unknown. Here, we aim to explore the driving mechanisms of outbreaks based on the one health perspective. Outbreak information for 20 types of airborne viral EIDs was collected from the Global Infectious Disease and Epidemiology Network database and a systematic literature review. Four statistically significant and high-risk spatiotemporal clusters for airborne viral EID outbreaks were identified globally using multivariate scan statistic tests. There were 112 outbreaks with clear infection sources, and zoonotic spillover was the most common source (95.54%, 107/112). Since 1970, the majority of outbreaks occurred in healthcare facilities (24.82%), followed by schools (17.93%) and animal-related settings (15.93%). Significant associations were detected between the number of earthquakes, storms, duration of floods, and airborne viral EIDs' outbreaks using a case-crossover study design and multivariable conditional logistic regression. These findings implied that zoonotic spillover and extreme weather events are driving global outbreaks of airborne viral EIDs, and targeted prevention and control measures should be made to reduce the airborne viral EIDs burden.

First-in-human phase I dose-escalation and dose-expansion trial of the selective MEK inhibitor HL-085 in patients with advanced melanoma harboring NRAS mutations.

BACKGROUND: HL-085 is a selective, orally administered MEK1/2 inhibitor. We aimed to evaluate the safety and efficacy of HL-085 in patients with advanced melanoma harboring NRAS mutations. METHODS: This was a multicenter phase 1 study. HL-085 was administered twice daily in a standard 3 + 3 dose-escalation design (10 dose cohorts; 0.5-18 mg twice daily), followed by dose expansion at the recommended phase II dose (RP2D). The primary endpoints included tolerability, dose-limiting toxicity (DLT), maximum tolerated dose (MTD) and RP2D. RESULTS: Between September 13, 2017, and January 18, 2021, 42 patients were enrolled (dose escalation phase: n = 30; dose expansion phase: n = 12). No DLT was reported during dose escalation and MTD was not reached with HL-085 doses up to 18 mg twice daily. The RP2D was 12 mg twice daily. The most common all-grade drug-related adverse events (AEs) across all dose levels were rash (61.9%), increased creatine phosphokinase (CK, 59.5%), face edema (50.0%), increased aspartate aminotransferase (47.6%), peripheral edema (40.5%), diarrhea (33.3%), alanine aminotransferase (33.3%), and paronychia (19.0%), most of which were grade 1 and 2. Most frequency of grade ≥ 3 AEs were CK (14.2%), asthenia (7.1%), peripheral edema (4.8%), and acneiform dermatitis (4.8%). In the cohort of 12 mg twice daily dose (15 patients), confirmed objective response rate was 26.7%; disease control rate was 86.7%; median duration of response was 2.9 months; median progression-free survival was 3.6 months. CONCLUSIONS: The HL-085 showed acceptable tolerability and substantial clinical activity in patients with advanced melanoma harboring NRAS mutations. TRIAL REGISTRATION: Trial registration ClinicalTrials.gov number: NCT03973151.

Evaluation of Lens Culinaris Agglutinin-Reactive α-Fetoprotein in Diagnosis of Malignant Tumors.

BACKGROUND: To assess the potential of AFP-L3% for the utility to diagnose malignant tumors. METHODS: AFP-L3 was concentrated from clinically-collected serum samples via the Hotgen Biotech glycosyl capture spin columns and then measured through the protein microarrays. The levels of AFP and AFP-L3 were detected by electrochemiluminescence immunoassay. In this retrospective study, 266 patients with the level of serum AFP-L3 over 1 ng/mL were recruited from December 2014 through April 2019. Among them, 155 patients were clinically diagnosed/confirmed with malignant tumors, including 101 hepatocellular carcinomas, 47 stomach malignant tumors, and 7 other malignant tumors; and the rest of 111 patients were nonmalignant tumors. RESULTS: Patients with serum AFP-L3 level of greater than 1 ng/mL were mainly detected in hepatic diseases, including hepatocellular carcinoma, cirrhosis and chronic hepatitis. In patients with no tumors, the levels of serum AFP-L3 over 1 ng/mL were only observed in liver disease. The levels of AFP-L3 in blood were substantially greater in patients with HCC. Among the malignant tumor patients with the level of serum AFP-L3 over 1 ng/mL, HCC accounted for 60%, gastric cancer for nearly 40%. The AFP, AFP-L3, and AFP-L3% in blood were increased significantly in patients with liver malignancy, chronic liver disease, and cirrhosis. However, the elevation of AFP-L3 and AFP-L3% in the malignant cohort was more evident than that in the nonmalignant counterpart. CONCLUSIONS: AFP-L3 is likely to contribute to the differential diagnosis of HCC as well as other hepatic diseases. AFP-L3% is a reliable indicator for diagnosing benign and malignant tumors.

Epidemic of HIV infection among persons who inject drugs in mainland China: a series, cross-sectional study.

BACKGROUND: Studies have suggested that the injection drug use (IDU) was no longer the main transmission route of HIV/AIDS in China. However, there has never been a study to assess the national HIV epidemic among persons who inject drugs (PWIDs) based on a nationwide database. METHODS: PWIDs among new entrants in detoxification centers with HIV test results were extracted from the 2008-2016 National Dynamic Management and Control Database for Persons Who Use Drugs (NDMCD). Logistic regressions were used to analyze factors associated with HIV infection, and joinpoint regression were used to examine trends in the HIV prevalence. RESULTS: A total of 103,619 PWIDs among new entrants tested for HIV in detoxification centers between 2008 and 2016 were included in the analysis. The HIV prevalence was 5.0% (n = 5167) among PWIDs. A U-shaped curve of the HIV prevalence decreased from 4.9% in 2008 to 3.3% in 2010 (Annual Percent Change [APC] - 20.6, 95% CI - 32.5 to - 6.7, p < 0.05) and subsequently increased from 3.3% in 2010 to 8.6% in 2016 (APC 17.9, 95% CI 14.5-21.4, p < 0.05) was observed. The HIV prevalence in west regions in China all presented decreased trends, while central and eastern regions presented increased trends. CONCLUSIONS: Although the HIV prevalence has been declining in general population, the HIV prevalence among PWIDs has shown an increasing trend since 2010. Current policies on HIV control in PWIDs should be reassessed.

Estimation of COVID-19 outbreak size in Harbin, China.

Since the first level response to public health emergencies was launched on January 25, 2020, in Heilongjiang province, China, the outbreak of COVID-19 seems to be under control. However, an outbreak of COVID-19 caused by imported cases developed in Harbin during April 2020. A mathematical model is established to investigate the transmission of COVID-19 in Harbin. Based on the dynamical analysis and data fitting, the research investigates the outbreak of COVID-19 in Harbin and estimates the outbreak size of COVID-19 in Harbin. The outbreak size estimated of COVID-19 in Harbin reaches 174, where 54% of infected cases were identified while 46% of infected cases were not found out. We should maintain vigilance against unfound infected people. Our findings suggest that the effective reproduction number decreased drastically in contrast with the value of 3.6 on April 9; after that the effective interventions were implemented by the Heilongjiang province government. Finally, the effective reproduction number arrived at the value of 0.04 which is immensely below the threshold value 1, which means that the Heilongjiang province government got the outbreak of COVID-19 in Harbin under control.

Treatment and recurrence on re-treatment tuberculosis patients: a randomized clinical trial and 7-year perspective cohort study in China.

Previously treated TB patients still pose a serious threat to global control of TB, yet new re-treatment therapies were little studied. This study aimed to examine the therapeutic effects of new re-treatment regimens, and explore risk factors associated with recurrence after successful treatment. We conducted a cohort study in nine regions of China and enrolled previously treated TB patients from October, 2008 to December, 2010. Patients were randomly divided into four treatment regimen groups including standard, high-dose, long-course, and individualized treatment. After treatment, those with successful treatment outcomes were followed up to 7 years. The effects of different regimens and the information of recurrence were recorded. Risk factors to poor treatment outcomes were calculated using logistic regression model, while risk factors to recurrence or death were calculated using Cox model. Four hundred ninety-two participants were enrolled during the study time and 419 patients were included in our analysis of treatment effects. Overall, the treatment success rate is 75.9%, and the recurrence and death rate is 6.9% and 3.8%, respectively. Reduced risks of poor outcomes were observed in patients who were treated with high-dose and individualized regimen compared with standard regimen, and the adjusted ORs were 0.3 (0.1-0.6), 0.2 (0.1-0.5), respectively. In our analysis of factors associated with recurrence, all documented variables were not significant. Revised re-treatment regimen has better therapeutic effects compared to standard regimen, but it was not associated with lower risk of TB recurrence. Further studies are warranted to evaluate the role of other revised re-treatment regimens in recurrence risk. Trial registration: chictr.org Identifier: ChiCTR1800017441.

Protect MSM from HIV and other sexually transmitted diseases by providing mobile health services of partner notification: protocol for a pragmatic stepped wedge cluster randomized controlled trial.

BACKGROUND: Recently, more and more men who have sex with men (MSM) look for casual partners through online dating platforms in China. However, most are unable to know their partners' HIV and other sexually transmitted diseases (STD) statuses, leading to the rapid increase in HIV infection among Chinese MSM. Effective partner notification is urgently needed to increase the risk awareness of MSM and prevent HIV and other STDs transmission. However, the traditional intervention mainly targets to the HIV-positive MSM and the effect is not promising. Our study aims to provide Internet-based partner notification, along with a series of health services for HIV-negative MSM to protect them from HIV and other STDs. METHODS: A pragmatic stepped wedge cluster randomized controlled trial design is used to evaluate the effectiveness of a new intervention paradigm, which aims to reduce HIV and other STDs incidences among MSM in China. Through integrating a mobile health (mHealth) service application (app) to the current HIV and other STDs prevention and control methods, the new paradigm provides partner notification of HIV, syphilis, hepatitis B, and hepatitis C statuses. A total of 6172 MSM in 16 districts of Beijing, China will be recruited and randomized to sequentially receive partner notification intervention through the app at 6-month intervals. The primary outcomes are HIV incidence and the additional cost of the intervention. The secondary outcomes include incidences of syphilis, hepatitis B, and hepatitis C, disease transmission social networks, testing adherence, knowledge of HIV and STDs control, health self-responsibility awareness, changes of high risk behaviors and other related outcomes. The generalized linear mixed models (GLMM) will be used to analyze the differences of outcomes in the control period and in the intervention period. DISCUSSION: We expect that the HIV incidence will be significantly lower and the secondary outcomes will also be improved with providing health service of partner notification through mhealth intervention. The feasible and affordable public health intervention paradigm will have implications for HIV and STDs prevention and control among MSM and other key populations. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04349748 . Registered on 16 April 2020.

Adherence of HIV Self-Testing Among Men Who Have Sex With Men in China: Longitudinal Study.

BACKGROUND: The World Health Organization recommended HIV self-testing (HIVST) for individuals practicing unsafe sexual behaviors; however, the adherence to HIV testing has not been reported. OBJECTIVE: In this study, we attempted to determine the adherence to HIVST among men who have sex with men (MSM), as well as the impact factors and potential effects of their adherence. METHODS: We conducted a longitudinal study among MSM in Harbin, Heilongjiang province, China from July 1, 2017 to June 30, 2018. A mobile app system was used to provide the "Mailing rapid test reagent kit" for the HIVST service. The proportion of those who adhered to HIV testing every 3 months was calculated. Logistic regression was used to explore the impact factors related to adherence to HIVST. Rates of HIV infection between MSM who adhered to HIVST and those who did not were compared using Cox proportional hazards regression. Changes of condom use behaviors between the two groups were also compared using the chi-square test. RESULTS: A total of 1315 MSM who received the HIVST service through the app were included in the study. Overall, 10% of the MSM adhered to HIVST, and the proportion of adhering tests was only 34.9%. Adherence of HIVST was associated with marital status (adjusted odds ratio [OR]unmarried vs married 2.31, 95% CI 1.13-4.71) and the number of HIV tests they received (adjusted OR3 times vs 2 times or below 3.36, 95% CI 2.01-5.63; adjusted OR4 times or above vs 2 times or below 7.30, 95% CI 4.67-11.42). Twenty HIV seroconversions were observed during 1-year follow up. The rate of HIV infection in the adherence group (17.10 per 100 person years, 95% CI 8.80-30.84) was significantly higher than that in the nonadherence group (4.80 per 100 person years, 95% CI 2.77-7.88; adjusted hazard ratio 3.33, 95% CI 1.35-8.20). Those who adhered to HIV testing were more likely to improve condom use behaviors, although the difference was not statistically significant. CONCLUSIONS: Regular HIV testing is necessary for early detection of HIV infection among MSM. Given the poor adherence, a new internet-based management paradigm for MSM is needed to raise their health awareness to optimize the implementation of HIVST.

Associations Between Affective States and Sexual and Health Status Among Men Who Have Sex With Men in China: Exploratory Study Using Social Media Data.

BACKGROUND: Affective states, including sentiment and emotion, are critical determinants of health. However, few studies among men who have sex with men (MSM) have examined sentiment and emotion specifically using real-time social media technologies. Moreover, the explorations on their associations with sexual and health status among MSM are limited. OBJECTIVE: This study aimed to understand and examine the associations of affective states with sexual behaviors and health status among MSM using public data from the Blued (Blued International Inc) app. METHODS: A total of 843,745 public postings of 377,610 MSM users located in Guangdong were saved from the Blued app by automatic screen capture. Positive affect, negative affect, sexual behaviors, and health status were measured using the Simplified Chinese Linguistic Inquiry and Word Count. Emotions, including joy, sadness, anger, fear, and disgust, were measured using the Weibo Basic Mood Lexicon. A positive sentiment score and a positive emotion score were also calculated. Univariate and multivariate linear regression models on the basis of a permutation test were used to assess the associations of affective states with sexual behaviors and health status. RESULTS: A total of 5871 active MSM users and their 477,374 postings were finally selected. Both positive affect and positive emotions (eg, joy) peaked between 7 AM and 9 AM. Negative affect and negative emotions (eg, sadness and disgust) peaked between 2 AM and 4 AM. During that time, 25.1% (97/387) of negative postings were related to health and 13.4% (52/387) of negative postings were related to seeking social support. A multivariate analysis showed that the MSM who were more likely to post sexual behaviors were more likely to express positive affect (beta=0.3107; P<.001) and positive emotions (joy: beta=0.027; P<.001), as well as negative emotions (sadness: beta=0.0443; P<.001 and disgust: beta=0.0256; P<.001). They also had a higher positive sentiment score (beta=0.2947; P<.001) and a higher positive emotion score (beta=0.1612; P<.001). The MSM who were more likely to post their health status were more likely to express negative affect (beta=0.8088; P<.001) and negative emotions, including sadness (beta=0.0705; P<.001), anger (beta=0.0058; P<.001), fear (beta=0.0052; P<.001), and disgust (beta=0.3065; P<.001), and less likely to express positive affect (beta=-0.0224; P=.02). In addition, they had a lower positive sentiment score (beta=-0.8306; P<.001) and a lower positive emotion score (beta=-0.3743; P<.001). CONCLUSIONS: The MSM social media community mainly expressed their positive affect in the early morning and negative affect after midnight. Positive affective states were associated with being sexually active, whereas negative affective states were associated with health problems, mostly about mental health. Our finding suggests the potential to deliver different health-related intervention strategies (eg, psychological counseling and safe sex promotion) on a social media app according to the affective states of MSM in real time.

Correction: Associations Between Affective States and Sexual and Health Status Among Men Who Have Sex With Men in China: Exploratory Study Using Social Media Data.

[This corrects the article DOI: 10.2196/13201.].

Using traveller-derived cases in Henan Province to quantify the spread of COVID-19 in Wuhan, China.

Wuhan shutdown was implemented on January 23 and the first level response to public health emergencies (FLRPHE) was launched over the country, and then China got the outbreak of COVID-19 under control. A mathematical model is established to study the transmission of COVID-19 in Wuhan. This research investigates the spread of COVID-19 in Wuhan and assesses the effectiveness of control measures including the Wuhan city travel ban and FLRPHE. Based on the dynamical analysis and data fitting, the transmission of COVID-19 in Wuhan is estimated and the effects of control measures including Wuhan city travel ban and FLRPHE are investigated. According to the assumptions, the basic reproduction number for COVID-19 estimated that for Wuhan equal to 7.53 and there are 4.718 × 10 4 infectious people in Wuhan as of January 23. The interventions including the Wuhan city travel ban and FLRPHE reduce the size of peak and the cumulative number of confirmed cases of COVID-19 in Wuhan by 99%. The extraordinary efforts implemented by China effectively contain the transmission of COVID-19 and protect public health in China.

Inferring the Population Mean with Second-Order Information in Online Social Networks.

With the increasing use of online social networking platforms, online surveys are widely used in many fields, e.g., public health, business and sociology, to collect samples and to infer the population characteristics through self-reported data of respondents. Although the online surveys can protect the privacy of respondents, self-reporting is challenged by a low response rate and unreliable answers when the survey contains sensitive questions, such as drug use, sexual behaviors, abortion or criminal activity. To overcome this limitation, this paper develops an approach that collects the second-order information of the respondents, i.e., asking them about the characteristics of their friends, instead of asking the respondents' own characteristics directly. Then, we generate the inference about the population variable with the Hansen-Hurwitz estimator for the two classic sampling strategies (simple random sampling or random walk-based sampling). The method is evaluated by simulations on both artificial and real-world networks. Results show that the method is able to generate population estimates with high accuracy without knowing the respondents' own characteristics, and the biases of estimates under various settings are relatively small and are within acceptable limits. The new method offers an alternative way for implementing surveys online and is expected to be able to collect more reliable data with improved population inference on sensitive variables.

Multidrug-resistant tuberculosis (MDR-TB) disease burden in China: a systematic review and spatio-temporal analysis.

BACKGROUND: Surveillance data on the proportion of incident TB cases with MDR was limited and there is no systematic study of MDR-TB in China to date. Our aim was to estimate MDR-TB disease burden in 2012 and change trends during 2003-2012 using spatio-temporal systematic analysis. METHODS: We systematically searched Chinese and English databases for primary articles and reviews that contain MDR-TB survey data about China during the period of 2003-2012. We estimated the proportion of incident TB cases with MDR in cities which had no data to report in 2012 by Kriging spatial interpolation analysis. The primary outcomes were the proportion of incident TB cases with MDR at 2012 and the change trend during 2003-2012. RESULTS: Total 487 articles met the screening criteria, including 450 in Chinese and 37 in English, and have been used in analysis. The proportion of incident TB cases with MDR among all cases in 2012 showed clear geographic differences. From 2003 to 2012, the proportion of incident TB cases with MDR in all, new and previously treated TB cases were higher during 2006-2009 and significantly lower during 2010-2012 in comparison with the period during 2003-2005 (P < 0.0167). The estimated median proportion of incident TB cases with MDR among all cases, as well as in new and previously treated cases in 2012 was 12.8% (IQR 9.8-17.3%), 5.4% (4.5-7.3%) and 28.5% (20.5-30.9%) respectively, which led to an estimate of 121,600 (IQR93,000-164,350) MDR-TB cases in China. CONCLUSIONS: This estimate of MDR-TB burden is considerably higher than data reported by the Chinese fifth national tuberculosis epidemiological sampling survey in 2010 but close to the WHO report, which implies that detailed investigations of MDR-TB burden in China is needed. This research provides data to guide public health decisions at various scales; methods described here can be extended to estimate of the other chronic diseases as well.

[Analysis of biochemical recurrence following radical prostatectomy].

OBJECTIVE: To analyze the risk factors to impact biochemical recurrence after radical prostatectomy. METHODS: A total of 1 090 patients who received radical prostatectomy from May 2002 to December 2013 in Department of Urology of Fudan University Shanghai Cancer Center were recruited. The average age of the patients was 67.9 years (ranged from 41 to 84 years) and the average preoperative prostate specific antigen (PSA) level was 32.7 (ranged from 3.2 to 256.3) µg/L. The distribution of patients with respect to clinical stage was: 20.09% (219/1 090) had T1, 50.09% (546/1 090) had T2 and 29.82% (325/1 090) had T3. The biochemical-free-survival curve was drawn by Kaplan-Meier method and the univariate and multivariate Cox regression models were used to evaluate the clinical and pathological variables for the development of biochemical recurrence. RESULTS: Of all the 1 090 patients, the biochemical recurrence free survival was 95.99%, 81.90% and 70.89% at 1, 3 and 5 years. PSA level at diagnosis (P=0.000), neo-adjuvant hormonal therapy (P=0.001), pre-operative Gleason score (P=0.000), clinical stage (P=0.010), surgical margin status (P=0.028), post-operative Gleason score (P=0.000), pathological stages (P=0.000) and pelvic lymph-node metastasis (P=0.000) were associated with biochemical recurrence in the univariate analysis. However, in the multivariate analysis, only PSA level at diagnosis (P=0.000), pre-operative Gleason score (P=0.020), pathological stages (P=0.014) and pelvic lymph-node metastasis (P=0.017) were independent prognostic factors. CONCLUSION: For the patients who received radical prostatectomy, PSA level at diagnosis, pre-operative Gleason score, pathological stages and pelvic lymph-node metastasis status are independent prognostic factors for biochemical recurrence.

Antiretroviral therapy to prevent HIV transmission in serodiscordant couples in China (2003-11): a national observational cohort study.

BACKGROUND: On the basis of the results of the randomised clinical trial HPTN 052 and observational studies, WHO has recommended that antiretroviral therapy be offered to all HIV-infected individuals with uninfected partners of the opposite sex (serodiscordant couples) to reduce the risk of transmission. Whether or not such a public health approach is feasible and the outcomes are sustainable at a large scale and in a developing country setting has not previously been assessed. METHODS: In this retrospective observational cohort study, we included treated and treatment-naive HIV-positive individuals with HIV-negative partners of the opposite sex who had been added to the national HIV epidemiology and treatment databases between Jan 1, 2003 and Dec 31, 2011. We analysed the annual rate of HIV infection in HIV-negative partners during follow-up, stratified by treatment status of the index partner. Cox proportional hazards analyses were done to examine factors related to HIV transmission. FINDINGS: Based on data from 38,862 serodiscordant couples, with 101,295·1 person-years of follow-up for the seronegative partners, rates of HIV infection were 2·6 per 100 person-years (95% CI 2·4-2·8) among the 14,805 couples in the treatment-naive cohort (median baseline CD4 count for HIV-positive partners 441 cells per µl [IQR 314-590]) and 1·3 per 100 person-years (1·2-1·3) among the 24,057 couples in the treated cohort (median baseline CD4 count for HIV-positive partners 168 cells per µl [62-269]). We calculated a 26% relative reduction in HIV transmission (adjusted hazard ratio 0·74, 95% CI 0·65-0·84) in the treated cohort. The reduction in transmission was seen across almost all demographic subgroups and was significant in the first year (0·64, 0·54-0·76), and among couples in which the HIV-positive partner had been infected by blood or plasma transfusion (0·76, 0·59-0·99) or heterosexual intercourse (0·69, 0·56-0·84), but not among couples in which the HIV-positive partner was infected by injecting drugs (0·98, 0·71-1·36). INTERPRETATION: Antiretroviral therapy for HIV-positive individuals in serodiscordant couples reduced HIV transmission across China, which suggests that the treatment-as-prevention approach is a feasible public health prevention strategy on a national scale in a developing country context. The durability and generalisability of such protection, however, needs to be further studied. FUNDING: Chinese Government's 12th Five-Year Plan, the National Natural Science Foundation of China, and the Canadian International Development Research Centre.

Tuberculosis burden in China: a high prevalence of pulmonary tuberculosis in household contacts with and without symptoms.

BACKGROUND: In the context of decreasing tuberculosis prevalence in China, we examined the effectiveness of screening household contacts of tuberculosis patients. METHODS: A tuberculosis survey was conducted in 2008. All 3,355 household contacts of notified tuberculosis cases were examined with a questionnaire interview, chest X-ray and three sputum smear tests. The effectiveness was examined by comparing the prevalence of pulmonary tuberculosis in household contacts with or without presenting clinical symptoms against the respective notification rates. Regression models were used to evaluate the factors associated with pulmonary tuberculosis. RESULTS: Of the 3,355 household contacts, 92 members (2.7%) had pulmonary tuberculosis, among which 46 cases were asymptomatic. The prevalence of pulmonary tuberculosis and smear positive cases in household contacts without symptoms were 20 and 7 times higher than the notification rates in 2008, while those in household contacts with symptoms were 247 and 108 times higher than notification rates, respectively. The patients detected were mainly Index Cases' spouses, sisters/brothers and those who were in contact with female Index Cases. CONCLUSIONS: The present study provides convincing evidence that household contacts of notified tuberculosis cases are at higher risk of developing tuberculosis. Routine screening for household contacts without any symptoms is recommended for sustained tuberculosis control in China as well as in the world.

A new algorithm for calculating optimal viewing angles in coronary angiography based on 4-D cardiac computed tomography.

BACKGROUND: Coronary stenosis is the main cause of the coronary heart disease (CHD). However, coronary arteriography (CAG), which is considered as the 'gold standard' of determining the location and severity of CHD, hardly acquires a satisfactory image for some lesions by traditional viewing angles. OBJECTIVE: We proposed a new approach to calculate the optimal viewing angles of CAG system to observe vessel segment of interest. METHODS: Firstly, the 4-D coronary arteries are segmented to obtain a dynamic vessel model. Then, a "rendering" method in computer graphics is used to calculate the optimal viewing angles of the vessel segment in the entire cardiac cycle. At last, an intersection of these angles can be regarded as the optimal ones in the whole cardiac cycle. RESULTS: Within the constraint of 2% foreshortening, the single phase data show 1% foreshortening without overlapping at the optimal angles proposed by our method, compared with 1.8% foreshortening at working angles set by clinical experts. And the multi-phase experiments also have good results. CONCLUSIONS: The new approach can provide doctors optimal viewing angles of interested vessel segment in the whole cardiac cycle.

Urine immunofixation electrophoresis and serum free light chain analyses benefit diagnosis of multiple myeloma in orthopedic patients with normal serum total proteins, creatinine, calcium, and hemoglobin.

BACKGROUND: A substantial number of patients with multiple myeloma (MM) who have bone destruction are initially admitted into the orthopedic service at the hospital. However, routine laboratory testing usually fails to identify these patients, thus delaying optimal therapy. Therefore, there is a clear medical need for early diagnosis of MM in these patients. METHODS: Between 2019 and 2021, 42 patients receiving treatment for orthopedic conditions had normal hemoglobin (Hb), total protein (TP), albumin (ALB), creatinine (CREA), and blood calcium (Ca) levels before their surgical procedure(s) but were subsequently pathologically confirmed to have MM, based on their presenting orthopedic symptoms. During the same period, 52 patients with orthopedic conditions were pathologically excluded from the diagnosis of MM and were recruited into our control group. Serum free light chain (sFLC) testing was performed in 94 consecutive patients in the orthopedic service using Siemens N Latex FLC kits. The levels of Hb, TP, ALB, CREA, and Ca were also measured. All 42 patients with MM were divided into group A (n = 25: κ proliferation) and group B (n = 17: λ proliferation) by the pathology department. RESULTS: There were no significant differences in levels of Hb, TP, ALB, CREA, and Ca between group A and group B and the control group. However, the sFLC κ/λ ratio of group A and B was also significantly different from that of the control group (P < .001). The results of serum immunofixation electrophoresis (IFE) testing demonstrated negative results in 14 cases (58.3%) in group A and 4 cases (25.0%) in group B. CONCLUSIONS: Some patients with orthopedic conditions who do not have typical MM laboratory results, such as those with abnormal Hb, TP, ALB, CREA, and Ca levels before their operation(s), actually have MM. MM should be highly suspected in patients with unexplained bone lesions and with an abnormal sFLC κ/λ ratio. Further tissue or bone marrow biopsy is needed in these patients even if serum and urine IFE results are negative and light chain ratio is normal.