Effect of e-health interventions on HIV prevention: a protocol of systematic review and meta-analysis.

BACKGROUND: Global epidemiological data indicates that despite implementation of multiple interventions and significant financial investment, the HIV/AIDS epidemic remained inadequately controlled as of 2020. E-health presents a novel approach in delivering health information and health care and has gained popularity in HIV prevention worldwide. However, evidence on the effectiveness of e-health interventions on HIV prevention among diverse populations remains inadequate. Our study aims to systematically evaluate the effectiveness of varying e-health interventions on HIV prevention, with the objective of providing data support and guidance for the development of future e-health HIV intervention strategies. METHODS: A systematic search of electronic English databases, including MEDLINE through PubMed, Embase, Scopus, and Web of Science, along with three Chinese databases, including National Knowledge Infrastructure (CNKI), Chinese Wanfang Digital Periodicals (WANFANG), and Chinese Science and Technology Periodicals (VIP) database, will be conducted for the period of 1 January 1980 to 31 December 2022. Additionally, gray literature and unpublished trials in trial registers will be searched. Studies aimed at HIV prevention through e-health interventions, with full-text publications available in either English or Chinese, will be included. Study types will be limited to RCT, cluster RCT, and quasi-experiment study. The risk of bias in individual studies will be assessed following the guideline highlighted by the Cochrane Handbook for Systematic Reviews of Interventions. The outcomes will cover cognitive, behavioral, psychological, management, and biological measures of individuals involved in e-health interventions. The quality of evidence will be assessed by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Ultimately, a systematic review with meta-analysis will be conducted to compare the effectiveness of e-health interventions among diverse populations. DISCUSSION: This systematic review seeks to establish novel insights into the effectiveness of e-health interventions in diverse populations worldwide. It will inform the design and use of e-health interventions to optimize HIV-related strategies. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42022295909.

Attenuation of cartilage pathogenesis in osteoarthritis by blocking the phosphorylation of tyrosine kinase Fyn to ß-catenin, AZD0530.

OBJECTIVE: To observe the effect of AZD0530 on the progression of knee OA after blocking ß-catenin phosphorylation and then dormancy of the Wnt/ß pathway by tyrosine kinase Fyn. METHODS: The levels of Fyn, ß-catenin, p-ß-catenin (Tyr142), the chondrocyte positive marker Aggrecan, and the chondrocyte negative marker MMP13 were observed in human knee tibial plateau chondrocytes in vivo and in vitro. Different doses of AZD0530 were used to treat chondrocytes of the human OA tibial plateau chondrocytes in vitro, and the degree of chondrocyte degeneration was observed. Different doses of AZD0530 were intraarticularly injected into OA rats to observe the degree of tibial plateau cartilage degeneration. RESULTS: When OA occurred in human knee, the levels of tyrosine kinase Fyn,ß-catenin and p-ß-catenin (Tyr142) in chondrocytes increased significantly.The level of Aggrecan decreased and MMP13 increased in chondrocytes. The levels of ß-catenin, p-ß-catenin (Tyr142) and MMP13 in chondrocytes decreased, while the level of Aggrecan increased after AZD0530 was used to intervene chondrocytes in vitro, which was positively correlated with the dose of AZD0530. Intra-articular injection of AZD0530 obviously attenuated the degeneration of articular cartilage, which was positively correlated with the dose of AZD0530. CONCLUSION: The level of Fyn in chondrocytes of human knee tibial plateau increased significantly when OA occurred. AZD0530 can inhibit tyrosine kinase Fyn from ß-catenin phosphorylation, a key Wnt/ß pathway protein, and then inhibit Wnt/ß pathway levels in chondrocytes. This finding also suggests that disruption of the Wnt/ß pathway with AZD0530 provides chondral protection in rat posttraumatic OA.

Epidemics of HIV Infection among Heavy Drug Users of Depressants Only, Stimulants Only, and Both Depressants and Stimulants in Mainland China: A Series, Cross-Sectional Studies.

Background: Heavy drug users was a global consensus high-risk population of HIV infection. However, the specific impact of drug on HIV infection has not yet been established. Depressants and stimulants were most widely used drugs in mainland China, and mix use of the two drugs was also serious. We assessed the HIV infection rate and trends in heavy drug users by analyzing data from the National Dynamic Management and Control Database for Drug Users (NDMCDDU). Methods: All heavy drug users with HIV test results in NDMCDDU from 2008 to 2016 were grouped into depressants only group (DOG), stimulants only group (SOG), and both depressants and stimulants group (DSG). We used joinpoint regression to examine trends of HIV infection rates. Multivariable logistic regression was used to examine factors related to HIV infection. Results: A total of 466,033 heavy drug users with 9522 cases of HIV infection were included in this analysis. HIV infection rate was estimated at 2.97% (95% CI 2.91-3.04%) of 265,774 users in DOG, 0.45% (95% CI 0.42-0.49%) of 140,895 users in SOG, and 1.65% (95% CI 1.55-1.76%) of 59,364 users in DSG. In DOG, a U-shaped curve of HIV infection rate decreased from 3.85% in 2008 to 2.19% in 2010 (annual percent change (APC) -12.9, 95% CI -19.3--6.0, p < 0.05), then increased to 4.64% in 2016 (APC 8.3, 95% CI 6.1-10.4, p < 0.05) was observed. However, SOG and DSG showed consistent increases from 0.15% in 2008 to 0.54% in 2016 (APC 8.2, 95% CI 4.8-11.8, p < 0.05) and from 0.78% in 2008 to 2.72% in 2016 (APC 13.5, 95% CI 10.7-16.4, p < 0.05), respectively. HIV infection rate of DOG in the southwest region presented a U-shaped trend. All groups showed significant increases in HIV infection in east and central regions. Conclusions: The U-shaped curve for HIV infection rate among DOG users and consistent increases among SOG and DSG users implies drug abuse is still a critical focus of HIV infection in China. It is urgently needed to reassess the effectiveness of current strategies on HIV prevention and control among drug users.

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

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

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

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

[Clinical efficacy analysis of transverse tibial bone transport combined with vacuum drainage for the treatment of diabetic foot ulcer].

OBJECTIVE: To investigate clinical effect of transverse tibial bone transport micro vessels regeneration technology combined with vacuum drainage in treating diabetic foot ulcer. METHODS: From November 2015 and December 2016, clinical data of 19 diabetic foot ulcer patients treated with transverse tibial bone transport micro vessels regeneration technology combined with vacuum drainage were retrospective analyzed, including 15 males and 4 females aged from 42 to 82 years old with an average of (64.57±7.14) years old;the courses of diabetic ranged was (14.62±6.19) years;12 cases on the left side and 7 cases on the right side;the area of ulcer ranged from 2 cm×3 cm to 8 cm×6 cm. All patients were stage D according to Texas classification, 3 cases were grade 2, 10 cases were grade 3 and 6 cases were grade 4. Ankle-brachial index and Michigan Neuropathy Screening Instrument (MNSI) were used to evaluate recovery of peripheral vessel and nerve before and after operation, the result of angiography and vascular ultrasound were also compared after operation. RESULTS: Seventeen of 19 patients were followed up from 3 to 13 months with an average of 6.9 months. Seventeen patients' surface wound were healed. Ankle-brachial index was increased from (0.51±0.20) before operation to (0.93±0.18) at 3 months after operation, and had significant difference(t=13.63, P=0.000);MNSI was increased from (4.06±1.36) before operation to(5.76±1.44) at 3 months after operation, and differences were statistically significant (t=7.31, P=0.000). Postoperative angiography and vascular ultrasound showed satisfied regeneration of micro-vessel and affected foot achieved normal movement and daily life. CONCLUSIONS: Transverse tibial bone transport micro vessels regeneration technology could reconstruct micro-vessel under lower affected limb, promote recovery of peripheral vessel and nerve, while with vacuum drainage could promote wound healing, has advantages of simple operation, obvious clinical effect, and high success rate of limb-salvage, and is one of ideal treatment for diabetic foot ulcer.

Evaluation of expression levels and mechanism of complement activation.

The present study aimed to reveal the expression changes of complement system activation and complement activation product C3a receptor during acute myocardial infarction. Blood samples were collected from healthy individuals and from patients with coronary artery stenosis or acute myocardial infarction. The subjects received physical examination in hospital between January and July 2015 (n=5). Cytometric bead array was performed to measure the levels of complement system activation product anaphylatoxin C3a, C4a and C5a. Immunohistochemical investigations were performed in tissues of patients who underwent coronary artery bypass grafting between January and July 2015 to detect the expression of C3a receptor. The results of cytometric bead array showed that the content of complement activation products C3a, C4a and C5a in the plasma of patients with coronary artery stenosis and acute myocardial infarction were significantly higher than those of the control group (P<0.01). The results of immunoblotting suggested that the protein expression of C3a receptor in infarct tissues of patients with acute myocardial infarction was significantly higher than that of normal tissues adjacent to the infarcted area (P<0.05). There is complement system activation in patients with acute myocardial infarction. Additionally, the increase in the expression of complement C3a receptor in tissues of infarct area suggested that C3a-C3a receptor signaling pathway may be involved in the development of myocardial infarction.

Chemokine Receptors CXCR4 and CXCR7 are Associated with Tumor Aggressiveness and Prognosis in Extramammary Paget Disease.

Chemokines are involved in many aspects of oncogenesis, including regulation of cancer cell growth, dissemination and host-tumor response. However, the potential of the chemokine receptors, CXCR4 and CXCR7, in serving as biomarkers in extramammary Paget's disease (EMPD) has been rarely examined. Expressions of CXCR4 and CXCR7 were evaluated in 92 EMPD specimens by immunohistochemistry. High expression of CXCR4 and CXCR7 were both correlated with regional lymph node metastasis and presence of lymphovascular invasion. High expression of CXCR7 also correlated with the depth of invasion. The prognostic value of these two chemokines were also investigated in progression-free survival (PFS) and cancer-specific survival (CSS). Both high expression of CXCR4 and CXCR7 were indicative of shorter PFS and CSS. In the combined prognostic model, concomitant high expression of CXCR4 and CXCR7 were suggestive of poor prognosis compared with the other two groups. In the multivariate analysis, depth of invasion, combined prognostic model and regional lymph node metastasis at diagnosis were the independent prognostic factors for EMPD patients for PFS, and the former two factors independently impacted CSS. Our results demonstrated that CXCR4 and CXCR7 can be used as prognostic biomarkers and prediction of aggressiveness of EMPD. Therapy targeting CXCR4 and CXCR7 may helpful to prevent EMPD progression and improve the prognosis of EMPD.

Factors influencing biochemical recurrence in patients who have received salvage radiotherapy after radical prostatectomy: a systematic review and meta-analysis.

Several studies have evaluated the risk factors influencing biochemical recurrence (BCR) of prostate cancer in patients receiving salvage radiotherapy (SRT) for BCR after radical prostatectomy (RP), but the results remain conflicting. In this study, we performed a meta-analysis to resolve this conflict. We searched the following databases: PubMed, Embase, and Web of Science using the following terms in "All fields": "salvage radiation therapy," "salvage IMRT," "S-IMRT," "salvage radiotherapy," "SRT," "radical prostatectomy," "RP," "biochemical recurrence," "BCR," "biochemical relapse." Eleven studies, with a total of 1383 patients, were included in our meta-analysis. Of all the variables, only Gleason score (GS) ≥7 (odds ratio [OR]: 3.82; 95% confidence interval [CI]: 2.60-5.64) and pathological tumor (pT) stage ≥3a (OR: 1.82; 95% CI: 1.36-2.42) were positively correlated with BCR. However, SRT combined with androgen deprivation therapy (ADT) (OR: 0.63; 95% CI: 0.44-0.90) and radiation therapy (RT) dose ≥64 Gy (OR: 0.35; 95% CI: 0.19-0.64) were negatively correlated with BCR. Perineural invasion (OR: 2.64; 95% CI: 1.11-6.26), preoperative prostate-specific antigen (PSA) ≥10 ng ml-1 (OR: 1.36; 95% CI: 0.94-1.96), positive surgical margin (OR: 0.92; 95% CI: 0.7-1.19), and seminal vesicle involvement (SVI) (OR: 1.09; 95% CI: 0.83-1.43) had no effect on BCR. Our meta-analysis indicated that pT stage, GS, RT dose, and SRT combined with ADT may influence BCR, while preoperative PSA, surgical margin, perineural invasion, and SVI have only a weak effect on BCR.

Relationship between circumcision and human papillomavirus infection: a systematic review and meta-analysis.

Male circumcision (MC) is reported to reduce human papillomavirus (HPV) prevalence in men. However, the efficacy remains imprecise. The aim of this study was to conduct a systematic review and meta-analysis to assess the relationship between MC and genital HPV infection and genital warts. PUBMED, EMBASE, and Web of Science were searched from inception to March 22, 2015. We identified 30 papers, including a total of 12149 circumcised and 12252 uncircumcised men who were evaluated for the association of circumcision with genital HPV or genital warts. Compared with men who were not circumcised, circumcised men may have had significantly reduced odds of genital HPV prevalence (odds ratio [OR]: 0.68; 95% confidence interval [95% CI]: 0.56-0.82). There was no significant association between MC and genital HPV acquisition of new infections (OR: 0.99; 95% CI: 0.62-1.60), genital HPV clearance (OR: 1.38; 95% CI: 0.96-1.97), and prevalence of genital warts (OR: 1.17; 95% CI: 0.63-2.17). This meta-analysis suggests that circumcision reduces the prevalence of genital HPV infections. However, no clear evidence was found that circumcision was associated with decreased HPV acquisition, increased HPV clearance, or decreased the prevalence of genital warts. More studies are required to evaluate adequately the effect of MC on the acquisition and clearance of HPV infections and prevalence of genital warts.

Notification Rate of Tuberculosis among Migrants in China 2005-2014: A Systematic Review and Meta-analysis.

BACKGROUND: Migrations have been reported to be associated with the high risk of tuberculosis (TB), but there is no systematic analysis of the available data for TB among migrant in China. The aim of this study was to examine the notification rate of active and sputum smear-positive TB by a systematic review and meta-analysis. METHODS: A systematic review and meta-analysis were performed to examine the notification rate of active and sputum smear-positive TB among migrants in China. Two reviewers searched the cross-sectional studies published in PubMed, EMBASE, SciFinder, and Web of Science in English and in CNKI and Wanfang databases in Chinese. Pooled estimates of notification rate of TB among migrants were calculated using a random effects model. Meta-regression analysis and subgroup analysis stratified by year, region were also performed. RESULTS: Seventy eligible studies met the inclusion criteria for the final analysis. The overall notification rate of active TB and sputum smear-positive cases among migrants were 53.12 (95% confidence interval [CI]: 47.32-59.63) and 24.53 (95% CI: 22.01-27.34) per 100,000 populations, respectively. The notification rate of active TB significantly increased from 50.95 (95% CI: 41.11-63.14) per 100,000 populations in 2005 to 84.62 (95% CI: 78.00-91.80) per 100,000 populations in 2014 while that of smear-positive TB was constant during the study time (P = 0.79). The geographic difference was identified both for active and sputum smear-positive TB, with the higher notification rates mainly distributing along the eastern coastal areas. CONCLUSIONS: The pooled estimate of active TB and sputum smear-positive TB among migrants was lower than the national notification rate among general population, but the gap between our data and national notification rate among general population is narrowed down during 2005-2014.

[Medium and long term results of high tibial osteotomy for the treatment of knee joint osteoarthritis].

OBJECTIVE: To analyze the medium and long term results of high tibial osteotomy(HTO) for the treatment of knee joint osteoarthritis(OA). METHODS: From January 2001 to December 2005, 45 patients(63 knees)with medial compartment OA were treated with HTO, including 10 males (15 knees) and 35 females (48 knees), ranging in age from 45 to 64 years old with an average of (55.76±5.54) years old. Preoperative normal anteroposterior and lateral X ray films of weight bearing knee were conducted, with an accurate measurement of the femoral tibial angle(FTA), and the mass of lateral tibial osteotomy was determined according to the preoperative FTA. Routine HTO was performed after epidural anesthesia. Most patients were treated with middle part fibulae osteotomy, and some patients were treated with the release of proximal tibiofibular joints. The functional exercise no weight bearing ambulation and weight bearing exercise began on the second day after operation 2 weeks after operation and 8 to 10 weeks after operation respectively. All the cases should be examined with X ray postoperatively on the second day, 8 to 10 weeks, 6 months, 1 year after operation and once a year. The VAS, HSS and KSS were used to evaluate knee pain, deformity, function, and range of motion preoperatively, 3 to 5 years postoperatively, 10 to 14 years postoperatively in all the patients. RESULTS: Forty three patients (61 knees) were followed up for more than 10 years. All the incisions were healed at the first stage. The bone healing was achieved 8 to 10 weeks after operation. The knee joint was evaluated according to the HSS standard 10 to 14 years after operation, and the average score was 76.24±5.27. Twenty seven patients got an excellent result, 25 good, 7 fair and 2 poor. The VAS, HSS and KSS scores of postoperative 3 to 5 years and 10 to 14 years were better than those of before operation. There were no obvious differences of scores between postoperative 3 to 5 years and postoperative 10 to 14 years. CONCLUSIONS: The long term curative effect of high tibial osteotomy in the treatment of knee OA(medial compartment arthritis) is satisfied, if the indications for surgical treatment are appropriate, and postoperative active exercises are performed.

Combination of circulating tumor cell enumeration and tumor marker detection in predicting prognosis and treatment effect in metastatic castration-resistant prostate cancer.

Although circulating tumor cell (CTC) enumeration in peripheral blood has already been validated as a reliable biomarker in predicting prognosis in metastatic castration-resistant prostate cancer (mCRPC), patients with favorable CTC counts (CTC < 5/7.5 ml) still experience various survival times. Assays that can reduce patients' risks are urgently needed. In this study, we set up a real-time quantitative polymerase chain reaction (RT-qPCR) method to detect epithelial-mesenchymal transition (EMT) and stem cell gene expression status in peripheral blood to validate whether they could complement CTC enumeration. From January 2013 to June 2014 we collected peripheral blood from 70 mCRPC patients and enumerated CTC in these blood samples using CellSearch system. At the same time, stem cell-related genes (ABCG2, PROM1 and PSCA) and EMT-related genes (TWIST1 and vimentin) were detected in these peripheral blood samples using an RT-qPCR assay. Patient overall survival (OS) and treatment methods were recorded in the follow-up. For patients who received first-line chemotherapy, docetaxel plus prednisone, PSA progression-free survival (PSA-PFS) and PSA response rate were recorded. At the time of analysis, 35 patients had died of prostate cancer with a median follow-up of 16.0 months. Unfavorable CTC enumerations (CTC ≥5/7.5 ml) were predictive of shorter OS (p = 0.01). Also, positive stem cell gene expression indicated poor prognosis in mCRPC patients (p = 0.01). However, EMT gene expression status failed to show any prognostic value in OS (p = 0.78). A multivariate analysis indicated that serum albumin (p = 0.04), ECOG performance status (p < 0.01), CTC enumeration (p = 0.02) and stem cell gene expression status (p = 0.01) were independent prognostic factors for OS. For the 40 patients categorized into the favorable CTC enumeration group, positive stem cell gene expression also suggested poor prognosis (p < 0.01). A combined prognostic model consisting of stem cell gene expression and CTC enumeration increased the concordance probability estimated value from 0.716 to 0.889 in comparison with CTC enumeration alone. For patients who received docetaxel plus prednisone as first-line chemotherapy, positive stem cell gene expression suggested a poor PSA-PFS (p = 0.01) and a low PSA response rate (p = 0.008). However, CTC enumeration and EMT gene expression status did not affect PSA-PFS or PSA response rates. As a result, detection of peripheral blood stem cell gene expression could complement CTC enumeration in predicting OS and docetaxel-based treatment effects in mCRPC patients.

HIV infection among new synthetic drug abusers: a pilot study in Beijing.

BACKGROUND: Following the increased human immunodeficiency virus (HIV) notification (infection) rates via sexual transmission and increased abuse of new synthetic drugs instead of heroin in China, a study on HIV infections and risk factors among synthetic drugs and heroin users in Beijing was conducted to provide a cue for further development of targets and strategies of HIV/AIDS control and prevention for different drug populations. METHODS: A total of 428 subjects including 224 heroin users and 204 new synthetic drug users was recruited from communities in Beijing by convenience sampling. A χ(2) test was used to compare HIV and syphilis infections between the two subpopulations. Logistic regression models were used to evaluate factors related to HIV, syphilis infections and abuse of synthetic drugs. RESULTS: Unbalanced distributions of demographics were detected between the two subpopulations. Compared with heroin users, most users of synthetic drugs were migrants, single and of younger age (age ≤ 30 years). Ten HIV infections and twenty-four syphilis infections were confirmed among 428 subjects. No significant difference in HIV infection was found between the two subpopulations (crude odds ratio (OR) = 0.46, 95% confidence interval (CI): 0.07 - 15.80 and adjusted odds ratio (AOR) = 1.26, 95%CI: 0.09 - 18.28) while four times as many syphilis infections were identified among users of synthetics drugs (AOR = 3.92, 95%CI: 1.06 - 14.56). HIV and syphilis infections appeared to work synergistically. The migrants who were of Han ethnicity, single and who had stayed in Beijing for more than six months were more likely to abuse synthetics drugs. CONCLUSIONS: The new synthetic drug users and heroin users are different subpopulations. We optimistically speculate that HIV has not yet been introduced into the former in Beijing, but considering higher syphilis infections in synthetic drug users and the role of syphilis in HIV infection, synthetic drug users, as a possible and important driver of the HIV/AIDS epidemic in Beijing, should be paid more attention in HIV prevention and control strategies.

[Optimal surgical timing and treatment of thumb duplication in children].

OBJECTIVE: To investigate the optimal surgical timing and treatment of congenital duplication of the thumb in children. METHODS: A clinical study was performed on 154 fingers of the 132 patients (including 85 males, 47 females;mean age (1.53 +/- 2.47) years; ranged from 2 months to 13 years). Duplicated thumbs were surgically treated from December 2007 to February 2012. All patients underwent detailed physical examination and radiological assessment. Surgical methods should be selected according to the age, Wassel classification and deformity. The operation steps included resection of the most hypoplastic thumb, followed by skin flap plasty, tendon shift (transplantation) , reconstruction of collateral ligament and articular capsule. 11 cases over the age of 6 underwent osteotomy discretion as appropriate. RESULTS: A total of 117 fingers of the 104 patients were followed up for an average 36. 7 months (range,6-55 months). We adopted upgrade Tada standard to evaluate the follow-up results as excellent in 77 thumbs, good in 21 thumbs, fair in 15 thumbs and poor in 4 thumbs. Three thumbs appeared secondary angular deformity 2 years after operation and one thumb appeared residual osteoepiphysis in the radial side of metacarpophalangeal joint 3 years after operation. The appearance and the function were almost normal after second operation. CONCLUSIONS: The optimal surgical timing of congenital duplication of thumb should be based on the appearance of thumb ossification center. The surgical timing of Wassel type- I and II should be chosen at 1. 5 years old when the ossification center of distal phalanx appears, Wassel type-III and IV should be chosen at 1 year old when the ossification center of proximal phalanx appears, Wassel type-V and VI should be chosen at 2. 5 years old when the ossification center of metacarpal appears, and Wassel type-VII should be chosen at 2. 5 years old. The surgical method should be selected on individualized principle. The key points are reconstruction of collateral ligament, tendon and articular capsule and correction of ulnar deviation (or radial deviation).

Heterosexual risk of HIV infection in China: systematic review and meta-analysis.

BACKGROUND: Heterosexual sex has become the dominant transmission route in China. Recently studies reported high heterogeneity in heterosexual transmission risk in resource-limited countries. The aim of this study was to summarize the risk of HIV transmission among Chinese serodiscordant couples. METHODS: A systematic review and meta-analysis of observational studies of heterosexual HIV transmission among serodiscordant couples in China was conducted. Two reviewers conducted a literature search using the China National Knowledge Infrastructure (CNKI), Chinese Medical Current Contents (CMCC), and Medline databases. Pooled transmission estimates per 100 person-years (PY) were calculated using a random-effects model. Meta-regression analysis and subgroup analysis stratified by study design, transmission direction and period of antiretroviral therapy (ART) availability were conducted to assess the factors associated with transmission. RESULTS: Eleven eligible studies were identified reporting on 11 984 couples and 405 HIV transmission events. HIV transmission risk from HIV-positive individuals to heterosexual partners was 1.68 (95%CI 0.74 - 2.62) per 100 PY. Study design did not reach statistical significance in meta-regression analysis. The pooled female-to-male transmission estimate was 1.11 (95%CI 0.09 - 2.14) per 100 PY and male-to-female transmission estimate was 1.43 (95%CI 0.19 - 2.68) per 100 PY. The pooled estimate for those before the availability of the Chinese National Free Antiretroviral Therapy Program (2.13 (95%CI 0.00 - 4.63) per 100 PY) was higher than that for those after the implementation of this program (1.44 (95%CI 0.62 - 2.26) per 100 PY). CONCLUSIONS: Transmission estimates in China were lower than other developing countries, but higher than developed countries. Research that better defines HIV secondary transmission rates and the associated behavioral, treatment adherence, and health-related risk factors among heterosexual serodiscordant couples in China is needed.

Combining domestic and foreign investment to expand tuberculosis control in China.

Jia and colleagues describe how a combination of increased domestic funding, supplemented by foreign loans and donations since 2002, have led to a dramatic increase in tuberculosis case finding in China.