Small extracellular vesicle microRNAs in pediatric myasthenia gravis plasma and skeletal muscle.

BACKGROUND: The diagnosis of myasthenia gravis (MG) in children remains difficult. Circulating small extracellular vesicle (sEV)-derived miRNAs (sEV-miRNAs) have been recognized as biomarkers of various diseases and can be excreted by different cell types. These biomarker candidates also play a vital role in autoimmune diseases via intercellular communication. METHODS: In the present study, we used sEV isolation and purification methods to extract the plasma-derived sEV-miRNAs from children with MG and healthy controls. A small RNA sequencing analysis confirmed the miRNA expression features in plasma-derived sEVs from MG patients. The miRNA expression analysis in vitro was determined using microarray analysis. The enrichment and network analyses of altered sEV-miRNAs were performed using miRNA databases and Database for Annotation, Visualization, and Integrated Discovery website. Quantitative real-time polymerase chain reaction was performed for validation of sEV-miRNA. The diagnostic power of altered sEV-miRNAs was evaluated using receiver operating characteristic curve analyses. RESULTS: Twenty-four sEV-miRNAs with altered expression level were identified between groups by DESeq2 method. The miRNAs were extracted from the sEVs, which were isolated from human primary skeletal muscle cell culture treated with mAb198. The target genes and enriched pathways of sEV-miRNAs partially overlapped between cell supernatant and plasma samples. The significantly downregulated miR-143-3p was validated in quantitative real-time polymerase chain reaction analysis. CONCLUSIONS: For the first time, we report that plasma-derived sEV-miRNAs may act as novel circulating biomarkers and therapeutic targets in pediatric MG.

Segmented Polyurethane Elastomers with Mechanochromic and Self-Strengthening Functions.

Mechanochromic elastomers that exhibit force-induced cross-linking reactions in the bulk state are introduced. The synthesis of segmented polyurethanes (SPUs) that contain difluorenylsuccinonitrile (DFSN) moieties in the main chain and methacryloyl groups in the side chains was carried out. DFSN was selected as the mechanophore because it dissociates under mechanical stimuli to form pink cyanofluorene (CF) radicals, which can also initiate the radical polymerization of methacrylate monomers. The obtained elastomers generated CF radicals and changed color by compression or extension; they also became insoluble due to the mechanically induced cross-linking reactions. Additionally, an SPU containing diphenylmethane units also exhibited highly sensitive mechanofluorescence. To the best of our knowledge, this is the first report to demonstrate damage detection ability and changes in the mechanical properties of bulk elastomers induced by simple compression or extension.

Age differences in sexual risk behaviors and related factors among people living with HIV in Guangxi, China.

Sexual risk behaviors by people living with HIV (PLHIV) can result in secondary HIV transmission and other health problems. Given the dearth of research on age differences in sexual behaviors among PLHIV, the objective of the study is to compare sexual risk behaviors and related factors among PLHIV by age groups. Data used in the current study were derived from a cross-sectional survey conducted from 2012 to 2013 in Guangxi, China. PLHIV were selected randomly from 12 sites with the largest number of HIV/AIDS cases. The 2,987 PLHIV completing the survey were included in the study. Participants were asked about key sociodemographic characteristics, health condition, same-sex behavior, and sexual risk behaviors (number of sex partners, condom use consistency, and change in condom use after HIV diagnosis). Univariate logistic regression analyses were conducted to evaluate associations of sexual risk behaviors with age and other factors. Those variables with a p-value of less than 0.2 were entered into multivariate logistic regression models. All statistical analyses were conducted using SAS 9.4. Differences in sexual risk behaviors across age groups were observed. Compared with their younger counterparts, who were ≥ 50 years of age were more likely to have multiple partners, use condoms inconsistently, and use condoms less than before HIV diagnosis. Moreover, lower education attainment, being in the lowest or highest category of income, having a sero-concordant or sero-unknown steady partner or no steady partner, and having contracted HIV from steady or casual/commercial partners, or through injection drug use appeared to be predictive of at least one of the sexual risk behaviors examined in the study. The findings call for HIV prevention interventions to be tailored to different age groups. The interventions that can help reduce unprotected sex among older PLHIV are urgently needed.

Social support, stigma, and HIV disclosure among parents living with HIV in Guangxi, China.

Both stigma and social support have been identified to be associated with HIV status disclosure among people living with HIV. This study aimed to examine cross-sectional associations of perceived social support and multiple types of stigma with both disclosure to various target groups and timing of disclosure among parents living with HIV (PLHIV) in Guangxi, China. Cross-sectional data from 1254 PLHIV in Guangxi, China were analyzed. Measures included demographics, disclosure to specific groups (steady partner/spouse, children, family and others) and timing of disclosure, perceived social support, and three types of HIV-related stigma (perceived, internalized, and enacted stigma). Logistic regression analyses were performed to identify the associations of interest. The participants who reported higher levels of perceived social support were more likely to have disclosed to steady partner/spouse, family or others. Those who experienced enacted stigma were more likely to have disclosed to children or family. Those who were married/cohabitating were more likely to have disclosed to steady partner/spouse, and less likely to have disclosed to children, family or others. Older PLHIV were less likely to have disclosed to steady partner/spouse, or family. Those who had a job were more likely to have disclosed to steady partner/spouse. Perceived social support appeared not to be associated with timing of disclosure. Those who disclosed within a shorter time after diagnosis were more likely to be women or have disclosed to steady partner/spouse, and less likely to have higher perceived stigma or have disclosed to family. Interventions are needed to help reduce the negative effect of perceived stigma at both family and community levels and to help enhance perceived social support in general and emotional support in particular among PLHIV, especially males and older adults.

Social support and amphetamine-type stimulant use among female sex workers in China.

BACKGROUND: Existing research has suggested a positive role of social support in reducing drug use among female sex workers (FSWs). However, there is limited research on the role of social support in amphetamine-type stimulant (ATS) use among FSWs in China. This study explored the present situation of ATS use among FSWs in Guangxi, China and examined the associations of different types of social support from different sources with ATS use. METHOD: A sample of 1022 FSWs was recruited from 56 commercial sex venues in Guangxi Autonomous Region in China. Bivariate comparison was used to compare demographic characteristics and source of emotional or tangible social support across frequency of ATS use among FSWs. The relationship between social support and ATS use was examined using multiple ordinal logistic regression models controlling for the potential confounding effects of demographic variables. RESULTS: The multiple ordinal logistic regression indicated that FSWs who were from younger age groups (aOR = 10.88 for age group <20; aOR = 2.80 for age group 20-23), and from all higher-income venues (aOR = 1.96 for venue level 1; aOR = 2.28 for venue level 2; aOR = 1.81 for venue level 3) tended to use ATS more frequently. They also tended to use ATS more frequently when they depended on their boyfriends (aOR = 1.08) for emotional support or on their co-workers for tangible support (aOR = 1.17). CONCLUSIONS: Different types of social support from different sources can be either positively or negatively associated with ATS use among FSWs, therefore, the future intervention efforts should differentiate and target different types and different sources of social support in response to the living and work conditions of FSWs.

Bayesian variable selection in joint modeling of longitudinal data and interval-censored failure time data.

Joint modeling of longitudinal data and survival data has gained great attention in the last two decades. However, most of the existing studies have focused on right-censored survival data. In this article, we study joint analysis of longitudinal data and interval-censored survival data and conduct Bayesian variable selection in this framework. A new joint model is proposed with a shared frailty to characterize the dependence between the two types of responses, where the longitudinal response is modeled with a semiparametric linear mixed-effects submodel and the survival time is modeled by a semiparametric normal fraility probit sub-model. Several Bayesian variable selection approaches are developed by adopting Bayesian Lasso, adaptive Lasso, and spike-and-slab priors in order to simultaneously select significant covariates and estimate their effects on the two types of responses. Efficient Gibbs samplers are proposed with all unknown parameters and latent variables being sampled directly from well recognized full conditional distributions. Our simulation study shows that these methods perform well in both variable selection and parameter estimation. A real-life data application to joint analysis of blood cholesterol level and hypertension is provided as an illustration.

Case Report: Intravesical and extravesical urachal cyst in children with lower abdominal pain and hematuria.

Bladder urachal cysts in children are a rare form of urachal abnormality. In this paper, we present a case of atypical imaging that presented with lower abdominal pain accompanied by hematuria, resulting in the formation of both internal and external urachal cysts in a child. A 6-year-old male child presented with repeated abdominal pain over a span of 4 days. Color ultrasound and pelvic CT scans revealed a soft tissue lesion on the right anterior wall of the bladder with an unclear boundary from the bladder wall. Voiding Cystourethrography (VCUG) showed no significant abnormalities in the bladder, while routine urine testing was positive for hematuria. A cystoscopy was simultaneously performed with a laparoscopic resection of the urachal cyst. Intraoperative cystoscopy identified the intravesical lesion, which was precisely removed using a cystoscope-assisted laparoscopy. Postoperative pathology confirmed that both extravesical and intravesical lesions were consistent with a urachal cyst. No complications were observed after the operation, and no recurrence was noted during a six-month follow-up. Therefore, for urachal cysts at the bladder's end, the possibility of intravesical urachal cysts should not be excluded, especially in patients with microscopic hematuria. We recommend performing cystoscopy simultaneously with laparoscopic urachal cyst removal to avoid missing intravesical lesions.

Application of clitoris exposure + episioplasty + dermabrasion + platelet-rich plasma injection + chemexfoliation in vulvar lichen sclerosus.

Introduction: To investigate the therapeutic effect of clitoris exposure + episioplasty + dermabrasion + platelet-rich plasma (PRP) injection + chemexfoliation on vulvar lichen sclerosus (VLS). Methods: Twenty children with VLS (under 14 years old) at our hospital from July 2020 to November 2022 were enrolled and treated with clitoris exposure + episioplasty + dermabrasion + PRP injection + chemexfoliation. Additionally, symptomatic changes and improvements in signs were recorded. Results: Significant therapeutic effects were achieved in all children enrolled in this study. The Cattanco score was 8.02 ± 1.22 points before surgery, 2.21 ± 0.70 points 3 months after surgery, and 2.61 ± 0.59 points 6 months after surgery, demonstrating that the score after surgery was significantly lower than that before surgery (p < 0.05). Mild complications (one case of mild vulvar swelling, one case of minor bleeding, and one case of superficial ulcer) were observed in three children after surgery, with an overall complication incidence of 15%; all complications were improved after the intervention, and no severe adverse reactions were observed. Recurrence was observed in one child (5%) 6 months after surgery. Conclusion: Clitoris exposure + episioplasty + dermabrasion + PRP injection + chemexfoliation is an effective approach for the treatment of VLS. Systematic Review Registration: https://www.chictr.org.cn/searchproj.html, identifier: ChiCTR2100054787.

Metagenomic next-generation sequencing and proteomics analysis in pediatric viral encephalitis and meningitis.

Introduction: Early and accurate identification of pathogens is essential for improved outcomes in patients with viral encephalitis (VE) and/or viral meningitis (VM). Methods: In our research, Metagenomic next-generation sequencing (mNGS) which can identify viral pathogens unbiasedly was performed on RNA and DNA to identify potential pathogens in cerebrospinal fluid (CSF) samples from 50 pediatric patients with suspected VEs and/or VMs. Then we performed proteomics analysis on the 14 HEV-positive CSF samples and another 12 CSF samples from health controls (HCs). A supervised partial least squaresdiscriminant analysis (PLS-DA) and orthogonal PLS-DA (O-PLS-DA) model was performed using proteomics data. Results: Ten viruses in 48% patients were identified and the most common pathogen was human enterovirus (HEV) Echo18. 11 proteins overlapping between the top 20 DEPs in terms of P value and FC and the top 20 proteins in PLS-DA VIP lists were acquired. Discussion: Our result showed mNGS has certain advantages on pathogens identification in VE and VM and our research established a foundation to identify diagnosis biomarker candidates of HEV-positive meningitis based on MS-based proteomics analysis, which could also contribute toward investigating the HEV-specific host response patterns.

Microstructures and Soft Magnetic Properties of Fe73.5-xCu1Nb3Si13.5B9Gdx (x = 0-1.5) Alloys.

In this experiment, the rare earth Gd element was added to Finemet alloy to observe the microstructure and soft magnetic properties. The experimental results showed that the samples with the addition of 0.5% Gd and 1.0% Gd can be quenched and cast normally, and the MS of Fe73Cu1Nb3Si13.5B9Gd0.5 alloy was 10.41% higher than that of Finemet. After annealing, crystal grains of about 10 nm were formed. The µi and µm values of Fe73Cu1Nb3Si13.5B9Gd0.5 alloy were 25.51% and 22.23% higher, respectively, and the coercivity HC was reduced by 12.19% compared to Finemet. At 1 kHz, the µe value of Fe73Cu1Nb3Si13.5B9Gd0.5 alloy at room temperature was 14.57% higher than that of Finemet, while the µe reached 162.34 k and 142.42 k at 90 °C and 150 °C (24% and 29.51% higher, respectively). The Fe72.5Cu1Nb3Si13.5B9Gd1.0 alloy had the best performance at 100 kHz, with higher µe values than Finemet across the ambient temperature range of 30 °C to 150 °C. After tension annealing, the µe values of Fe72.5Cu1Nb3Si13.5B9Gd1.0 alloy were 20-30% higher than those of Finemet.

Psychometric Properties of Four Common Clinical Tests for Assessing Hamstring Flexibility in Young Adults.

Objective: To examine the psychometric properties of four common hamstring muscle flexibility tests involving the straight leg raise (SLR), passive knee extension (PKE), sit and reach test (SRT) and toe touch test (TTT) in young adults. Methods: Forty-three young healthy adults (mean age 27.4 years) were recruited for 3 repeated sessions of hamstring flexibility assessments using the 4 tests mentioned above and the subsequent isokinetic examinations. The first two sessions (S1 and S2) were conducted by two different raters randomly on the first day (D1), and the third session (S3) was conducted by the same rater as S1 3 days later (D4). The next day (D5), the isokinetic performances of knee extensors and flexors of the dominant leg were assessed. To evaluate the interrater (S1 vs. S2) and test-retest (S1 vs. S3) reliability of hamstring flexibility tests, intraclass correlation coefficients (ICCs), standard errors of measurement, and the minimum detectable differences were calculated. Correlation analyses were performed to study the association of each hamstring flexibility test with the isokinetic muscle function of the knee flexors (H) and extensors (Q), including the peak torque (PT), total amount of work (TW) and average power (AP). Results: Excellent interrater and test-retest reliability of hamstring flexibility tests involving the SLR, PKE, SRT and TTT were confirmed with ICCs ranging from 0.923 to 0.986. Fair correlations were found between the 4 hamstring flexibility tests and the H/Q for the PT at angular speeds of 180°/s (Pearson's r at 0.330-0.449). In addition, the PKE was fairly correlated with the AP of the hamstring (Pearson's r = 0.320) and the H/Q for the TW (Pearson's r = 0.345) and AP (Pearson's r = 0.386) at angular speeds of 180°/s. Conclusions: This study confirmed that the SLR, PKE, SRT and TTT were reliable flexibility tests for hamstring muscles in young healthy adults, and the PKE might be a more valid outcome measure to predict hamstring injury.

Crystal Transition Behavior and Thermal Properties of Thermal-Energy-Storage Copolymer Materials with an n-Behenyl Side-Chain.

In this paper, we synthesized MC(BeA-co-MMA) copolymer microcapsules through suspension polymerization. The pendent n-behenyl group of BeA is highly crystalline, and it acts as the side-chain in the structure of BeA-co-MMA copolymer. The highly crystalline n-behenyl side-chain provides BeA-co-MMA copolymer thermal-energy-storage capacity. In order to investigate the correlation between the thermal properties and crystal structure of the BeA-co-MMA copolymer, the effects of monomer ratio, temperature changing and the changing rate, as well as synthesis method were discussed. The monomer ratio influenced crystal transition behavior and thermal properties greatly. The DSC results proved that when the monomer ratio of BeA and MMA was 3:1, MC(BeA-co-MMA)3 showed the highest average phase change enthalpy ΔH (105.1 J·g-1). It indicated that the n-behenyl side-chain formed a relatively perfect crystal region, which ensured a high energy storage capacity of the copolymer. All the DSC and SAXS results proved that the amount of BeA had a strong effect on the thermal-energy-storage capacity of the copolymer and the long spacing of crystals, but barely on the crystal lamella. It was found that MMA units worked like defects in the n-behenyl side-chain crystal structure of the BeA-co-MMA copolymer. Therefore, a lower fraction of MMA, that is, a higher fraction of BeA, contributed to a higher crystallinity of the BeA-co-MMA copolymer, providing a better energy storage capacity and thermoregulation property. ST(BeA-co-MMA) copolymer sheets with the same ingredients as microcapsules were also prepared through light-induced polymerization aiming at clarifying the effect of the synthesis method. The results proved that the synthesis method mainly influenced the copolymer chemical component, but lightly on the crystal packing of the n-behenyl side-chain.

Psychosocial correlates of health-related quality of life among people living with HIV in China: the mediating role of resilience.

OBJECTIVES: The current study aims to examine associations between psychosocial factors and health-related quality of life (HRQoL) and the role of psychological resilience in mediating the relationship between perceived social support (PSS) and HRQoL. DESIGN: A cross-sectional study was conducted among people living with HIV (PLHIV) in Guangxi, China. A sample of 2987 PLHIV (1876 men and 1111 women) was included in the current analysis. METHODS: Hierarchical multiple regression models were employed to assess the association of HRQoL with stigma, three types of PSS (informational, emotional and tangible), and resilience as well as to identify the possible role of resilience in mediating the effect of PSS on HRQoL RESULTS:: HRQoL was negatively associated with stigma (ß = -0.27, P < 0.001), but positively associated with emotional PSS (ß = 0.13, P < 0.001). After resilience was added to the model, HRQoL remained negatively associated with stigma (ß = -0.20, P < 0.001), but positively associated with resilience (ß = 0.38, P < 0.001). A mediating effect of resilience was found between emotional PSS and HRQoL (Sobel's Z = 16.87, P < 0.001). CONCLUSION: Interventions that consider enhancing resilience through building social support, especially emotional social support, will likely improve HRQoL among PLHIV.

Depression, Social Support, and Adherence to Antiretroviral Therapy Among People Living With HIV in Guangxi, China: A Longitudinal Study.

Depression can result in poor adherence to antiretroviral therapy (ART) among people living with HIV (PLHIV), and social support can help mitigate the negative relationship. However, little is known about how depression and social support synergistically influence ART adherence over time. The current study aims to explore longitudinal associations between them and examine which sources of social support can play a mediating role between depression and ART adherence over time. A randomized controlled clinical trial was conducted between 2013 and 2016 in Guangxi, China. The study sample was composed of 319 PLHIV who were randomized into control condition and provided data at baseline and at least one of the six follow-ups. The results revealed negative associations of depression with ART adherence over time, and a mediating effect of perceived support from spouse/partner or children. Interventions to promote ART adherence should focus on strengthening PLHIV's relationships with their spouse/partner and children, promoting collaborative provider-patient relationships, and enhancing peer support among PLHIV.

Physical Activity, Depression, and Antiretroviral Therapy Adherence Among People Living With HIV: A Mediation Analysis.

The aim of our study was to explore the relationships between physical activity, depression, and antiretroviral therapy (ART) adherence. Data were obtained from a randomized controlled trial of people living with HIV (N = 658) in China. Ordinal regression and logistic regression analyses were performed to examine associations between ART adherence, depression, and physical activity. A better ART adherence was associated with higher levels of physical activity (adjusted odds ratio [aOR] = 1.36, 95% confidence interval [CI] = 1.02-1.80) and lower levels of depression (aOR = 0.95, 95% CI = 0.92-0.99). Higher levels of physical activity were also associated with lower levels of depression (aOR = 0.50, 95% CI = 0.32-0.76). Sobel Z test indicated the mediating effect of depression between physical activity and ART adherence (Sobel Z = 1.96, p < .05). This study suggests the benefit of appropriate levels of physical activity to promote both psychological health and ART adherence in people living with HIV.

Downregulation of P2Y2 and HuD during the development of the enteric nervous system in fetal rats with anorectal malformations.

Certain patients with anorectal malforma-tions (ARMs) continue to suffer from postoperative dysphoria. The enteric nervous system (ENS) is closely associated with defecation. The purinergic receptor P2Y2 (P2Y2) and Hu antigen D (HuD) proteins contain multiple motifs that enable their activation and direct coupling to integrin and growth factor receptor signaling pathways; thus, they may serve as key points in ENS development. The aim of the present study was to investigate the expression pattern of P2Y2 and HuD proteins during anorectal development in ARM embryos. The embryogenesis of ARM in rats was induced by ethylenethiourea (ETU) on the 10th gestational day. The expression patterns of P2Y2 and HuD proteins were evaluated by immunohistochemistry and western blot analysis in normal, ETU and ARM rat embryos on embryonic days E17, E19 and E21; their mRNA levels were assessed via reverse transcription­quantitative polymerase chain reaction (RT­qPCR) of the distal rectum of fetal rats. Immunohistochemistry of the distal rectum demonstrated that on E17, the expression levels of the two proteins were not different between the three groups. On E19, the expression of HuD was significantly decreased in the ARM group. On E21, the two proteins were significantly decreased in the ARM group. Additionally, the expression levels of the two proteins on E17 were significantly lower than on E21 in the ARM group. Western blotting and RT­qPCR also revealed that the P2Y2 and HuD proteins and mRNA expression levels were significantly decreased in the ARM groups when compared with the normal group on E17 and E21 (P<0.01). Thus, the present study demonstrated that downregulation of P2Y2 and HuD may partly be related to the development of the ENS in ARM embryos.

A 3D Printable Thermal Energy Storage Crystalline Gel Using Mask-Projection Stereolithography.

Most of the phase change materials (PCMs) have been limited to use as functional additions or sealed in containers, and extra auxiliary equipment or supporting matrix is needed. The emergence of 3D printing technique has dramatically advanced the developments of materials and simplified production processes. This study focuses on a novel strategy to model thermal energy storage crystalline gels with three-dimensional architecture directly from liquid resin without supporting materials through light-induced polymerization 3D printing technique. A mask-projection stereolithography printer was used to measure the 3D printing test, and the printable characters of crystalline thermal energy storage P(SA-DMAA) gels with different molar ratios were evaluated. For the P(SA-DMMA) gels with a small fraction of SA, the 3D fabrication was realized with higher printing precision both on milli- and micro- meter scales. As a comparison of 3D printed samples, P(SA-DMAA) gels made by other two methods, post-UV curing treatment after 3D printing and UV curing using conventional mold, were prepared. The 3D printed P(SA-DMAA) gels shown high crystallinity. Post-UV curing treatment was beneficial to full curing of 3D printed gels, but did not lead to the further improvement of the crystal structure to get higher crystallinity. The P(SA-DMAA) crystalline gel having the highest energy storage enthalpy was developed, which reached 69.6 J·g-1. Its good thermoregulation property in the temperature range from 25 to 40 °C was proved. The P(SA-DMAA) gels are feasible for practical applications as one kind of 3D printing material with thermal energy storage and thermoregulation functionality.

Transanal endorectal stepwise gradient muscular cuff cutting pull-through method: Technique refinements and comparison with laparoscopy-assisted procedures.

In all existing radical resection procedures available for Hirschprung's disease (HD), the muscular cuff has been retained. In recent years, our study group has modified the procedure using a stepwise gradient muscular cuff cutting pull-through method for the treatment of HD. The objective of the present study was to assess patient prognosis following the use of the transanal endorectal pull-through (TEPT) method or the laparoscopy-assisted pull-through (LPT) method and to provide evidence to assist in clinical decisions. The medical records of 172 patients (age, ≥3 years) who underwent TEPT or LPT for HD between September 2003 and August 2014 at the Pediatric Surgery Department of The Affiliated Hospital of Zunyi Medical College (Zunyi, China) were reviewed (TEPT, n=94; LPT, n=78). Preoperative, intraoperative and post-operative data for the subjects involved were recorded. Each patient's family was interviewed using a uniform 12-item post-pull-through long-term outcome questionnaire, which was scored in order to compare the short and long-term treatment outcomes of patients in each group. Patients in the LPT group had significantly prolonged operating times, reduced intraoperative blood loss and perioperative transfusion rates and shorter anal dissection times. Furthermore, the oral feeding time and length of hospital stay were similar between groups. There were no significant differences in early complications between the groups. No significant differences in late complications, including anastomotic stricture and enterocolitis were observed; however, the soiling and constipation rates were significantly higher in the TEPT group compared with the LPT group. The stool pattern score was not significantly different between groups, while the frequency of bowel movements in the LPT group was significantly higher compared with the TEPT group from 9-24 months post-surgery. The stepwise gradient muscular cuff cutting pull-through method demonstrated a good safety profile and efficacy with regard to the long-term outcomes of patients with HD. These results support the clinical application of LPT as a promising surgical approach for children with HD.

Ethnicity, Stigma and Adherence to Antiretroviral Therapy (ART) among People Living with HIV/AIDS in Guangxi, China.

This study examines the impact of ethnicity and multiple types of HIV-related stigma on adherence to antiretroviral therapy (ART) among 2,146 people living with HIV/AIDS (PLWHA) in Guangxi, China who had initiated ART. The results of multiple binary logistic regressions indicate that those who had experienced enacted stigma tended to report lower adherence, while better adherence was associated with older age, being women and having a job. Ethnicity had a moderator effect on the association between internalized stigma and adherence since better adherence was associated with lower internalized stigma among participants in ethnic minority groups other than Zhuang. Our findings indicate that PLWHA of other ethnic minority groups could benefit from internalized stigma reduction interventions; PLWHA, overall, could benefit most from increased employment opportunities and acquisition of coping skills to mitigate the negative effects of enacted stigma.