PrEP Willingness and Adherence Self-Efficacy Among Men Who have Sex with Men with Recent Condomless Anal Sex in Urban China.

This study investigates PrEP willingness, adherence self-efficacy and potential impact of PrEP among HIV-negative, Chinese men who have sex with men (MSM; n = 622) with recent condomless anal sex. Facilitative factors of PrEP willingness included migrant status, sexual risk, and prior PrEP use, whereas barriers included concerns over being treated as an HIV/AIDS patient, recent HIV testing, identity concealment, and HIV prevention service usage. Adherence self-efficacy was associated with PrEP knowledge and confidence in PrEP efficacy of HIV prevention. A total of 39.3% anticipated increase in sex partners, 25.6% anticipated decrease in condom use, and 38.0% anticipated increased HIV testing following PrEP uptake. Results suggest a two-step approach to (1) promote PrEP acceptance among Chinese MSM and (2) enhance adherence and risk monitoring among PrEP-willing MSM. Efforts to reduce stigma, incorporate PrEP in the HIV prevention continuum, and increase PrEP knowledge will be crucial to optimize PrEP implementation.

Eight millimetre covered TIPS does not compromise shunt function but reduces hepatic encephalopathy in preventing variceal rebleeding.

BACKGROUND & AIMS: Currently, there are no recommendations in guidelines concerning the preferred diameter of stents for transjugular intrahepatic portosystemic shunt (TIPS), owing to the lack of adequate evidence. We therefore compared 8mm stents with 10mm stents, to evaluate whether 8mm stents would achieve similar shunt function, with less hepatic encephalopathy (HE) and better liver function. METHODS: Cirrhotic patients were randomly assigned to receive TIPS with an 8mm or 10mm covered stent to prevent variceal rebleeding. The primary endpoint was shunt dysfunction. All-cause rebleeding, orthotopic liver transplantation (OLT)-free survival, their composite endpoint, overt HE (overall and spontaneous) and liver function were designated as the secondary endpoints. RESULTS: From July 2012 to January 2014, 64 and 63 patients were allocated to the 8mm and 10mm groups, respectively. During a median follow-up of 27months in both arms, dysfunction rates (16% vs. 16% at two years, p=0.62), two-year rebleeding (16% vs. 17%, p=0.65), OLT-free survival (95% vs. 86%, p=0.37), and the composite endpoint (p=0.62) were not statistically different between the groups. Despite a marginal decrease in overall overt HE, there were significantly fewer spontaneous overt HE incidents in the 8mm group within two years (27% vs. 43%, p=0.03), with a risk reduction of 47%. Notably, patients receiving 8mm stents also developed less hepatic impairment. CONCLUSIONS: TIPS with 8mm covered stents showed similar shunt function to TIPS with 10mm stents, but halved the risk of spontaneous overt HE and reduced hepatic impairment. Therefore, 8mm TIPS stents should be preferred for the prevention of variceal rebleeding in cirrhotic patients. Lay summary: The optimal diameter for transjugular intrahepatic portosystemic shunt (TIPS) remained uncertain. This study showed that TIPS with 8mm covered stents did not compromise shunt patency, or influence the efficacy of variceal rebleeding prevention compared to TIPS with 10mm stents, but reduced the risk of spontaneous overt hepatic encephalopathy and the incidence of severe encephalopathy. Moreover, liver function reserve was also better in the 8mm stents group, suggesting that 8mm TIPS stents should be preferred for the prevention of variceal rebleeding in cirrhotic patients.

Feasibility of a Mobile Health Intervention for Providing a Continuum of HIV Services for MSM: Pilot Study of the WeTest Program in 3 Cities in China.

BACKGROUND: Men who have sex with men (MSM) in China have a high risk for HIV infection but experience suboptimal rates of HIV testing and service engagement due to various social and structural barriers. We developed a mobile health (mHealth) intervention entitled "WeTest-Plus" (WeTest+) as a user-centered "one-stop service" approach for delivering access to comprehensive information about HIV risk, HIV self-testing, behavioral and biomedical prevention, confirmatory testing, treatment, and care. OBJECTIVE: The goal of the current study was to investigate the feasibility of WeTest+ to provide continuous HIV services to high-risk MSM. METHODS: Participants completed a 3-week pilot test of WeTest+ to examine acceptability, feasibility, and recommendations for improvement. Participants completed a structured online questionnaire and qualitative exit interviews facilitated by project staff. "Click-through" rates were assessed to examine engagement with online content. RESULTS: 28 participants were included, and the average age was 27.6 years (standard deviation = 6.8). Almost all participants (96.4%) remained engaged with the WeTest+ program over a 3-week observational period. The majority (92.9%) self-administered the HIV self-test and submitted their test results through the online platform. Overall click-through rates were high (average 67.9%). Participants provided favorable comments about the quality and relevance of the WeTest+ information content, the engaging style of information presentation, and the user-centered features. CONCLUSION: This pilot assessment of WeTest+ supports the promise of this program for promoting HIV self-testing and linkage to in-person services for MSM in China. Findings underscore the utility of a user-centered approach to mHealth program design.

[Characteristics analyses of road traffic injury in Beijing in 2009].

OBJECTIVE: To analyze the characteristics and laws of road traffic accidents in Beijing, and provide some accident-prevention measures. METHODS: The data from Beijing Emergency Medical Center were managed by computer,then the descriptive statistical analyses were made. RESULTS: (1) A total of 2 984 traffic accidents with relatively complete information were recorded in our research,in which 42 people were led to death and 2 942 injured. Most of the casualties were male. The ages of the injured segments were mainly between 18 to 59 years.(2) The number of the injured in accidents between the motor vehicles was the largest, which was 1 883; The deaths caused by accidents between the motor vehicles and pedestrians were the most, with the number of 26;Major vicious accidents were mainly caused by accidents between the motor vehicles and the number was 11.(3) In one day accidents mainly happened at 8:00-10:00 ,and 14:00-18:00.(4) The most common injuries were the head and face injuries, with the number of 921, followed by multi-site combined injuries with the number of 761, and lower limb injuries, with the number of 541.(5) Human factors were the main causes of accidents, followed by vehicle factors. CONCLUSION: The illegal driving and walking through the pedestrian lane were the main causes of car accidents. Strengthening traffic safety education of the public, especially of the floating population, rigorous training of drivers for traffic rules and regulations, enhancing the public awareness of road safety, and improving the road traffic management and control measures were the main measures to prevent and control traffic injuries.

Paroxysmal tonic upgaze accompanied by occipital discharge on electroencephalography: a case report and literature review.

BACKGROUND: Paroxysmal tonic upgaze (PTU) is an infantile-onset paroxysmal neurological disorder that is characterized by episodes of sustained conjugate upward eye deviation. The paroxysmal abnormal eye movements need to be differentiated from seizures. We report a case of PTU with occipital discharge on electroencephalography (EEG), which made the diagnosis more complicated. CASE PRESENTATION: A 6-month-old girl presented with paroxysmal upward deviation or left strabismus of the eyes, with a bowed head, lowered jaw, raised eyebrows, closed lips, and slight grin. Each episode lasted for a few seconds, and episodes occurred multiple times per day. EEG showed spike waves in the right occipital region, and the girl was initially misdiagnosed with epilepsy. After further analysis using video EEG, we corrected her diagnosis as PTU and stopped the administration of an antiepileptic drug. CONCLUSION: PTU accompanied by discharge on EEG may lead to a misdiagnosis. Video EEG monitoring, and especially the analysis of EEG traces synchronized with attacks, can provide evidence to distinguish between seizures and non-epileptic events.

User Preferences for an mHealth Approach to Support HIV Self-Testing and Linkage to HIV Prevention or Care Services for MSM in China.

This research qualitatively explored user preferences for an app-based mHealth approach to support HIV self-testing and linkage to HIV prevention or care services developed for men who have sex with men (MSM) in China. We conducted 12 online focus group discussions with MSM participants (N = 48) about their preferences for using an app to meet their HIV self-testing and service linkage needs. Data were examined using thematic analysis. Participants specified four domains to align program delivery with their preferences for app-based intervention: (1) expanding HIV prevention/antiretroviral therapy concepts beyond basic knowledge; (2) enhancing the style and presentation of app-based messages; (3) incorporating interactive and dynamic app-engagement features; and (4) creating a "one station" app that covers the continuum of HIV services. Given the changing landscapes of HIV knowledge and community/user preferences for app-based interaction, findings underscore how engagement with end-user participants is essential to optimize mHealth interventions for HIV.

International Efforts to Save Healthcare Personnel during COVID-19.

Coronavirus disease 2019 (COVID-19) pandemic is a global challenge. Several governments of the world have decided to take drastic actions in order to combat the spread of the disease, including the closing of air, maritime and land borders, as an extreme measure of isolation of each country/region. However, such measures had not prevented the disease from spreading globally; as COVID-19 has already spread in almost all countries. This virus's main victims are the healthcare personnel (HCP), who are physically and psychologically affected. The HCP serves as the first line of defense against this pandemic, what if we faced a significant loss in their number? And what if our HCP was going through a deep dark depression? The condition would be terrifying not only for now but also in the future. This raises the need for an intensified International collaboration, that mainly supports the HCP. We are throwing by challenging moments, and it is clear that social distancing, cooperation, hygiene awareness and abide by the recommendation and help of all governments, as well as obtaining the support of international organizations could be an excellent tool for preventing an increase in the number of cases, principally in countries and regions were COVID-19 is in the early stage of the epidemic. However, this is not the final solution for the current pandemic. An intensified global program, which mainly supports the HCP, then considers the other aspects of the COVID19 pandemic might bring this pandemic to a peaceful end.

Intervention to train physicians in rural China on HIV/STI knowledge and risk reduction counseling: preliminary findings.

We evaluated an intervention to train physicians in rural China on knowledge of HIV/STI prevention, diagnosis, treatment options, and HIV/STI behavioral risk reduction counseling. This paper reports preliminary findings related to feasibility and acceptability of the program. Using a pre-post design, 69 physicians were recruited from rural county hospitals and participated in a 10-day group training program, followed by two months of clinical fieldwork and two additional weeks of training. Physicians completed baseline and six-month assessments. Patients' cohorts, recruited from clinic waiting areas of participating physicians, completed baseline and six-month HIV/STI risk assessments. Physicians reported increased knowledge of HIV biology and pathology, epidemiology, host immune response, opportunisitic infection and syndromic management, antiretroviral therapy, risk reduction counseling, and stigma reduction following the training. Patients reported improved knowledge of HIV, reduced HIV stigma, higher rates of HIV testing, and improved condom use at follow-up. The findings suggest that training physicians on HIV/STI-related knowledge and risk reduction counseling is a promising strategy for reducing HIV/STI epidemics in rural China.

[Intervention trial on HIV/AIDS among men who have sex with men based on venues and peer network].

OBJECTIVE: To determine feasibility and effectiveness of the intervention on HIV/AIDS among MSM based on venues and peer network. METHODS: The intervention trial was conducted in Mianyang and Yibin in Sichuan province, where the cultural and social environment were similar. These two cities have no HIV/AIDS intervention conducted yet before this study. The intervention was conducted in Mianyang, while Yibin was regarded as control, in which education materials related HIV/AIDS and VCT service were available. Intervention in Mianyang included MSM venue intervention distributing the education materials, condom and promoting HIV-test and STIs clinic referral by 40 MSM as Popular Opinion Leaders who received the knowledge and intervention skill training.Meanwhile, Popular Opinion Leader intervention was implemented in MSM peer network to advocate safe sex. After 6-month intervention the survey was conducted to assess the effectiveness of intervention. RESULTS: The scores of knowledge related HIV/STDs and self-efficacy of condom use was 1.293 (95%CI: 0.657 - 1.292, P < 0.05) and 1.556 (95%CI: 0.656 - 2.456, P < 0.05) higher in post-intervention than in pre-intervention which was (12.42 +/- 0.232) and (10.25 +/- 0.327) respectively in Mianyang, while no significant changing in Yibin during the time. Score of knowledge related HIV/STDs increase 0.577 (95%CI: -0.173 - 1.327, P > 0.05) in post-intervention compared with (10.40 +/- 0.412) in pre-intervention and score of self-efficacy of condom use decreased 0.362 from 9.86 +/- 0.547 in pre-intervention (95%CI: -1.458 - 0.534, P > 0.05). In the six months prior to survey, the rate of unprotected sexual intercourse with male casual sexual partners in last 3 times decreased to 11.0% (22/200) (OR(adjusted) = 0.472, 95%CI: 0.265 - 0.841, P < 0.05) from 19.5% (39/200) baseline in Manyang, while in Yibin that increased to 19.0% (38/200) from 17.5% (35/200) in baseline (OR(adjusted) = 1.153, 95%CI: 0.660 - 2.014, P > 0.05). The rate of HIV-test increased significantly from 9.0% (18/200) to 22.0% (44/200) (OR = 2.852, 95%CI: 1.583 - 5.138, P < 0.05) in intervention city and Accordingly in the control, that was 24.5% (29/200) in baseline and 24.0% (28/200) in post-intervention (OR = 0.960, 95%CI: 0.548 - 1.682, P > 0.05). No difference was found in number of male sexual partner pre- and post-intervention both in intervention and control city. CONCLUSION: The intervention based on MSM venues and peer network among MSM is feasible and can increase knowledge related HIV/STDs and self-efficacy and as well as condom use and HIV testing.

[Long-term efficacy of integrative medicine for treatment of systemic lupus erythematosus].

OBJECTIVE: To investigate the long-term efficacy of integrative medicine in treating systemic lupus erythematosus (SLE). METHODS: Adopting randomized grouping method, the SLE patients were assigned to two groups, 74 in each group, the treatment group treated by combined hormonotherapy with Chinese drugs for detoxifying, and the control group treated by hormonotherapy alone. The period of the stable phase and active phase, clinical manifestations, 24-h urinary protein, systemic lupus erythematosus disease activity index (SLEDAI) score and complement 3 (C3), etc. were observed. RESULTS: After 5-year treatment, the clinical manifestations, including arthritis, hydrohymenitis and fever revealed between groups were significantly different (P < 0.05). Comparison between groups in the 5th year of observation showed that the treatment group had a longer time of the stable phase (305.41 +/- 14.32 days); lower SLEDAI scores (8.28 +/- 4.12) and 24-h urinary protein (0.18 +/- 0.01)g, and a higher level of C3 (0.98 +/- 0.35 g/L) than those in the control group (190.22 +/- 15.43 days, 12.79 +/- 5.43 scores, 0.31 +/- 0.06 g and 0.73 +/- 0.34 g/L), respectively, with statistical significances (P < 0.05). Adverse reactions occurred in 15 cases in the treatment group and 62 cases in the control group, also with significant difference between groups (P < 0.05). CONCLUSION: The combined therapy of Chinese and Western medicine can prolong the stable phase time and shorten the lasting period of SLE in patients, which embodies the view of "treating disease before its onset".

Hierarchical structured and programmed vehicles deliver drugs locally to inflamed sites of intestine.

Orally administrable drug delivery vehicles are developed to manage incurable inflammatory bowel disease (IBD), however, their therapeutic outcomes are compromised by the side effects of systemic drug exposure. Herein, we use hyaluronic acid functionalized porous silicon nanoparticle to bridge enzyme-responsive hydrogel and pH-responsive polymer, generating a hierarchical structured (nano-in-nano-in-micro) vehicle with programmed properties to fully and sequentially overcome the multiple obstacles for efficiently delivering drugs locally to inflamed sites of intestine. After oral administration, the pH-responsive matrix protects the embedded hybrid nanoparticles containing drug loaded hydrogels against the spatially variable physiological environments of the gastrointestinal tract until they reach the inflamed sites of intestine, preventing premature drug release. The negatively charged hybrid nanoparticles selectively target the inflamed sites of intestine, and gradually release drug in response to the microenvironment of inflamed intestine. Overall, the developed hierarchical structured and programmed vehicles load, protect, transport and release drugs locally to inflamed sites of intestine, contributing to superior therapeutic outcomes. Such strategy could also inspire the development of numerous hierarchical structured vehicles by other porous nanoparticles and stimuli-responsive materials for the local delivery of various drugs to treat plenty of inflammatory gastrointestinal diseases, including IBD, gastrointestinal cancers and viral infections.

Peroral endoscopic myotomy for the treatment of achalasia in a patient with esophageal varices. A case report.

Achalasia is very uncommon, and rarely does achalasia co-exist with esophageal varices. We present a 62-year-old woman who was diagnosed with both achalasia and esophageal varices in December 2014 and had a past history of hematemesis. The patient's achalasia symptoms' Eckardt score was 9, and her hepatic function was Child-Pugh grade A6. After comprehensive assessment of the patient's health and discussion of the pros and cons of various therapies for achalasia, the patient underwent a peroral endoscopic myotomy. She was symptom-free after the operation and had no recurrence of achalasia symptoms at 20-month follow-up. No adverse events were reported. Peroral endoscopic myotomy for achalasia with esophageal varices has not been previously reported in the English literature.

Effect of a knowledge-based and skills-based programme for physicians on risk of sexually transmitted reinfections among high-risk patients in China: a cluster randomised trial.

BACKGROUND: China is experiencing growing epidemics of HIV and sexually transmitted infections (STIs). Programmes to train physicians in China on HIV and STI knowledge, diagnosis, treatment, and risk reduction counselling can potentially reduce HIV and STI risk among high-risk patients. We aimed to assess a knowledge-based and skills-based programme for physicians in China to reduce patients' STI risk. METHODS: In this cluster randomised trial, we block randomised counties in two provinces in eastern China to intervention or control groups. In the intervention group, physicians from county general hospitals participated in a structured HIV and STI training programme and received opportunities to enhance their clinical and counselling skills, whereas in the control group, physicians from county hospitals received the training after the intervention group completed final assessments. We recruited STI patients from physicians in both groups, treated baseline gonorrhoea and chlamydia infections, and assessed 9-month gonorrhoea and chlamydia reinfection as the primary outcome. Statistical comparisons between intervention and delayed-control patients used multilevel analyses to account for cluster effects at county and physician levels. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, NCT00644150. FINDINGS: Between April 1, 2007, and Sept 1, 2008, 51 counties were randomly assigned; 27 to receive immediate intervention and 24 to receive delayed intervention. 249 physicians from the 51 county-level hospitals were enrolled, 121 physicians in the intervention group and 128 in the control group. From these physicians, we enrolled 633 and 491 patients, respectively, of whom 508 (80%) and 402 (82%) were available for reassessment at 9 months. Intervention patients at follow-up had significantly lower odds of combined gonorrhoea or chlamydia reinfection than did control patients (58/508 [11%] vs 123/402 [31%]; adjusted odds ratio 0·62 [95% CI 0·46-0·84]). INTERPRETATION: Integrating HIV and STI training into medical education in China could be an effective strategy to reduce the country's growing HIV risk and STI epidemics. FUNDING: US National Institutes of Health.

Survey on HIV/AIDS-related high risk behaviors among male sex workers in two cities in China.

OBJECTIVE: To investigate HIV/AIDS-related high-risk behaviors and condom use among male sex workers (MSW). DESIGN AND METHODS: A cross-sectional survey in which 'snow-ball' sampling was used to recruit 85 male sex workers in Beijing and Qingdao City. Face-to-face interviews were conducted to obtain quantitative information on HIV related high-risk behaviors and condom use. RESULTS: The rate of receptive anal intercourse, insertive anal intercourse, receptive oral sex and insertive oral sex with clients was 57.6, 48.2, 65.8 and 65.8%, respectively. The rate of condom use while having above sex with clients was 53.1, 70.7, 23.2 and 19.6%, respectively. Multivariate analysis showed that consistent condom use with commercial receptive anal intercourse was associated with having regular partners, regretting their involvement in the sex trade, serving both male and female clients, and being required to use a condom by clients. Factors associated with condom use in commercial insertive sex included: age older than 20 years, knowing the protective effect of condom use, and being required to use a condom by clients. CONCLUSION: HIV-related high-risk behaviors were common among male sex workers. HIV prevention activities should be delivered through websites and in the sites where male sex workers and their clients usually meet, such as bars, bathhouses or saunas, and parks. Preventive measures targeting this population are urgently needed, given their particular vulnerability, and infections are likely to disseminate into the general population given the high proportion of bisexual activity and marriage.