BackgroundWe sought to describe the epidemiological characteristics of pregnant women with syphilis in Beijing, China, and to investigate the determinants of adverse pregnancy outcomes, including congenital syphilis.Material/MethodsWe used data from laboratory-confirmed syphilis-infected women who delivered between 2013 and 2015 and were registered in China’s Information Management System for Prevention of Mother-to-Child Transmission of Syphilis. Sociodemographic, clinical, and prevention predictors of adverse pregnancy outcomes (i.e., congenital syphilis, neonatal death, and neonatal asphyxia) were assessed using multivariable regression analyses.ResultsAmong 807 eligible pregnant women with syphilis in Beijing, the maternal syphilis ratios increased from 1.1 (in 2013) to 1.4 (in 2015) per 1000 live births, while adverse pregnancy outcomes decreased, including congenital syphilis (1.3% to 0.4%), neonatal deaths (1.3% to 0%), and neonatal asphyxia (0.9% to 0%). Both prevention and treatment interventions increased, including antenatal testing (93.5% to 93.9%), any treatment (76.6% to 85.2%), adequate treatment (51.1% to 65.1%), and treatment initiated in the first trimester (30.7% to 42.8%). In the logistic regression analysis, higher maternal rapid plasma reagin antibody titers (aOR=1.1 95%CI=1.0–1.1) and third-trimester syphilis diagnosis (aOR=1.7 95%CI=1.1–2.6) were independent risk factors for adverse pregnancy outcomes. Protective factors included being married (aOR=0.4; 95%CI=0.2–0.6) and adequate prenatal treatment (aOR=0.3; 95%CI=0.1–0.7).ConclusionsIntegrated strategies for maternal syphilis control were associated with improved outcomes but must be strengthened. Future efforts should include education and outreach for antenatal care for at-risk women, syphilis screening at first antenatal care visit, immediate initiation of treatment, and syphilis screening extended to women presenting with miscarriage or stillbirth.
Yunnan is a province located in southwestern China. The aim of this study was to investigate the genetic diversity of Mycobacterium tuberculosis (MTB) strains circulating in Yunnan Province. We used spoligotyping and a 12-locus high-resolution VNTR set to identify a total of 271 MTB isolates collected from six prefectures' Yunnan. All the 271 patients were classified as 11 different ethnic groups, including 133 Han patients (49.1%) and 138 minority patients (50.9%). Spoligotyping analyses revealed that the largest two spoligotypes were SIT1 (Beijing family, n = 136) and SIT53 (T family, n = 35). Statistical analysis indicated that the proportion of Beijing genotype in Qujing was significantly higher than that in the ethnic enclaves (P ≤ 0.01). Compared with the percentage of Beijing-family isolates from patients under 25 years of age (72.7%), those from patients aged 45~64 years (44.6%, P < 0.01) and older than 64 years (48.1%) (P = 0.04) were significantly lower. Beijing genotype strains (23.8%, 36/151) showed higher clustering rate than non-Beijing genotype strains (16/120, 13.3%, P = 0.029). In conclusion, our data demonstrated that the Beijing genotype was the predominant genotype in Yunnan Province. The distribution of Beijing genotype strains showed geographic diversity. In addition, Beijing genotype was associated with recent transmission rather than drug resistance.
Adolescents have been largely neglected from tuberculosis control efforts. In low- to medium burden settings much of the tuberculosis burden in this age group occurs from school outbreaks. We report on a large tuberculosis outbreak in adolescents from a boarding high school in Jiangsu Province, China. From March to June 2018, a tuberculosis outbreak occurred in a boarding high school. We conducted an outbreak investigation involving clinical diagnostic tests and molecular analysis to determine the outbreak origin. Cases were detected through symptom screening, tuberculin skin testing (TST), chest radiography, sputum smear, solid sputum culture and GeneXpert MTB/RIF. Mycobacterial interspersed repetitive-unit-variable-number tandem-repeat (MIRU-VNTR) genotyping and spoligotyping methods were performed on Mycobacterium tuberculosis (M. tuberculosis) isolates to identify the outbreak origin. A total of 845 students and 131 teachers/staff attended a TST screening for tuberculosis infection. The prevalence of elevated tuberculin reactions at ≥5, ≥10 and ≥15 mm was 12.19% (119/976), 6.35% (62/976) and 3.28% (32/976), respectively. Radiographic abnormalities were present in 5.73% (56 of 976) individuals, 40 students and 16 teachers/staff. Of these, 12 students were diagnosed with confirmed tuberculosis. In total, 14 students (two index cases and 12 confirmed cases) were diagnosed and reported in the tuberculosis outbreak, an attack rate of 1.7% (14/847) among students (two index cases and 845 screened students). Results from MIRU-VNTR typing and spoligotyping analyses demonstrated that three M. tuberculosis strains belong to the Beijing family with corresponding MIRU-VNTR alleles. This school-based tuberculosis outbreak among adolescents demonstrates that transmission among individuals in this age group is common and must be prioritised. It suggests that identifying and timely diagnosis of smear-positive cases, especially in the early phase of outbreaks, is the key to preventing further spread among close contacts.
In this study, we report an investigation of a tuberculosis (TB) outbreak in a high school in China. Eleven students with active TB were identified. A culture-negative 17-year-old girl was considered as index case affected by pulmonary and meningeal TB. Screening results indicated latent TB in 32.8% of the students in the classroom of index case, whereas a significantly decreased prevalence of TB infection was found among students on the same floor, ranging from 1.3 to 8.2%. Genotyping revealed that all the Mycobacterium tuberculosis (MTB) isolates belonged to Beijing spoligotype international types 1 (SIT1). In conclusion, a diagnostic delay for the culture-negative index case played an important role in the transmission of Beijing genotype MTB strain in the boarding school in Yunnan. The separate locations of classrooms and sufficient air ventilation contributed to the significant difference in proportions of TB infection between classmates and other students in this outbreak.
Community detection in a complex network is an ongoing field. While the air transport network has gradually formed as a complex system, the topological and geographical characteristics of airline networks have become crucial in understanding the network dynamics and airports’ roles. This research tackles the highly interconnected parts in weighted codeshare networks. A dataset comprising ten major international airlines is selected to conduct a comparative analysis. The result confirms that the clique percolation method can be used in conjunction with other metrics to shed light on air transport network topology, recognizing patterns of inter- and intra-community connections. Moreover, the topological detection results are interpreted and explained from a transport geographical perspective, with the physical airline network structure. As complex as it may seem, the airline network tends to be a relatively small system with only a few high-order communities, which can be characterized by geographical constraints. This research also contributes to the literature by capturing new insights regarding the topological patterns of the air transport industry. Particularly, it reveals the wide hub-shifting phenomenon and the possibility of airlines with different business models sharing an identical topology profile.
With the ever-increasing demand for air traffic over the years, safety risk assessment has become significant in maintaining the operational safety of the air transport system for long-term development towards sustainability. This paper conducts a safety risk assessment of the air traffic control (ATC) system based on game theory and cloud matter element analysis. The safety risk of the ATC system is evaluated from four aspects, including human, machine, environment, and management. The Nash equilibrium is introduced from game theory to weigh the indicators. The cloud matter element assessment adopts the cloud model from fuzzy sets and probability theory to replace the certain value in conventional matter element theory, which takes the randomness, ambiguity, and incompatibility of the indicators into consideration. In this sense, the safety risk level of the ATC system can be evaluated by calculating the correlation degree of the standard cloud matter element between the indicators and the risks. This paper expands the research scope by introducing and combing game theory and cloud matter element analysis. Furthermore, the applicability and the robustness of the method are examined with a case study of the ATC system, which enriches the existing literature and points out the direction for future work.
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