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Abstract Background Chlamydia is common among women of reproductive age and can cause serious health issues. This study aimed to examine the trends and factors linked to newly diagnosed and reported chlamydia cases in women aged 15–49 in Guangdong Province from 2006 to 2020. Methods We included all newly diagnosed and reported chlamydia cases from January 1, 2006, to December 31, 2020. Data from 21 cities in Guangdong Province were sourced from the National Notifiable Infectious Disease Reporting Information System in China. Temporal trends were analyzed using Joinpoint regression models. City-level factors (population density, net migration rate, and male-to-female sex ratio) were derived from the Guangdong Statistical Yearbook and the Guangdong Health and Family Planning Statistical Yearbook. Quasi-Poisson regression models were used to explore the relationship between sociodemographic factors and chlamydia incidence. Results From 2006 to 2020, 523,367 new chlamydia cases were reported among women of reproductive age in Guangdong. The mean reported rate was 122.6 per 100,000 population over 15 years, significantly increasing from 1.4 in 2006 to 179.7 in 2020 (average annual percent change [AAPC] = 47.4%, 95% CI: 42.8%-52.2%, P

Abstract Background Chlamydia and gonorrhea notifications are rapidly rising in men who have sex with men (MSM). Currently, there are limited data on the prevalence of chlamydia and gonorrhea across various anatomical sites. Our study aimed to explore the prevalence, association and changing trends of urethral and rectal chlamydia and gonorrhea among MSM in Guangdong Province, China. Methods We analyzed data among MSM attending sexually transmitted infections (STI) clinics in the Guangdong governmental sentinel network between 2018 and 2022. Chi-square tests were used to compare the difference, Join-point regressions for analyzing changing trends, and multivariate logistic regressions for examining associated factors. Results We included 4856 men in the analysis. Rectal chlamydia significantly increased from 13.8% to 26.4% over the past 5 years (average annual percentage change [AAPC] 19.2%, 95%CI 1.0-40.6, p = 0.043). After adjusting for covariates, chlamydia infection positively associated with main venue used to seek sexual partners (aOR = 2.31, 95%CI 1.17–4.55), having regular sexual partners in the past 6 months (aOR = 3.32, 95%CI 1.95–5.64), receiving HIV counselling and testing services (aOR = 2.94, 95%CI 1.67–5.17), receiving peer education (aOR = 1.80, 95%CI 1.14–2.83), infection with syphilis (aOR = 2.02, 95%CI 1.02–4.01) and infection with gonorrhea (aOR 7.04, 95% CI 3.01–16.48). Gonorrhea infection positively associated with having regular sexual partners in the past 6 months (aOR = 3.48.95%CI 1.16–10.49), and infection with chlamydia (aOR 7.03, 95% CI 2.99–16.51). Conclusions To conclude, our findings reveal a high prevalence of chlamydia infections among MSM, particularly in the rectal area. Comprehensive chlamydia and gonorrhea health services are necessary for MSM to improve sexual health.

Abstract Background Female sex workers (FSW) are particularly vulnerable to unintended pregnancy. Research examining the experience of unintended pregnancy due to commercial sex among Chinese FSW, however, is limited. This study aimed to examine the prevalence and correlates of unintended pregnancy due to commercial sex among FSW in China. Methods In 2021, a cross-sectional study was conducted among 1257 FSW in five cities from Guangdong provinces in South China. Data were collected on social-demographic characteristics, sexual behaviors, experience of unintended pregnancy due to commercial sex and its pregnancy outcome, as well as experience of abortion in lifetime. Multivariable logistic regression analysis was employed to identify factors associated with unintended pregnancy. Results Among the 1257 FSW, 19.3% reported having at least one unintended pregnancy due to commercial sex. Of those, 96.7% chose to terminate the pregnancy through induced abortion, and 40.5% reported undergoing multiple induced abortions in their lifetime. Multivariable logistic regression indicated that FSW working in current location over one year (adjusted Odds Ratio (aOR): 2.82, 95% CI 1.71–4.64) and having more than seven clients in the past week (aOR: 4.53, 95% CI 2.74–7.51) were more likely to have had unintended pregnancy due to commercial sex. Working in high tier (aOR: 0.21, 95% CI 0.14–0.30) and consistent condom use with clients in the past month (aOR: 0.16, 95% CI 0.10–0.23) were associated with a lower proportion of FSW having ever had unintended pregnancy. Conclusions Unintended pregnancy are prevalent among FSW in South China. Interventions aimed at reducing the prevalence of unintended pregnancy and enhancing post-abortion care could be necessary among Chinese FSW.

Abstract Background HIV self-testing (HIVST) was recommended to improve HIV testing services. China initiated some of the first HIVST pilots in the world, providing a unique opportunity for implementation research. We aim to investigate HIVST adoption and its following linkage to care among Chinese men who have sex with men (MSM). Methods Data were collected using an online questionnaire distributed on major social media platforms in 2018, one year after HIVST was officially endorsed and allowed for sale. MSM who were at least 16 years old, assigned as male at birth, and ever tested for HIV were eligible. Primary outcome, adoption was defined as ever use of HIVST. Bivariate and multivariable logistic regressions were performed to explore the association between HIVST adoption and sociodemographic and behavioral factors. Linkage to care was also described via the following sequential events as indicators: (1) receiving result after recent test (2), seeking care from healthcare facility if test result was positive or indeterminate, and (3) delayed time before seeking care. Results A total of 540 participants were included with an average age of 27.4 ± 6.6. Most were never married (87.4%) and half completed college (52.2%). Overall, 75.2% had adopted HIVST. Self-test kits were commonly obtained from community-based organizations (54.4%) and from online (46.6%). HIVST adoption was positively associated with having college or higher education (OR = 1.66, 95%CI: 1.07–2.57), and negatively associated with age older than 30 (AOR = 0.52, 95%CI: 0.32–0.84). Adoption was not associated with other socio-demographic or behavioral factors. After receiving HIV-positive or indeterminate results, 25/25 of HIVST adopters sought care while 3 out of 7 (42.9%) non-adopters sought care (p

BackgroundSeasonal influenza continues to pose a substantial public health challenge for older adults residing in rural areas worldwide. Vaccination remains the most efficacious means of preventing influenza. This study aimed to investigate the extent of influenza vaccine coverage and identify the factors influencing vaccine uptake among older adults in rural regions of south China.MethodsA cross-sectional study utilizing convenience sampling was conducted in two rural sites in Guangdong Province. Individuals needed to meet specific inclusion criteria: (1) attainment of 60 years of age or older; (2) originating from rural households; (3) demonstrating a voluntary desire to partake in the survey, either through written or verbal informed consent. Data encompassed variables such as socio-demographic information, influenza infection and vaccination history, knowledge and attitudes toward influenza vaccination, and perceived beliefs regarding the influenza vaccine. Univariate and multivariable logistic regression analyses were employed to ascertain the factors associated with influenza vaccine utilization. In the multivariable model, adjustments were made for gender, age, legal marital status, highest educational attainment, and monthly income.ResultsA total of 423 participants were ultimately included in this study, with the majority falling within the age range of 60–75 years (81.3%). Only one-third of the participants had received an influenza vaccine in the past year (30.0%). Notably, nearly half of the older adults exhibited hesitancy toward influenza vaccination (45.1%). The multivariable analysis revealed that rural older people with a robust understanding of influenza vaccines and a positive attitude toward them (adjusted odds ratio [aOR] = 2.60, 95% confidence interval [CI]: 1.41–4.81), along with a high level of trust in vaccination service providers (aOR = 2.58, 95% CI: 1.01–6.63), were positively associated with receiving influenza vaccination in the past year.ConclusionThis study reveals a low rate of influenza vaccine uptake among older adults residing in rural areas of south China. Given the limited adoption of influenza vaccination and the significant threat it poses, there is an urgent imperative to devise precise interventions aimed at enhancing the effectiveness of influenza vaccination programs.

Background The indiscriminate use of antibiotics has accelerated antimicrobial resistance (AMR) in Neisseria gonorrhoeae (NG), emphasising the need to follow treatment guidelines. This study aimed to assess the rate of adherence to standard treatment among patients with gonorrhoea and identify influencing factors.Methods A survey was conducted in Guangdong province, China, involving uncomplicated gonorrhoea cases registered in the Chinese Information System for Disease Control and Prevention. Data on demographic characteristics and medical information were collected to determine the standard treatment rate, defined as the proportion of patients receiving treatment according to national guidelines (ie, a single dose of ceftriaxone 250 mg, spectinomycin 2 g, cefotaxime 1 g or other third-generation cephalosporins). Medication choices were documented. χ² tests and multilevel logistic regression were used to analyse factors associated with standard treatment.Results The survey included 2424 patients with gonorrhoea from 59 hospitals. The standard treatment rate was 30.7% (743/2424), with 36.2% for females and 29.6% for males. Common reasons for substandard treatment included the use of non-guideline medications (42.3%, 710/1681) and incorrect dosing (36.2%, 605/1681). Factors associated with the standard treatment rate included gender, address, educational level, department, physicians’ training, number of diagnosed gonorrhoea cases and hospital level.Conclusion The standard treatment rate for gonorrhoea in Guangdong province, China, is below expectations. Comprehensive measures, such as establishing a goal-directed monitoring system and implementing promotional activities, are needed to improve adherence to treatment guidelines.

Abstract Background Online communication platforms have the potential to facilitate commercial sex among female sex workers (FSW), increasing the risk of contracting sexually transmitted diseases (STD). This study aimed to describe the patterns of online commercial sex-seeking and examine the associated factors among FSW in China. Methods A venue-based cross-sectional study was conducted in five cities in Guangdong Province, China, between April and October 2020. Data on socio-demographic characteristics, sexual behaviors, and online commercial sex-seeking patterns were collected through face-to-face interviews. Venous blood and urine samples were collected for STD testing. Univariate and multivariable logistic regressions were used to explore the factors associated with online commercial sex-seeking. Results A total of 1155 FSW were recruited in physical venues for this study. Among them, 33.42% reported ever using online applications to seek commercial sex. The prevalence of HIV, syphilis, gonorrhea, chlamydia, and STD was 0.26%, 1.30%, 4.40%, 15.54%, and 18.39%, respectively, among FSW who had ever used both physical and online venues to seek commercial sex, which was higher than among FSW who had never sought commercial sex online. Multivariable logistic regression indicated that FSW who used online platforms to seek commercial sex were more likely to have STD (adjusted odds ratio (aOR) = 1.48, 95%CI: 1.05–2.09), experience unintended pregnancies due to commercial sex (aOR = 1.78, 95%CI: 1.21–2.62), be diagnosed as infertile (aOR = 3.20, 95%CI: 1.42–7.21), and undergo abortions (aOR = 1.69, 95%CI: 1.29–2.20). Conclusion A significant proportion of FSW who practiced in physical venues in China engaged in seeking commercial sex online, and this behavior is positively correlated with both STD and reproductive health outcomes. Given the high prevalence of online sex-seeking, it is crucial to provide a wide range of internet-based healthcare interventions and reproductive health services to Chinese FSW.

Abstract Background Men who have sex with men (MSM) are at high risk of hepatitis C virus (HCV) infection, especially for those living with human immunodeficiency virus (HIV). Learning about knowledge of and attitudes towards HCV is essential to inform health promotion interventions development. This is one of very limited studies to examine the level of knowledge and attitudes towards HCV and their determinants among HIV-negative MSM and MSM living with HIV in China. Methods A cross-sectional survey was conducted across seven provinces in China from December 2021 to January 2022. All the MSM living with HIV were recruited offline, whereas the recruitment ratio for HIV-negative MSM was half online and half offline. Data on socio-demographic characteristics, sexual behaviors, knowledge about HCV, and attitude towards HCV from participants were collected through the online survey. Univariate and multivariable logistic regressions were used to determine the associated factors. Results Only 39.3% (33/84) of HIV-negative men and 44.0% (37/84) of men living with HIV had a good level knowledge about HCV. Nearly one-third (32.1%, 27/84) of HIV-negative men and 41.7% (35/84) of men living with HIV reported a positive attitude towards HCV. For HIV-negative men, positive attitude towards HCV was associated with the multiple sexual partners (aOR: 5.8, 95%CI:1.9–18.1) and the use of recreational substances (aOR: 3.1, 95%CI: 1.0-9.4). For men living with HIV, knowledge about HCV was associated with disclosing sexual orientation to healthcare providers, family or friends (aOR: 7.0, 1.9–26.0), the multiple sexual partners (aOR: 0.2, 0.1-1.0), the use of recreational substances (aOR: 3.7, 95%CI: 1.1–13.1) and the HBV testing history (aOR: 7.3, 95%CI: 1.6–32.7); positive attitude towards HCV was associated with the use of recreational substances (aOR: 3.1, 95%CI: 1.1-9.0). Conclusions The majority of Chinese MSM showed an inadequate knowledge of and negative attitude towards HCV irrespective of HIV infection status. More tailored education campaigns and multicomponent interventions are required to be targeted on MSM, and more researches are also needed to inform how best to address the negative attitudes of this population towards HCV.

Abstract Human immunodeficiency virus (HIV) and sexually transmitted diseases (STDs) cause substantial morbidity and mortality both in African and China. However, there is limited data available on the prevalence of HIV/STDs and the uptake of testing experience ever during in China among African migrants. A venue-based survey was conducted at a tertiary hospital in Guangzhou to investigate the prevalence of HIV/STDs through laboratory testing and identify the associated factors. A total of 200 eligible participants completed the survey and bring into the analysis from April to October 2019, and the temporary visitors were excluded. The prevalence rates of HIV, syphilis, NG, CT, and HBsAg among the participants were 1.0%, 2.5%, 1.0%, 1.5%, and 5.5%, respectively. The overall reported rate of HIV/STD testing was 37.0%, with rates of 23.0% for HIV, 16.5% for syphilis, 12.5% for NG, 6.5% for genital herpes, 5.0% for condyloma acuminata, and 2.5% for CT. HIV/STD testing was associated with living environment in Guangzhou, having medical insurance in China, and utilizing health services in China in the past year. HIV/STDs are prevalent among Africans in Guangzhou, and the epidemic is likely to spread due to a significant proportion of unprotected sexual behaviors and low rates of HIV/STD testing. Urgent interventions, including targeted health education, promotion of health service utilization, and active surveillance of HIV/STDs, are needed to reduce the risk of HIV/STD transmission.

Abstract Background Chlamydia Trachomatis (CT) is among the most prevalent sexually transmitted diseases (STDs) globally. According to the World Health Organization, more than 131 million people get infected with CT annually. CT is usually transmitted via sexual contact or perinatal exposure and can result in severe long-term complications. In developing nations, particularly, the prevention and control of CT is challenging. Hence, this study will explore the feedback mechanisms of chlamydia prevention and control, as well as identify the essential factors affecting the control and prevention of this infection in China. Methods Our study will employ a mixed-methods research design that encompasses both qualitative and quantitative methods. Firstly, we will develop a causal loop diagram (CLD) based on the literature review and optimize it via in-depth interviews with stakeholders. Additionally, we will utilize a quantitative method called MICMAC(Impact Matrix Cross-Reference Multiplication Applied to a Classification tool) to obtain consensus among different stakeholders and pinpoint the key information. Next, the CLD will be transformed into a system dynamics model (SDM) to evaluate the feedback mechanisms within the CLD. The causality in the CLD will be modeled using mathematical equations, which facilitate the transformation into an SDM. As such, we will be able to analyze the dynamic behavior of the system and its response to different decisions. Discussion Our study offers a systematic perspective on the control and prevention of chlamydia infection through system dynamics modeling, examining the dynamic properties and background factors of the system. The creation of the CLD affords stakeholders the chance to comprehend the functionality of their relationships and improve cooperation. Consequently, by evaluating the outcomes of these simulations, it will be possible to analyze and determine potential interventions and their effects on chlamydia infections. This modeling approach can help us gain insight into the dynamic characteristics of the system, evaluate the potential outcomes of different decisions, and design control strategies to either stabilize the system or adjust its behavior.

Abstract Background HCV self-testing (HCVST) may be an effective strategy to address low rates of HCV test uptake among men who have sex with men (MSM). We evaluated the effectiveness and cost of providing HCVST to increase HCV test uptake among MSM in China. Methods Two parallel, unmasked, individual-level randomized controlled trials were conducted. HIV-negative MSM and MSM living with HIV were enrolled from 22 cities in China. Men in both trials were randomly assigned (1:1) into standard-of-care (SOC) or HCVST arms. The primary outcome was the proportion of participants who tested for HCV during the trial period. Intervention effects were estimated using multiply imputed data in the main analysis. Costs were measured using a micro-costing approach. Results A total of 84 men who were HIV-negative (trial 1) and 84 men living with HIV were enrolled (trial 2). Overall, the proportion of individuals who underwent HCV testing during the trial period was higher in the HCVST arm compared to SOC in trial 1 (estimated risk difference (RD): 71.1%, 95% CI: 54.6 to 87.7%) and trial 2 (estimated RD: 62.9%, 95% CI: 45.7 to 80.1%). Over half (58.6%, 34/58) of HCV self-testers reported the self-test was their first HCV test. The cost per person tested in trial 1 was $654.52 for SOC and $49.83 for HCVST, and in trial 2 was $438.67 for SOC and $53.33 for HCVST. Conclusions Compared to the standard of care, providing HCVST significantly increased the proportion of MSM testing for HCV in China, and was cheaper per person tested. Trial registration Chinese Clinical Trial Registry. Registration number: ChiCTR2100048379.

iGABAR, a member of the Cys-loop ligand-gated ion channel superfamily, is a significant target of the insecticide ivermectin (IVM). GRD is the potential subunit of the insect iGABAR. However, little information about GRD in Ae. aegypti has been reported. In this study, we involved cloning and characterizing the iGABAR subunit GRD of Ae. aegypti (Ae-GRD). Sequence analysis indicated that Ae-GRD, as part of the cysteine-loop ligand-gated ion channel family, is similar to other insect GRD. RNA interference (RNAi) was employed to explore IVM resistance in Ae. aegypti, resulting in a significant reduction in Ae-GRD expression (p < 0.05), and the mortality of Ae. aegypti adults with Ae-GRD knockdown was significantly decreased after exposure to ivermectin. Bioinformatics prediction identified miR-71-5p as a potential regulator of Ae-GRD. In vitro, dual-luciferase reporter assays confirmed that Ae-GRD expression was regulated by miR-71-5p. Microinjection of miR-71-5p mimics upregulated miR-71-5p expression and downregulated Ae-GRD gene expression, reducing mortality by 34.52% following IVM treatment. Conversely, microinjection of a miR-71-5p inhibitor decreased miR-71-5p expression but did not affect the susceptibility to IVM despite increased Ae-GRD expression (p < 0.05). In conclusion, Ae-GRD, as one of the iGABA receptor subunits, is a potential target of ivermectin. It may influence ivermectin resistance by modulating the GABA signaling pathway. The inhibition of Ae-GRD expression by miR-71-5p decreased ivermectin resistance and consequently lowered the mortality rate of Ae. aegypti mosquitoes. This finding provides empirical evidence of the relationship between Ae-GRD and its miRNA in modulating insecticide resistance, offering novel perspectives for mosquito control strategies.

Objective To investigate the influence of mild psoriasis on the quality of patients' lives. Methods Based on PASI score and quality of life index, a questionnaire was designed to investigate the quality of lives in aspects of physiology, psychology, daily life, social entertainment, family, work and study in 95 patients with mild plaque psoriasis, aged 18~65 years. Logistic regression was used to analyze the quality of life-related factors. Results The quality of lives of 45 patients (47.37%) was affected by psoriasis. Moreover, an increase in one PASI score increased the risk of affecting quality of lives to 1.291 times, while an increase in one PGA score increased the risk of affecting quality of lives to 3.574 times. Conclusion Mild plaque psoriasis can affect the quality of patients′ lives to some extent.

Abstract Background The purpose of this study was to study the infection rates of Chlamydia trachomatis (CT), Ureaplasma urealyticum (UU), Neisseria gonorrhoeae (NG), and co-infections with human papillomavirus (HPV) in a hospital gynecology outpatient clinic in the Haikou region in 2021. Methods From January to December 2021, the Women and Children Medical Center of Hainan Province collected 2389 samples of cervical exfoliated cells and vaginal swab specimens from gynecologic outpatients. The samples were then analyzed descriptively for data, and the detection rate of each pathogen was tallied. All vaginal swabs were obtained for CT, UU, and NG DNA testing, and cervical exfoliated cells for HPV genotyping. Analyses were performed on the detection rate of each group. Results In 2389 samples, the frequencies of pathogen identification among the 2389 samples were as follows: UU (58.43%); HPV (17.29%); CT (7.99%); and NG (0.38%). HPV, CT, UU, and NG were detected in 33.33%, 22.55%, 77.45%, and 2.94% of individuals between 15 and 20 years of age, respectively. The detection rates of CT, UU, and NG were substantially greater in the HPV-positive group than the the HPV-negative group (P

Abstract Background Sexual uses of alcohol and drugs are pervasive among men who have sex with men (MSM) and associated with increased risk of HIV infection. However, there are limited studies related to sexual uses of alcohol and drugs among MSM in China. This study aims to describe the pattern of alcohol use, drug use, and multi-drug use during sex among Chinese MSM and to examine the association between condomless anal intercourse, group sex, commercial sex and HIV infection. Methods We conducted an online cross-sectional survey in China. Characteristics on social-demographic, sexual behaviors, and sexual uses of alcohol and drugs were collected. The associations with high-risk sexual behaviors and HIV infection were analyzed with multivariable logistic regression. Results A total of 699 MSM were included in this study. About 39.5% (230/582) of men reported sexual alcohol use in the past three months and 50.8% (355/699) reported sexual drug use. Of those reporting sexual drug use, around 10.7% (38/355) reported having multi-drug use. Factors associated with both sexual uses of alcohol and drugs included: reporting more male sexual partners (alcohol: adjusted odds ratio [aOR] = 1.77; drug: aOR = 2.12), reporting condomless anal intercourse in the past three months (alcohol: aOR = 2.08; drug: aOR = 2.08), having ever engaged in group sex (alcohol: aOR = 2.04; drug: aOR = 5.22; multi-drug: aOR = 3.52) and commercial sex (alcohol: aOR = 4.43; drug: aOR = 4.22 multi-drug: aOR = 5.07). Sexual drug use was also correlated with reported HIV-positive status (drug: aOR = 2.53, 95% CI:1.31–4.90). Conclusion Sexual uses of alcohol and drugs are prevalent among Chinese MSM. Interventions to reduce the sexual use of alcohol and other drugs may be warranted among MSM in China.

BackgroundMost Chlamydia trachomatis (CT) infections are asymptomatic. The infection can persist and lead to severe sequelae. Therefore, screening for CT can primarily prevent serious sequelae.AimTo systematically evaluate CT screening from the perspective of health economics, summarize previous findings from different target populations, and make practical recommendations for developing local CT screening strategies.MethodsPubMed, Web of Science, Embase, Cochran Library, and National Health Service Economic Evaluation Database (Ovid) were searched from January 1, 2000, to March 4, 2023. Studies reporting the cost-effectiveness, cost-benefit, or cost-utility of CT screening were eligible to be included. A narrative synthesis was used to analyze and report the results following the PRISMA guidelines. The Consensus on Health Economic Criteria (CHEC) list was used to assess the methodological quality of included studies.ResultsOur review finally comprised 39 studies addressing four populations: general sexually active people (n = 25), pregnant women (n = 4), women attending STD and abortion clinics (n = 4), and other high-risk individuals (n = 6). The total number of participants was ~7,991,198. The majority of studies assessed the cost-effectiveness or cost-utility of the screening method. The results showed that the following screening strategies may be cost-effective or cost-saving under certain conditions: performing CT screening in young people aged 15–24 in the general population, military recruits, and high school students; incorporating CT screening into routine antenatal care for pregnant women aged 15–30; opportunistic CT screening for women attending STD and abortion clinics; home-obtained sampling for CT screening using urine specimens or vaginal swab; performing CT screening for 14–30-year-old people who enter correctional institutions (i.e., jail, detention) as soon as possible; providing CT screening for female sex workers (FSWs) based on local incidence and prevalence; adding routine CT screening to HIV treatment using rectal samples from men who have sex with men (MSM).ConclusionWe found that CT screening in general sexually active people aged 15–24, military recruits, high school students, pregnant women aged 15–30, women attending STD and abortion clinics, people entering jail, detention, FSWs, and MSM has health economic value. Due to the different prevalence of CT, diversities of economic conditions, and varying screening costs among different populations and different countries, regions, or settings, no uniform and standard screening strategies are currently available. Therefore, each country should consider its local condition and the results of health economic evaluations of CT screening programs in that country to develop appropriate CT screening strategies.

Objective To explore basic characteristics and related influencing factors of white hair in females in Guangzhou city, and to provide clinical data for the intervention of white hair. Methods A total of 146 females with white hair, aged 18-60 years, were recruited from the Dermatology Hospital, Southern Medical University and the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from November 2021 and May 2022. Questionnaire survey and dermatological physical examination were carried out. Subjects were divided into early or late premature hair graying (PHG). Data analysis included single-factor analysis of 11 factors (BMI, dietary habits, hair ironing and dyeing habits, sleeping habits and so on), and multiple factor analysis of 5 factors, i.e., BMI, dietary habits, physical exercise frequency, familial history of PHG, smoking or a history of exposure to second hand smoke. Results ① The median age of initial appearance of white hair was 35.50 years, of which 56 cases (38.36%) were early PHG. Initial involved sites were mainly the vertex and frontal scalp. Localized and diffuse white hair accounted for 59.59% (87 cases) and 40.41% (59 cases), respectively. Forty-nine (87.50%) subjects in PHG group were mild (number of white hair: 100). The severity of white hair differed significantly between the two groups (χ2=11.54, P

Objective To analyze the infection rate of genital tract Chlamydia trachomatis infection in female sex workers in rural areas, and explore related risk factors. Methods Convenient sampling was used to enroll 250 subjects in rural areas of Yunfu city, Guangdong province. A questionnaire survey was used to collect demographic characteristics and sexual behavior characteristics. Blood sample from subjects was used for syphilis and HIV testing, while urine sample was collected for detection of gonorrhea and chlamydia, using real time PCR. Results The infection rate of Chlamydia trachomatis in the genital tract was 22.00% (55/250), while the infection rate of Neisseria gonorrhoeae was 11.60% (29/250). The infection rates of syphilis and HIV were 0.80% (2/250) and 0, respectively. In subjects with chlamydia infection, the co-infection rates of gonococcus and syphilis were 40.0% and 0, respectively. The higher infection rate of Chlamydia trachomatis in the genital tract was associated with lower monthly income (OR=3.052), lower education level (OR=2.611), the non-continuous use of condoms in the last month (OR=3.226), more encounter partners per week (OR=2.109). Conclusions Female sex workers in rural areas have a high rate of Chlamydia trachomatis infection in genital tract. It is recommended to strengthen the detection and health education of genital tract Chlamydia trachomatis infection, and improve the self-prevention and risk control awareness of genital tract infection with Chlamydia trachomatis.

We deal with a single-machine scheduling problem with an optional maintenance activity (denoted by $ ma $), where the actual processing time of a job is a function of its starting time and position. The optional $ ma $ means that the machine will perform a $ ma $, after $ ma $ is completed, the machine will return to the initial state. The objective is to determine an optimal job sequence and the location of the maintenance activity such that makespan is to be minimized. Based on some properties of an optimal sequence, we introduce a polynomial time algorithm to solve the problem, and the time complexity is $ O({n}^4) $, where $ {n} $ is the number of jobs.

Abstract Background The Internet has become an important virtual venue for men who have sex with men to seek sexual partners, with a high potential threat to spread sexually transmitted infections (STIs). However, the online sex-seeking use and its risk causing STIs spread remain unclear among heterosexual men. We conducted a cross-sectional study to investigate the use of online sex-seeking venues and the related risky sex activities (e.g. condomless sex, quick sex) in STIs clinics in Guangdong, China. Methods These STIs clinics were involved in the Guangdong governmental sentinel network and we recruited heterosexual men (age > = 18) between March and August 2018. Multivariable logistic regression models were used to identify the factors associated with online sex-seeking use and risky sex activities with online sex partners. Results 191 of 2,154 participants (8.9%) ever sought sex online. Among users,16.8% met their partners in-person within 24 h, 31.4% engaged in condomless sex with their last online partner. Online sex-seeking was positively associated with a) Ever been diagnosed with STIs (aOR = 3.0, 95%CI:2.0–4.6), and b) Had casual sex in the last three months (aOR = 3.3, 95%CI 2.4–4.6). Condomless sex with the last online partner was negatively associated with the correct answer of “Having only one partner can reduce the risk to infect HIV” (aOR = 0.3, 95%CI:0.1–0.8). Conclusion In China, online sex-seeking and its related risky sexual activities are not rare among heterosexual men. Future prevention strategies to reduce STIs incidence should especially target heterosexual men engaging in online sex-seeking.

Abstract Background Syphilis testing uptake remains low among men who have sex with men (MSM) in many low-and middle-income countries. Syphilis self-testing is an efficacious approach on increasing syphilis testing coverage. However, one unintended consequence is the syphilis self-testing coercion from others (including partners, healthcare providers, friends, etc.). This study aimed to examine the prevalence, pattern and correlates of coerced syphilis self-testing among MSM in China. Methods A nationwide online cross-sectional study was conducted from 14 to 28 July 2018. Sociodemographic characteristics, sexual behaviors and coerced syphilis self-testing variables were collected through a questionnaire that targeted MSM in China. Multivariable logistic regression was used to explore associated factors with syphilis self-testing coercion. Results Overall, 174 MSM were recruited in this study, 31 men (17.8%) reported ever experiencing syphilis self-testing coercion. The most common types of coercion before syphilis self-testing were verbal abuse (38.7%, 12/31) and threatening to end a relationship (38.7%, 12/31). After obtaining the self-test results, men were mostly subjected to end a relationship (45.2%, 14/31) and threaten of violence (35.5%, 11/31). Multivariable logistic regression indicated that men who used condoms inconsistently in the past three months, ever used substances before or during sex, ever had group sex with males and commercial sex were more likely to experience syphilis self-testing coercion. Conclusions Coerced syphilis self-testing was prevalent among MSM in China. Innovative intervention to reduce coerced syphilis self-testing is necessary among MSM in China.

In this article, we investigate the single-machine scheduling problem with truncated learning effect and resource allocation, where the actual processing time of a job is a general function of its additional resources and position in a sequence. The goal is to determine the optimal resource allocation and optimal sequence such that a weighted sum of scheduling cost and resource consumption cost is minimized. We show that the problem can be solved in $ O(n^3) $ time by using an assignment formulation, where $ n $ is the number of jobs.

In this paper, we investigate the single-machine scheduling problem that considers due date assignment and past-sequence-dependent setup times simultaneously. Under common (slack and different) due date assignment, the objective is to find jointly the optimal sequence and optimal due dates to minimize the weighted sum of lateness, number of early and delayed jobs, and due date cost, where the weight only depends on it's position in a sequence (i.e., a position-dependent weight). Optimal properties of the problem are given and then the polynomial time algorithm is proposed to obtain the optimal solution.

This article investigates the due-window assignment scheduling problem with setup times on a single machine, where setup times of jobs are past-sequence-dependent. Under common, slack and unrestricted due-window assignment methods, the goal is to determine the optimal job sequence and due-window such that the cost function (i.e., the weighted sum of earliness and tardiness, number of early and tardy jobs, due-window starting time and size) is minimized. We solve the problem optimally by introducing a polynomial time algorithm. An extension to the problem with learning and deterioration effects is also studied.

Abstract Background The purpose of this study was to develop and validate a simple-to-use nomogram for the prediction of syphilis infection among men who have sex with men (MSM) in Guangdong Province. Methods A serial cross-sectional data of 2184 MSM from 2017 to 2019 was used to develop and validate the nomogram risk assessment model. The eligible MSM were randomly assigned to the training and validation dataset. Factors included in the nomogram were determined by multivariate logistic regression analysis based on the training dataset. The receiver operating characteristic (ROC) curves was used to assess its predictive accuracy and discriminative ability. Results A total of 2184 MSM were recruited in this study. The prevalence of syphilis was 18.1% (396/2184). Multivariate logistic analysis found that age, the main venue used to find sexual partners, condom use in the past 6 months, commercial sex in the past 6 months, infection with sexually transmitted diseases (STD) in the past year were associated with syphilis infection using the training dataset. All these factors were included in the nomogram model that was well calibrated. The C-index was 0.80 (95% CI 0.76–0.84) in the training dataset, and 0.79 (95% CI 0.75–0.84) in the validation dataset. Conclusions A simple-to-use nomogram for predicting the risk of syphilis has been developed and validated among MSM in Guangdong Province. The proposed nomogram shows good assessment performance.

BackgroundHIV-positive men who have sex with men (MSM) tend to have high syphilis incidence. Our objective is to evaluate the prevalence of syphilis and determine the risk factors of syphilis among HIV-positive MSM.MethodsA cross-sectional study with convenience sampling was performed among HIV-positive MSM in six cities of Guangdong Province from June 2020 to August 2021. Participants completed a survey including social-demographic characteristics, sexual behaviors and self-reported syphilis, chlamydia, gonorrhea, herpes, human papillomavirus statuses after HIV diagnosis. Multivariate logistic regression was used to determine the factors associated with syphilis and sexually transmitted diseases (STD).ResultsAmong 944 HIV-positive MSM, 141 (14.9, 95% CI: 12.7–17.2%) men had syphilis and 220 (23.3, 95% CI: 20.6–26.0%) men had STD. Multivariate analysis indicated that MSM who met male sexual partners mainly through traditional meeting places (spa or bath house, sauna, foot or body massage parlor) in the last 6 months [adjusted Odds Ratio (aOR) = 2.91, 95% CI: 1.09–7.79], and who were diagnosed with herps after the HIV diagnosis (aOR = 3.79, 95% CI: 1.16–12.39) were more likely to have syphilis. In addition, MSM who met male sexual partners mainly through traditional meeting places in the last 6 month (aOR = 2.55, 95% CI: 1.01–6.42), and who had more than one male sexual partner in the last 6 months (aOR = 1.88, 95% CI: 1.17–3.02) were more likely to have STD.ConclusionsThe prevalence of syphilis and other STDs is relatively high among HIV-positive MSM in southern China. Routine syphilis screening as a part of HIV monitoring among HIV-positive MSM will have important epidemiological significance for the management of infected patients, and can help reduce the spread of syphilis.

BackgroundHepatitis C virus self-testing (HCVST) may increase test uptake especially among marginalized key populations such as men who have sex with men (MSM). We conducted an observational study to assess the usability, acceptability and feasibility of HCVST among MSM in China.MethodsAn observational study with convenience sampling was performed among MSM in Guangzhou, China in 2019. The OraQuick® HCV Rapid Antibody Test kits were used in this study. Participants performed all 12 HCVST steps and interpreted the results in the presence of a trained observer. Usability was defined as the number and percentage of participants who completed all testing steps correctly without assistance and interpreted the results correctly. Inter-reader concordance was calculated as the percentage agreement between the results interpreted by the participant and those interpreted by a trained staff member. The same process was used to estimate inter-operator agreement between the self-testing and professional use test results. Acceptability was assessed using an interviewer-administered semi-structured questionnaire.ResultsAmong 100 participants with median age 27 (interquartile range 23–30) years, 4% reported prior history of HCV testing, 41% reported using blood-based HIV self-testing in the past, 54% (95%CI: 43.7–64.0%) completed all self-testing steps correctly without assistance and interpreted the results correctly. Both the inter-reader and inter-operator concordance were excellent at 97% (95%CI: 91.5–99.4%) and 98% (95%CI: 93.0–99.8%), respectively. The majority rated the HCVST process as very easy (52%, 95%CI: 41.8–62.1%) or easy (41%, 95%CI: 31.3–51.3%), 76% (95%CI: 66.4–84.0%) were willing to use HCVST again, and 75% (95%CI: 65.3–83.1%) would recommend it to their family and friends.ConclusionsOur findings demonstrate that oral fluid HCVST has high usability and acceptability among Chinese MSM. More implementation research is needed to plan how best to position and scale-up HCVST alongside other facility-and community-based testing approaches and ensure data linkage into health systems.

Abstract Background Men who have sex with men (MSM) bear a high burden of syphilis infection. Expanding syphilis testing to improve timely diagnosis and treatment is critical to improve syphilis control. However, syphilis testing rates remain low among MSM, particularly in low- and middle-income countries. We describe the protocol for a randomised controlled trial (RCT) to assess whether provision of syphilis self-testing services can increase the uptake of syphilis testing among MSM in China. Methods Four hundred forty-four high-risk MSM will be recruited online and randomized in a 1:1:1 ratio to (1) standard syphilis self-testing arm; (2) a self-testing arm program enhanced with crowdsourcing and a lottery-based incentive, and (3) a standard of care (control). Self-testing services include a free syphilis self-test kit through the mail at monthly intervals. Participants in the lottery incentive arm will additionally receive health promotion materials generated from an open crowdsourcing contest and be given a lottery draw with a 10% chance to win 100 RMB (approximately 15 US Dollars) upon confirmed completion of syphilis testing. Syphilis self-test kits have step-by-step instructions and an instructional video. This is a non-blinded, open-label, parallel RCT. Participants in each arm will be followed-up at three and 6 months through WeChat (a social media app like Facebook messenger). Confirmation of syphilis self-test use will be determined by requiring participants to submit a photo of the used test kit to study staff via secure data messaging. Both self-testing and facility-based testing will be ascertained by sending a secure photographic image of the completed kit through an existing digital platform. The primary outcome is the proportion of participants who tested for syphilis in the past 3 months. Discussion Findings from this study will provide much needed insight on the impact of syphilis self-testing on promoting routine syphilis screening among MSM. The findings will also contribute to our understanding of the safety, effectiveness and acceptability of syphilis self-testing. These findings will have important implications for self-testing policy, both in China and internationally. Trial registration ChiCTR1900022409 (10 April, 2019).

Leukocyte esterase test (LET) detection is a simple and inexpensive test performed by urinalysis. This study investigated the predictive value of LET for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infection among men attending HIV and sexually transmitted infection (HIV/STI) clinics in Guangdong Province, China. A total of 5,509 urine samples were collected from HIV and sexually transmitted infection clinics in Guangdong Province between 2017 and 2019. Specimens from 5,464 males were tested by both LET and nucleic acid amplification test (NAAT). Of 5,464 males, 497 (9.1%) tested positive for CT or NG by NAAT, with respective prevalence rates of 6.4% (95% confidence interval [95% CI]: 5.8–7.1%) and 3.8% (95% CI: 3.3–4.3%), including 1.2% (95% CI: 0.9–1.4%) co-infected. Compared to the HIV-negative individuals, individuals living with HIV tend to have a higher prevalence of CT, NG and co-infection with CT and NG. The LET sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for CT were 46.4% (95% CI: 41.2–51.7%), 92.0% (95% CI: 91.2–92.7%), 28.4% (95% CI: 24.8–32.1%), and 96.1% (95% CI: 95.6–96.7%), respectively. The LET sensitivity, specificity, PPV, and NPV for NG were 68.4% (95% CI: 62.1–74.7%), 91.8% (95% CI: 91.1–92.6%), 25.0% (95% CI: 21.4–28.5%), and 98.7% (95% CI: 98.3–99%), respectively. Compared to the HIV-negative individuals, higher sensitivity and specificity were observed for HIV-positive individuals, but there was no statistical difference. The incremental cost-effectiveness ratio (ICER) using economic costs per additional person CT positive and NG positive was –$238.74 and –$145.60 compared with LET positive, respectively. LET is a cost-effective test and will be valuable for predicting CT and NG infection, which is highly prevalent in low- and middle-income countries.

BackgroundLow syphilis testing uptake is a major public health issue among men who have sex with men (MSM) in many low- and middle-income countries. Syphilis self-testing (SST) may complement and extend facility-based testing. We aimed to evaluate the effectiveness and costs of providing SST on increasing syphilis testing uptake among MSM in China.Methods and findingsAn open-label, parallel 3-arm randomized controlled trial (RCT) was conducted between January 7, 2020 and July 17, 2020. Men who were at least 18 years of age, had condomless anal sex with men in the past year, reported not testing for syphilis in the last 6 months, and had a stable residence with mailing addresses were recruited from 124 cities in 26 Chinese provinces. Using block randomization with blocks of size 12, enrolled participants were randomly assigned (1:1:1) into 3 arms: standard of care arm, standard SST arm, and lottery incentivized SST arm (1 in 10 chance to win US$15 if they had a syphilis test). The primary outcome was the proportion of participants who tested for syphilis during the trial period and confirmed with photo verification and between arm comparisons were estimated with risk differences (RDs). Analyses were performed on a modified intention-to-treat basis: Participants were included in the complete case analysis if they had initiated at least 1 follow-up survey. The Syphilis/HIV Duo rapid test kit was used. A total of 451 men were enrolled. In total, 136 (90·7%, 136/150) in the standard of care arm, 142 (94·0%, 142/151) in the standard of SST arm, and 137 (91·3%, 137/150) in the lottery incentivized SST arm were included in the final analysis. The proportion of men who had at least 1 syphilis test during the trial period was 63.4% (95% confidence interval [CI]: 55.5% to 71.3%, p = 0.001) in the standard SST arm, 65.7% (95% CI: 57.7% to 73.6%, p = 0.0002) in the lottery incentivized SST arm, and 14.7% (95% CI: 8.8% to 20.7%, p < 0.001) in the standard of care arm. The estimated RD between the standard SST and standard of care arm was 48.7% (95% CI: 37.8% to 58.4%, p < 0.001). The majority (78.5%, 95% CI: 72.7% to 84.4%, p < 0.001) of syphilis self-testers reported never testing for syphilis. The cost per person tested was US$26.55 for standard SST, US$28.09 for the lottery incentivized SST, and US$66.19 for the standard of care. No study-related adverse events were reported during the study duration. Limitation was that the impact of the Coronavirus Disease 2019 (COVID-19) restrictions may have accentuated demand for decentralized testing.ConclusionsCompared to standard of care, providing SST significantly increased the proportion of MSM testing for syphilis in China and was cheaper (per person tested).Trial registrationChinese Clinical Trial Registry: ChiCTR1900022409.

Objectives This study aimed to determine the variation in the interval between the onset of symptoms and clinical presentation, and its associated factors among symptomatic individuals with gonorrhoea.Design A cross-sectional study was conducted between 1 June and 30 July 2017.Setting 129 sexually transmitted disease clinics from 21 cities of Guangdong, China.Participants Using convenience sampling method to recruit symptomatic individuals with gonorrhoea over 18 years old.Outcome measure Time to clinical presentation.Results Among 1664 participants, the median age was 29 (24–36) years old, and the majority were male (92.5%) and married (52.9%). The median time to clinical presentation was 3 (2–6) days. About 471 (28.3%) patients had sexual contact while symptomatic. After adjusting for covariates, participants who were female (aβ=0.44, 95% CI: 0.22 to 0.80), from east Guangdong region (aβ=0.44, 95% CI: 0.22 to 0.80) and had the absence of dysuria (aβ=0.26, 95% CI: 0.06 to 0.46) had increased time to clinical presentation. Participants who had commercial sex in the past 6 months (aβ=−0.11, 95% CI: −0.21 to –0.01) had decreased time to clinical presentation. Participants who were female (adjusted odds ratio (aOR)=1.66, 95% CI: 1.08 to 2.50) and delayed in seeking healthcare more than 7 days (aOR=46.71, 95% CI: 24.27 to 89.93) were more likely to have sexual contact while symptomatic.Conclusion The time to clinical presentation for individuals with symptomatic gonorrhoea is variable and a high proportion of participants continued to have sexual behaviour while symptomatic. Strategies to increase health literacy may help to minimise the sequelae of gonorrhoea and reduce onward transmission.

Background: Sexual health among older adults is a major public health concern globally. The syphilis burden is increasing in older adults in China. This study aimed to describe factors associated with syphilis infection and diagnosis among older adults in China during a 16 year period.Methods: Using 16 years of data (2004–2019) from the syphilis case report system of Guangdong, China, we compared data from older adults (aged ≥50 years) with those from younger people (aged 15–49 years). We compared the two age group with the Chi-square test for difference, and Joinpoint regression models to assess the temporal trends.Results: During the study period, 242,115 new syphilis diagnoses were reported in older adults. The mean notification rate of new diagnoses was 64.1 per 100,000 population across the entire 16-year period, which significantly increased over time (average annual percent change [AAPC] 16.2%, 95% CI 13.7–18.7). Syphilis diagnoses increased significantly over time among less developed cities and older women. In 2019, compared with younger adults, newly diagnosed older adults were more likely to be male, native to reporting city, had unknown transmission routes, and were diagnosed late.Conclusion: Our findings call for an urgent need to deliver more targeted prevention interventions for older adults, such as strengthen awareness among health care providers, and integration of syphilis services and primary health care for older adults.

Objectives To assess the health utilisation status and associated factors among African migrants in China.Design A national cross-sectional study was conducted among African migrants in China in 2019.Setting Participants were recruited online and offline to participate in a self-report survey. Online participants were recruited through WeChat across China, and offline participants were recruited in Guangzhou.Participants We recruited participants who were from an African country; had spent at least 1 month cumulatively in China; were at least 18 years old; were willing to provide informed consent. A total of 1025 participants were recruited online and offline, 19 of them were excluded due to invalid response and 1006 people were finally included in the analysis.Outcome measures The primary outcome was health service utilisation and associated factors among African migrants during their stay in China in the past 12 months. The potential factors include the predisposing factors (demographic characteristics and social structure variables), enabling factors (annual income, health insurance in China) and need factors (non-communicable chronic and infectious diseases, depression) which determined by Anderson framework were measured.Results Eight hundred and seven online and 218 offline participants completed the survey, including 624 males and 382 females, with an average age of 26.4±8.9 years. Around 28.5% reported health utilization in the past 12 months. Results showed that longer duration in China, migration to China for business (aOR=2.23, 95% CI:1.13-4.40) and study (aOR=5.00, 95% CI:2.74-9.11), living in apartment (aOR=2.59, 95% CI:1.62-4.14) or dormitory (aOR=3.22, 95% CI:2.17-4.80) in China, suffering from chronic diseases, communicable diseases, and greater depressive symptoms (aOR=1.91, 95% CI:1.42-2.56) facilitated health service utilization.Conclusions The healthcare service that African migrants received in China is low. The existing public health policies and intervention measures need to be improved to make health utilisation more accessible and feasible for African migrants.

BackgroundPrevious studies exploring the factors associated with the incidence of syphilis have mostly focused on individual-level factors. However, recent evidence has indicated that social-level factors, such as sociodemographic and socioeconomic factors, also affect the incidence of syphilis. Studies on the sociodemographic and socioeconomic factors associated with syphilis incidence are scarce, and they have rarely controlled for spatial effects, even though syphilis shows spatial autocorrelation.Methodology/principal findingsSyphilis data from 21 cities in Guangdong province between 2005 and 2017 were provided by the National Notifiable Infectious Disease Reporting Information System. The incidence time series, incidence map, and space-time scanning data were used to visualize the spatiotemporal distribution. The spatial panel data model was then applied to explore the relationship between sociodemographic factors (population density, net migration rate, male:female ratio, and the number of health institutions per 1,000 residents), socioeconomic factors (gross domestic product per capita, the proportion of secondary/tertiary industry), and the incidence of primary and secondary syphilis after controlling for spatial effects. The incidence of syphilis increased slowly from 2005 (11.91 per 100,000) to 2011 (13.42 per 100,000) and then began to decrease, reaching 6.55 per 100,000 in 2017. High-risk clusters of syphilis tended to shift from developed areas to underdeveloped areas. An inverted U-shaped relationship was found between syphilis incidence and gross domestic product per capita. Moreover, syphilis incidence was significantly associated with population density (β = 2.844, P = 0.006), the number of health institutions per 1,000 residents (β = -0.095, P = 0.007), and the net migration rate (β = -0.219, P = 0.002).Conclusions/significanceOur findings suggest that the incidence of primary and secondary syphilis first increase before decreasing as economic development increases further. These results emphasize the necessity to prevent syphilis in regions at the early stages of economic growth.

BackgroundTumor-infiltrating lymphocytes (TILs) are considered a manifestation of the host immune response against cancer and tertiary lymphoid structures (TLS) may contribute to lymphocytes recruitment. Both of them have been reported as potential prognostic parameters in some human malignancies. However, the roles of TILs, TLS, and their correlation in Epstein-Barr Virus-associated gastric carcinoma (EBVaGC) and EBV-negative gastric carcinoma (EBVnGC) are largely unknown.MethodsTo observe the correlation among TILs, TLS, and clinicopathological characteristics and their prognostic significance in EBVaGC and EBVnGC, respectively. TILs and TLS were assessed by morphology and/or immunohistochemistry, and accompanied by clinicopathological analysis from 846 gastric cancer patients in multiple institutions.ResultsForty-two (5.0%) cases of EBVaGC and 804 cases of EBVnGC were identified by in situ hybridization, respectively. For EBVnGC, higher TILs grade was correlated with TLS-present. EBVnGC patients with high TILs grade and TLS-present exhibited survival benefits. TILs (P = 0.001) and TLS (P = 0.003), especially TILs & TLS (P < 0.001) were independent prognostic factors in EBVnGC. A nomogram was constructed and validated for predicting the probability of overall survival and performed well with a good calibration. No significant prognostic value was detected in EBVaGC.ConclusionTILs and TLS, especially TILs & TLS were promising prognostic indicators for overall survival in EBVnGC. TILs and TLS were highly overlapping in their extent and prognostic abilities, and may be considered as a coindicator of prognosis of gastric cancer. The evaluations of TILs and TLS are simple and can be assessed routinely in pathological diagnosis.

Background: Urogenital Chlamydia trachomatis is the most prevalent bacterial sexually transmitted infection (STI) globally. Reviews suggest high and persistently endemic STI epidemics in low and middle income countries. However population-based prevalence estimates in these settings are less common, underscoring the need for analyses of available data to characterize patterns of disease burden. We identified spatio-temporal clusters and key behavioral, social, or environmental factors contribution to transmission in order to inform the prioritization and targeting of evidence based interventions. Methods: Using 11 years of data (2006–2016) from the chlamydia case report system of Guangdong, China, we identified county level spatio-temporal hot and cold spots using the Getis-Ord Gi* statistic and discrete Poisson models in SaTScan 9.6. We also estimated associations between observed distribution patterns and area-level demographic, social, and economic factors using quasi-Poisson regression models that controlled for annual counts of certified laboratories to account for fluctuations in location-specific detection capacity. Findings: Cluster analysis indicates an expanding chlamydia epidemic in Guangdong, with cases clustered in regions of greatest economic activity. Greater male-to-female sex ratio (RR, 3.63; 95% CI, 1.41–9.45) and greater urbanicity (RR, 2.44; 95% CI, 1.98–2.99) were predictive of higher chlamydia case occurrence. Interpretation: We found that chlamydia case occurrence in Guangdong province has been accelerating over the past 11 years and that its expansion is tied to indicators of social and economic development. These estimates not only identify high prevalence regions to target but also areas where data gaps potentially remain. The salience of sex ratios and urbanicity may best be understood through the lens of China's modern history of labor migration which has reshaped the gender dynamics and health access landscape of urban China. Future chlamydia control efforts will require a population-based approach focused on reengaging sexually active adults of diverse economic and migratory backgrounds. Funding: This was an unfunded study using routinely collected public health data.

BackgroundThe four ERBB tyrosine kinase family members [ERBB1 (epidermal growth factor receptor, EGFR), ERBB2 (HER2), ERBB3 (HER3), and ERBB4 (HER4)] (ERBB receptor family) have been shown, according to previous studies, to be related to the cutaneous melanoma. ERBB3 is the only member of the ERBBs that lacks tyrosine kinase activity and thus needs to dimer with other tyrosine kinases receptors to trigger the signaling pathway, while ERBB3 may dimer with all members of the ERBB family. Melanoma progression depends on activation of ERBB signaling, especially the ERBB3/ERBB2 cascade. There are lymphocytes and T cell infiltrates in melanoma. Numerous pieces of evidences indicate that local immune status plays an important role in the formation of anti-tumor immune responses. However, the relationship between the ERBBs and prognosis and immune infiltration in cutaneous melanoma is not completely clear.MethodsThe expression of the ERBBs was analyzed through the Oncomine database, Gene Expression Profiling Interactive Analysis (GEPIA), respectively. Immunohistochemistry of ERBBs was obtained from the Human Protein Atlas is increased before HPA database. ERBBs genes expression and mutation analysis in cutaneous melanoma from the cBioPortal. Functional annotation and Kyoto Encyclopedia of Genes and Genomes is increased before KEGG pathway enrichment analysis from the Metascape. Correlations between ERBBs and 31 genes that were close to each other and frequently altered were explored by GEPIA. Using the GEPIA database, we also investigated the relationship between ERBBs and myeloid-derived suppressor cells (MDSC) in cutaneous melanoma. The disease-free survival and different tumor stages of ERBBs were evaluated by GEPIA. The correlation of ERBBs and tumor-infiltrating immune cells and prognostic(5 years survival rates) was tested by the Tumor Immune Estimation Resource (TIMER).ResultsIn general, the expression levels of ERBB1/2 in cutaneous melanoma were lower than those in normal skin tissue. By contrast, the ERBB3 expression level was higher in cutaneous melanoma than in normal skin tissue. Low expression of ERBB1/2 and high expression of ERBB3 were detrimental to the 5 years survival of cutaneous melanoma patients (ERBB1: log-rank P: 0.03; ERBB2: log-rank P: 0.008; ERBB3: log-rank P: 0.039). ERBB4 expression may not affect the prognosis of patients with cutaneous melanoma. ERBBs may not play a role in the tumor stage and disease-free survival in cutaneous melanoma patients. The relationship between the ERBB family and 31 genes that were close to each other and frequently altered is demonstrated as the genes regulated by the ERBB family being mainly concentrated in the RAS/RAF/MEK/ERK signaling pathway. ERBB2 can induce infiltration of CD8+ T cells and B cells, while ERBB3 can induce infiltration of CD4+ T cells, CD8+ T cells, and Neutrophil cells. ERBBs are more significantly associated with M1 macrophages, dendritic cells, Th1, Th2, Th17, and Treg cellular immune markers (Cor > 0.2). ERBB2/3 were related to MDSC in cutaneous melanoma, including human mononuclear myeloid-derived suppressor cells (M-MDSC) and polymorphonuclear myeloid-derived suppressor cells (PMN-MDSC), and may influence the progression of cutaneous melanoma through MDSC, but the conclusion needs further probing.ConclusionThis study investigated the prognosis and immune infiltration of the ERBB family in cutaneous melanoma. Our results suggest that ERBB1/2/3 may serve as early prognostic markers and potential therapeutic targets in cutaneous melanoma.

Objectives The COVID-19 pandemic has overwhelmed health systems globally. With the increase of global migration, quantifying the health needs and key correlates of these outcomes is a global health priority. This study assessed migration characteristics, COVID-19 attitudes and the postmigration social environment as key correlates of depression, quality of life and alcohol misuse among international migrants in China.Design A nationwide cross-sectional online survey was conducted from 17 February and 1 March 2020.Setting Links to the online survey were disseminated by migrant-focused community-based organisations through WeChat.Participants English speaking international migrants who met the inclusion criteria. Inclusion criteria were being born in a country outside of China, aged 18 years or over, cumulatively living in China for 1 month or more and staying in China between December 2019 and February 2020.Outcome measures Depression, quality of life and alcohol misuse.Results Regression models indicated that planning or considering leaving China due to COVID-19, lacking the confidence to protect themselves and not being confident that the epidemic would end soon was associated with greater depression, lower quality of life and greater levels of alcohol misuse. Worry about contracting COVID-19 and feeling helpless to prevent infection were associated with greater depression and lower quality of life. General perceived social support, and trust in Chinese people, institutions and systems were protective factors for depression and associated with higher reported quality of life.Conclusions This study identifies key correlates that, if adequately addressed through public health outreach, may safeguard migrant well-being during a public health emergency. Trust in people and systems within the postmigration environment is an important consideration for future public health planning efforts.

Objectives Underscreening of HIV and syphilis in clinical settings is pervasive in resource-constrained settings. Heavy patient loads and competing health priorities in these settings inhibit provider’s ability to meet screening coverage targets. The objective of this study was to examine determinants of provider-initiated HIV and syphilis testing uptake at sexually transmitted disease (STD) clinics in China.Design A cross-sectional study was performed between July 2016 and December 2016.Setting Seven STD clinics in Guangdong Province, China.Participants Heterosexual STD clinic patients met the inclusion criteria, regardless of their interest in receiving HIV or syphilis testing.Outcome measures The syphilis and HIV testing uptake determined by patient receipt of results.Results A total of 1943 individuals were recruited in this study. Among those participants, 60.6% (1177/1943) and 74.3% (1443/1943) conducted HIV testing and syphilis testing during the study, respectively, of whom, 2.2% (26/1177) and 21.5% (310/1443) were found to be HIV-positive and syphilis-positive, respectively. The most common reason for rejecting HIV and syphilis testing was a low self-perceived risk of HIV and syphilis infection. After adjusting for covariates, condom use in the last sexual act, consistent condom use in the last 6 months, having paid sex in the last 6 months and having received any kind of HIV/STD-related knowledge during the last 12 years were positively associated with both HIV and syphilis testing uptake.Conclusions The low-level of HIV and syphilis testing uptake, alongside with the high-level of engagement in risky sexual behaviours among heterosexual STD clinic patients, warranted a more targeted and intensive behavioural interventions to promote HIV and syphilis testing in this population.

Abstract Background Increasing human immunodeficiency virus (HIV) testing is critical for HIV control. This study aimed to evaluate the interaction between social norms and self-efficacy on HIV testing among Chinese men who have sex with men (MSM). Methods We conducted an online survey in eight Chinese cities in Shandong and Guangdong Provinces in July 2016. We included participants who were born as a male, at least 16 years old, currently living in one of the designated cities, and had ever engaged in anal sex with a man. We collected information regarding socio-demographics, high-risk behaviors, and history of HIV and other STI testing. We coded sensitivity to social norms using six items asking participants about their perceived social norm regarding HIV testing. We coded HIV testing self-efficacy using a separate six-item scale. We interpreted higher mean scores as higher sensitivity to social norms and higher self-efficacy, respectively. We conducted logistic regressions to evaluate the interaction between self-efficacy and social norms on HIV testing. Results A total of 2105 men completed the survey. The mean age of the participants was 25.97 ± 6.42 years. Over four-fifths (85.9%) of participants were unmarried, 22.7% were students, and 64.6% at least had a college degree. 62.5 and 32.6% of participants ever and tested HIV in the last three months, respectively. With respect to uptake of HIV testing in the last three months, the adjusted odds ratio was 1.01(95% CI: 0.96–1.06) for higher sensitivity to social norms and 1.09 (95% CI: 1.05–1.14) for higher self-efficacy, with an interaction effect of 1.02 (95% CI: 1.01–1.03), respectively. With respect to uptake of lifetime HIV testing, the adjusted odds ratio was 1.03(95% CI: 0.99–1.07) for higher sensitivity to social norms and 1.15 (95% CI: 1.11–1.19) for higher self-efficacy, with an interaction effect of 1.02 (95% CI: 1.01–1.04), respectively. Conclusions Our survey demonstrated that there is a significant association between the uptake of HIV testing with sensitivity to the social norm, higher self-efficacy, as well as the interaction between them. Tailored studies for improving HIV testing among MSM in China can combine these two interventions together.

Objectives An increased trend in the number of reported gonorrhoea cases has been observed between 2014 and 2017 in China. This study aims to describe the reported epidemic of gonorrhoea and potential driving forces in Guangdong Province, China.Design A review of surveillance data.Participants Three different sources of data from Guangdong Province were analysed: gonorrhoea cases reported to the Chinese sexually transmitted infections (STI) case report system (CRS); a clinic-based retrospective study conducted to collect information on annual gonorrhoea screening coverage and data from the Guangdong governmental sentinel surveillance network (SSN) to examine the gonorrhoea prevalence among males attending STI clinics.Outcome measures Reported incidence of gonorrhoea, number of reported gonorrhoea cases, number of screening tests for gonorrhoea and gonorrhoea prevalence.Results The STI CRS data showed that the reported incidence of gonorrhoea has increased rapidly from 15.7 cases per 100 000 population in 2014 to 27.3 cases per 100 000 in 2017 in Guangdong (p

Abstract Background Early diagnosis of syphilis and timely treatment can effectively reduce ongoing syphilis transmission and morbidity. We examined the factors associated with the early diagnosis of syphilis to inform syphilis screening strategic planning. Methods In an observational study, we analyzed reported syphilis cases in Guangdong Province, China (from 2014 to mid-2015) accessed from the national case-based surveillance system. We categorized primary and secondary syphilis cases as early diagnosis and categorized latent and tertiary syphilis as delayed diagnosis. Univariate analyses and multivariable logistic regressions were performed to identify the factors associated with early diagnosis. We also examined the factors associated with early diagnosis at the individual and city levels in multilevel logistic regression models with cases nested by city (n = 21), adjusted for age at diagnosis and gender. Results Among 83,944 diagnosed syphilis cases, 22% were early diagnoses. The city-level early diagnosis rate ranged from 7 to 46%, consistent with substantial geographic variation as shown in the multilevel model. Early diagnosis was associated with cases presenting to specialist clinics for screening, being male and attaining higher education level. Cases received syphilis testing in institutions and hospitals, and diagnosed in hospitals were less likely to be in early diagnosis. At the city-level, cases living in a city equipped with more hospitals per capita were less likely to be early diagnosis. Conclusions To enhance early diagnosis of syphilis, city-specific syphilis screening strategies with a mix of passive and client/provider-initiated testing might be a useful approach.