Abstract Background China has always been one of the countries with the most serious Tuberculosis epidemic in the world. Our study was to observe the Spatial-temporal characteristics and the epidemiology of Tuberculosis in China from 2004 to 2017 with Joinpoint regression analysis, Seasonal Autoregressive integrated moving average (SARIMA) model, geographic cluster, and multivariate time series model. Methods The data of TB from January 2004 to December 2017 were obtained from the notifiable infectious disease reporting system supplied by the Chinese Center for Disease Control and Prevention. The incidence trend of TB was observed by the Joinpoint regression analysis. The Seasonal autoregressive integrated moving average (SARIMA) model was used to predict the monthly incidence. Geographic clusters was employed to analyze the spatial autocorrelation. The relative importance component of TB was detected by the multivariate time series model. Results We included 13,991,850 TB cases from January 2004 to December 2017, with a yearly average morbidity of 999,417 cases. The final selected model was the 0 Joinpoint model ( P = 0.0001) with an annual average percent change (AAPC) of − 3.3 (95% CI: − 4.3 to − 2.2, P < 0.001). A seasonality was observed across the 14 years, and the seasonal peaks were in January and March every year. The best SARIMA model was (0, 1, 1) X (0, 1, 1) 12 which can be written as (1-B) (1-B 12 ) X t = (1–0.42349B) (1–0.43338B 12 ) ε t , with a minimum AIC (880.5) and SBC (886.4). The predicted value and the original incidence data of 2017 were well matched. The MSE, RMSE, MAE, and MAPE of the modelling performance were 201.76, 14.2, 8.4 and 0.06, respectively. The provinces with a high incidence were located in the northwest (Xinjiang, Tibet) and south (Guangxi, Guizhou, Hainan) of China. The hotspot of TB transmission was mainly located at southern region of China from 2004 to 2008, including Hainan, Guangxi, Guizhou, and Chongqing, which disappeared in the later years. The autoregressive component had a leading role in the incidence of TB which accounted for 81.5–84.5% of the patients on average. The endemic component was about twice as large in the western provinces as the average while the spatial-temporal component was less important there. Most of the high incidences (> 70 cases per 100,000) were influenced by the autoregressive component for the past 14 years. Conclusion In a word, China still has a high TB incidence. However, the incidence rate of TB was significantly decreasing from 2004 to 2017 in China. Seasonal peaks were in January and March every year. Obvious geographical clusters were observed in Tibet and Xinjiang Province. The relative importance component of TB driving transmission was distinguished from the multivariate time series model. For every provinces over the past 14 years, the autoregressive component played a leading role in the incidence of TB which need us to enhance the early protective implementation.
Estimated glomerular filtration rate (eGFR) decline in HIV-1-infected patients exposure to tenofovir disoproxil fumarate (TDF) has been widely assessed using linear models, but nonlinear assumption is not well validated. We constructed a retrospective cohort study to assess whether eGFR decline follows nonlinearity during antiviral therapy.We examined 823 (299 of TDF users and 524 of non-TDF users) treatment-naïve HIV-1-infected participants (age ≥ 17 years, initial eGFR ≥ 90 mL/min/1.73m2). Estimated GFR trajectories were compared by one-linear and piecewise-linear mixed effects models, before and after propensity score matching, respectively. Whether the incidence of renal dysfunction (reduced renal function [RRF], eGFR < 90 mL/min/1.73 m2 and rapid kidney function decline [RKFD], eGFR > -3 mL/min/1.73 m2/year) follows nonlinearity was assessed by logistic regression.The median follow-up time of this study was 10 (interquartile range, 2-20) months, during which 178 (21.6%) experienced RRF, and 451 (54.8%) experienced RKFD. The slopes (mL/min/1.73 m2/year) of eGFR were -5.31 (95% CI: -6.57, -4.06) before 1.40 years, 4.83 (95% CI: 1.38, 8.28) from years 1.40 to 2.30 and -3.71 (95% CI: -5.97, -1.45) after 2.30 years among TDF users. Within years 1.40-2.30, each year of TDF exposure was associated with a 78% decreased risk of RKFD (95% CI: -91%, -49%). In comparison, eGFR increased slightly at the initiation of antiviral therapy, declined after 2.15 years (-4.96; 95% CI: -5.76, -4.17) among non-TDF users. Such a progression nonlinear trajectory was missed on the assumption of one-linearity, whether in TDF or non-TDF users.Over the piecewise mixed-effects analyses with the advantage of revealing the true nature of the exposure outcome relationships, an interesting reverse S-shaped relationship was observed. A routine screen based on nonlinearity could be more helpful for patient management.
Objective To evaluate the application value of the up-converting Phoshor technology immunochromatography for HBV large envelope protein (HBV-LP) quantitative determination strip in hepatitis B patients.Methods Serum HBV-LP was detected by a new UPT-based immunochromatograhpic technology,and HBV DNA was quantitively detected by real time fluorescent quantitation polymerase chain reaction (RT-PCR),HBV five serum markers were detected by chemiluminescence method.Results In 500 cases of patients with hepatitis B,HBV-LP and HBV DNA positive rates were 58.0％ and 42.2％ respectively,there was significant difference between the positive rate of HBV DNA and that of HBeAg(P ＜ 0.01); In 215 cases of HBeAg negative specimens,the positive rates of HBV DNA and HBV-LP were 29.3％ and 37.2％ respectively,the difference was statistically significant (P ＞ 0.05); and HBeAg positive rate was 57.0％,there was significant difference between the positive rate of HBV DNA and that of HBeAg (P ＜ 0.01).Conclusion HBV-LP detected by UPT method can be used for the evaluation of viral replication and prognosis of patients with HBeAg negative and HBV DNA low copies patients.Combing detection of HBV DNA,HBV-LP and HBeAg is conducive to the judgment of HBV replication level and determination of antiviral treatment end point.
Key words:
Viral envelope proteins; Immunochemistry; Virus replication; Up-converting phosphor technology
To investigate the diagnostic value of selected exosomal miRNAs for Tuberculosis (TB) among people living with human immunodeficiency virus (PLHIV). A total of 43 adult HIV patients, including 20 diagnosed with TB and 23 controls, were enrolled. The levels of six exosomal miRNAs (miR-20a, miR-20b, miR-26a, miR-106a, miR-191, and miR-486) were measured using qRT-PCR. The levels of these six exosomal miRNAs (miR-20a, miR-20b, miR-26a, miR-106a, miR-191, and miR-486) were significantly higher in the plasma of TB patients compared to controls among PLHIV. The Receiver Operating Characteristic (ROC) curve of these six miRNAs showed a fair performance in distinguishing TB patients from controls, with Area Under Curve (AUC) values of 0.78 (95 %CI 0.63–0.93), 0.81 (95 %CI 0.67–0.95), 0.77 (95 %CI 0.61–0.93), 0.84 (95 %CI 0.70–0.98), 0.82 (95 %CI 0.68–0.95) and 0.79 (95 %CI 0.65–0.93), respectively. These miRNAs showed higher AUC values for extrapulmonary tuberculosis compared to pulmonary tuberculosis. An analysis of subgroups was performed based on CD4 + T cell count (<200 and ≥ 200 cells·µL−1). In the high CD4 count group, all these six exosomal miRNAs appeared to have higher AUC values compared to the low CD4 count group. These six exosomal miRNAs could serve as potential biomarkers for diagnosing TB among PLHIV.
Objective To analyse the clinical value of HBV large surface protein(LHBs)in the therapeutic observation of adefovir dipivoxil on chronic hepatitis B.Methods The levels of serum LHBs、HBV DNA、 HBeAg of 30 chronic hepatitis B cases with anti-viral of adefovir dipivoxil were detected at the time of 0,6,12,18,24 months.Results There was no statistical difference between the positive rate of LHBs(90.00%) and HBV DNA(100%) (χ~2=3.16,P > 0.05).LHBs levels were correlated with the logarithm of HBV DNA copies (r=0.912).There was no statistical difference between the positive rate of HBeAg(80.00%)and LHBs(χ~2=1.18,P > 0.05).Conclusions The serum LHBs has a good consistency with HBV DNA.It can be used as a new indicator of viral replication.The long LHBs positive duration indicates the high risk of invalid anti-viral treatment.
Key words:
Hepatitis B; chronic; Anti-viral treatment; Large surface protein; Adefovir dipivoxil
Abstract BackgroundChina has always been one of the countries with the most serious tuberculosis epidemic in the world. Our study was to observe the Spatial-temporal characteristics and the epidemiology of tuberculosis in China from 2004 to 2017 with Joinpoint regression analysis, Seasonal Autoregressive integrated moving average (SARIMA) model, geographic cluster, and multivariate time series model.MethodsThe data of TB from January 2004 to December 2017 were obtained from the notifiable infectious disease reporting system supplied by the Chinese Center for Disease Control and Prevention. The incidence trend of TB was observed by the Joinpoint regression analysis. The Seasonal autoregressive integrated moving average (SARIMA) model was used to predict the monthly incidence. Geographic clusters was employed to analyze the Spatial autocorrelation analysis was performed to detect. The heterogeneous transmission of TB was detected by the multivariate time series model. ResultsWe included 13,991,850 TB cases from January 2004 to December 2017, with a yearly average morbidity of 999,417 cases. The final selected model was the 0 Joinpoint model (P=0.0001) with an annual average percent change (AAPC) of -3.3 (95% CI: -4.3 to -2.2, P<0.001). A seasonality was observed across the fourteen years, and the seasonal peaks were in January and March every year. The best SARIMA model was (0, 1, 1) X (0, 1, 1)12 which can be written as (1-B) (1-B12) Xt = (1-0.42349B) (1-0.43338B12) εt, with a minimum AIC (880.5) and SBC (886.4). The predicted value and the original incidence data of 2017 were well matched. The MSE, RMSE, MAE, and MAPE of the modelling performance were 201.76, 14.2, 8.4 and 0.06, respectively. The provinces with a high incidence were located in the northwest (Xinjiang, Tibet) and south (Guangxi, Guizhou, Hainan) of China. The hotspot of TB transmission was mainly located at southern region of China from 2004 to 2008, including Hainan, Guangxi, Guizhou, and Chongqing, which disappeared in the later years. The autoregressive component had a leading role in the incidence of TB which accounted for 81.5% - 84.5% of the patients on average. The endemic component was about twice as large in the western provinces as the average while the spatial-temporal component was less important there. Most of the high incidences (>70 cases per 100,000) were influenced by the autoregressive component for the past fourteen years. ConclusionIn a word, China still has a high TB incidence. However, the incidence rate of TB was significantly decreasing from 2004 to 2017 in China. Seasonal peaks were in January and March every year. Obvious geographical clusters were observed in Tibet and Xinjiang Province. The spatial heterogeneity of TB driving transmission was distinguished from the multivariate time series model. For every provinces over the past fourteen years, the autoregressive component played a leading role in the incidence of TB which need us to enhance the early protective implementation.
The neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein-to-prealbumin ratio (CPAR) are novel markers of inflammation. The CPAR is an indicator of inflammation and malnutrition. We evaluated NLR and CPAR in combination as indicators of disease severity and prognosis in hospitalized older patients with coronavirus disease 2019 (COVID-19). A total of 222 hospitalized patients with COVID-19 (aged > 60 years) were divided into non-severe and severe groups. The severe group was subdivided into the surviving and deceased subgroups. We retrospectively assessed the predictive power of NLR and CPAR in combination (NLR + CPAR) to determine the prognosis of hospitalized older patients with COVID-19. The NLR and CPAR were significantly higher in the severe group than in the non-severe group ( P < .001). Furthermore, the NLR and CPAR were higher in the deceased subgroup than in the surviving subgroup ( P < .001). Pearson correlation analysis showed a highly significant positive correlation between NLR and CPAR ( P < .001, r = 0.530). NLR + CPAR showed an area under the curve of 0.827 and sensitivity of 83.9% in the severe group; the area under the curve was larger (0.925) and sensitivity was higher (87.1%) in the deceased subgroup. The receiver operating characteristic curve of NLR + CPAR was significantly different from the receiver operating characteristic curves of either biomarker alone ( P < .001). Kaplan–Meier analysis showed that patients in the severe group with elevated NLR + CPAR had a significantly lower 90-day survival rate than patients who lacked this finding (odds ratio 7.87, P < .001). NLR + CPAR may enable early diagnosis and assessment of disease severity in hospitalized older patients with COVID-19. This may also enable the identification of high-risk older patients with COVID-19 at the time of admission.
Abstract Background The objective was to identify the Spatial-temporal characteristics and the epidemiology of tuberculosis in China from 2004 to 2017 with Joinpoint regression analysis, Seasonal Autoregressive integrated moving average (SARIMA) model, geographic cluster, and multivariate time series model. Methods The data of TB from January 2004 to December 2017 were obtained from the notifiable infectious disease reporting system supplied by the China CDC. Joinpoint regression analysis was used to observe the trend. The monthly incidence was predicted by the Seasonal autoregressive integrated moving average (SARIMA) model. Spatial autocorrelation analysis was performed to detect geographic clusters. A multivariate time series model was employed to analyze heterogeneous transmission. Results We included 13,991,850 TB cases from 2004 to 2017. The final selected model was the 0 Joinpoint model with an annual average percent change of -3.3. A seasonality was observed across the fourteen years, and the seasonal peaks were in January and March. The best SARIMA model was (0, 1, 1) X (0, 1, 1) 12 , with a minimum AIC (880.5) and SBC (886.4). The predicted value and the original incidence data of 2017 were well matched. The provinces with a high incidence were located in the northwest (Xinjiang, Tibet) and south (Guangxi, Guizhou, Hainan) of China. The autoregressive component had a leading role in the incidence of TB which accounted for 81.5% - 84.5% of the patients on average. The endemic component was about twice as large in the western provinces as the average while the spatial-temporal component was less important there. Most of the high incidences areas were mainly affected by the autoregressive component for the past fourteen years. Conclusion A significant decreasing trend was seen from 2004 to 2017. The seasonal peaks were in January and March every year. Obvious clusters were identified in Tibet and Xinjiang Province. A spatial heterogeneity in the component driving the transmission of TB was identified from the multivariate time series model. This suggested that targeted preventive efforts should be made in different provinces based on the main component contributing to the epidemics.
The data of the impact of tenofovir (TDF) on kidney damage in Chinese HIV-1 infected patients are limited.The study aims to evaluate the incidence and risk factors of stage 3 chronic kidney disease (CKD) and rapid kidney function decline (RKFD) among Chinese HIV-1 infected patients starting with a TDF-based regimen.We enrolled 797 TDF-initiated HIV-1-infected patients in a Chinese cohort. Kidney dysfunctions were defined as stage 3 CKD (eGFR < 60 mL/min/1.73 m2 during follow-up) and RKFD (eGFR decline > 10 mL/min/1.73 m2/year). A linear mixed-effects model was used to quantify the average eGFR change per 48 weeks. A generalized estimating equation regression analysis was conducted to determine the risk factors associated with renal dysfunction. The method of multiple imputations was used to reduce the bias caused by missing data.In this retrospective study, 14 (2%) patients experienced stage 3 CKD, and 272 (34%) individuals experienced RKFD during a median of 26 (IQR, 4-78; maximum 325) weeks follow-up period. The mean loss in eGFR per 48 weeks increased consistently over time, from -2.59 mL/min/1.73 m2 before 48 weeks to -17.61 mL/min/1.73 m2 after 288 weeks. For every 10 mL/min/1.73 m2 increase of eGFR, the risk of RKFD increased by 29% (95%CI: 18%, 40%). Each 10 years older and every 10 mL/min/1.73 m2 higher in baseline eGFR, the risk of stage 3 CKD increased to 1.56 (95% CI: 1.00, 2.43) and decreased by 65% (95% CI: 48%, 76%), respectively. Anemia and higher viral load were significantly associated with RKFD. The results were robust across a range of multiple imputation analyses.TDF-associated CKD is rare in HIV-1 infected Chinese adults. Longer TDF-exposed patients are more likely to have renal dysfunction, especially those with older age, anemia, lower baseline eGFR, and higher viral load.
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