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Background To inform policy and implementation that can enhance prevention and improve tuberculosis (TB) care cascade outcomes, this review aimed to summarize the impact of various interventions on care cascade outcomes for active TB. Methods and findings In this systematic review and meta-analysis, we retrieved English articles with comparator arms (like randomized controlled trials (RCTs) and before and after intervention studies) that evaluated TB interventions published from January 1970 to September 30, 2022, from Embase, CINAHL, PubMed, and the Cochrane library. Commentaries, qualitative studies, conference abstracts, studies without standard of care comparator arms, and studies that did not report quantitative results for TB care cascade outcomes were excluded. Data from studies with similar comparator arms were pooled in a random effects model, and outcomes were reported as odds ratio (OR) with 95% confidence interval (CI) and number of studies (k). The quality of evidence was appraised using GRADE, and the study was registered on PROSPERO (CRD42018103331). Of 21,548 deduplicated studies, 144 eligible studies were included. Of 144 studies, 128 were from low/middle-income countries, 84 were RCTs, and 25 integrated TB and HIV care. Counselling and education was significantly associated with testing (OR = 8.82, 95% CI:1.71 to 45.43; I2 = 99.9%, k = 7), diagnosis (OR = 1.44, 95% CI:1.08 to 1.92; I2 = 97.6%, k = 9), linkage to care (OR = 3.10, 95% CI = 1.97 to 4.86; I2 = 0%, k = 1), cure (OR = 2.08, 95% CI:1.11 to 3.88; I2 = 76.7%, k = 4), treatment completion (OR = 1.48, 95% CI: 1.07 to 2.03; I2 = 73.1%, k = 8), and treatment success (OR = 3.24, 95% CI: 1.88 to 5.55; I2 = 75.9%, k = 5) outcomes compared to standard-of-care. Incentives, multisector collaborations, and community-based interventions were associated with at least three TB care cascade outcomes; digital interventions and mixed interventions were associated with an increased likelihood of two cascade outcomes each. These findings remained salient when studies were limited to RCTs only. Also, our study does not cover the entire care cascade as we did not measure gaps in pre-testing, pretreatment, and post-treatment outcomes (like loss to follow-up and TB recurrence). Conclusions Among TB interventions, education and counseling, incentives, community-based interventions, and mixed interventions were associated with multiple active TB care cascade outcomes. However, cost-effectiveness and local-setting contexts should be considered when choosing such strategies due to their high heterogeneity.

Cognitive Impairment (CI) is associated with an increased risk of ketoacidosis (DKA) and severe hypoglycemia (SH) in persons with diabetes (DM) . Post-discharge Care (PDC) in nursing homes and home care facilities provides continuous medical care after hospital discharges. This study examined whether PDC is associated with lower CI-related hospital readmission for DKA and SH in US adults with DM (age >18) . Our study population includes 43,467 and 166,221 adults admitted for DKA and SH from the 2016-2018 National Readmission Database, among which 1492 (3.43%) and 822 (0.49%) had CI, respectively. Readmission was defined as hospitalization for all causes within 30 days after discharge. CI-related readmission risk was estimated by comparing those with and without CI using a multiple logistic regression model, adjusting for age, sex, primary payer, income level, disease severity, mortality risk at the index discharge, and PDC status. PDC as an effect modulator was tested as an interaction term of PDC and CI. For patients initially admitted for DKA, CI was associated with 62% (adjusted odds ratio (aOR) =1.62, 1.25-2.11) higher odds of readmission among those who were discharged to home. The CI-related increase in readmission risk disappeared if patients received PDC (aOR=1.05, 0.88-1.26) . For patients initially admitted for SH, CI was associated with 34% (aOR=1.34, 95% CI 1.08-1.66) higher odds of readmission among those discharged to home and a 32% lower odds of readmission if patients received PDC (aOR=0.68, 0.59-0.81) . CI was associated with increased readmission risks for SH and DKA among adults with DM discharged to home. This CI-related readmission risk was substantially lower in patients who received PDC, indicating the importance of PDC for people with DM and CI. Disclosure Y.Wang: None. P.Zhang: None. R.R.Fang: None. J.D.Brown: None. T.Jiao: None. J.Guo: None. H.Shao: Board Member; BRAVO4HEALTH, LLC.

ImportanceA platelet ADP P2Y12 receptor (P2Y12) inhibitor plus aspirin is standard therapy for patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). Compared with clopidogrel, prasugrel and ticagrelor are associated with superior antiatherothrombotic effects but increased bleeding risk; with recent guideline updates, it is important to describe current treatment patterns and the role of bleeding risk in treatment choice.ObjectiveTo describe secular trends and determinants of initial P2Y12 inhibitor choice and switching, including deescalation (switch from prasugrel or ticagrelor to clopidogrel).Design, Setting, and ParticipantsThis retrospective cohort study used MarketScan Commercial Claims Data from 2010 to 2019 for patients aged 18 years or older who underwent PCI for ACS, had no P2Y12 inhibitor use in the past year, and filled a P2Y12 inhibitor prescription within 30 days after PCI hospitalization discharge. Data were analyzed from February to May 2022.ExposuresClopidogrel, prasugrel, and ticagrelor, with determinants including bleeding risk measured using Academic Research Consortium for High Bleeding Risk criteria, sociodemographic characteristics, P2Y12 inhibitor copays, and bleeding events during follow-up.Main Outcomes and MeasuresThe prevalence of each P2Y12 inhibitor among patients who initiated the drugs and the prevalence of switching within 12 months after PCI were evaluated. The association between baseline bleeding risk and bleeding manifestations during follow-up and initial treatment and deescalation were calculated using multivariable logistic and Cox proportional hazards regression models.ResultsBetween 2010 and 2019, 62 423 patients were identified who initiated P2Y12 inhibitors (females, 22.4%; males, 77.6%; mean [SD] age, 54.32 [7.13] years). The prevalence of clopidogrel as initial therapy decreased from 77.5% in 2010 to 29.6% in 2019, while initial use of prasugrel or ticagrelor increased from 22.5% to 60.4%. Within 1 year after PCI, 11.0% of patients switched therapy, mostly for deescalation. Deescalation prevalence increased from 1.8% in 2010 to 12.6% in 2018. Between 2016 and 2018, 8588 of 22 886 (37.5%) patients had major baseline bleeding risk, which decreased the selection of prasugrel or ticagrelor as initial therapy (adjusted odds ratio, 0.78; 95% CI, 0.74-0.84). Among 11 285 patients who initiated prasugrel or ticagrelor, major bleeding risk at baseline (adjusted hazard ratio, 1.11; 95% CI, 1.00-1.23) and the occurrence of bleeding during follow-up (adjusted hazard ratio, 4.42; 95% CI, 3.62-5.93) were associated with deescalation.Conclusions and RelevanceA strong shift in preference for prasugrel and ticagrelor as initial therapy following PCI for ACS was observed. Deescalation increased over the study period. Major bleeding risk at baseline was moderately associated with initial treatment choice but had a limited association with deescalation. The increasing use of more potent P2Y12 inhibitors emphasizes opportunities to enhance preemptive patient-centered treatment strategies to maintain optimal antiplatelet activity while reducing bleeding risk during the subacute period following PCI for ACS.

Purpose To explore the laparoscopic technique with the retroperitoneal approach for complex adrenal tumors. Patients and methods The clinical data of 11 patients with complex adrenal tumors from July 2017 to July 2018 were analyzed retrospectively. Among them, there were 4 males and 7 females, 4 with adrenal myelolipomas, 3 with adrenal pheochromocytomas, 2 with adrenal cysts, 1 with adrenocortical adenoma and 1 with adrenal ganglioneuroma. The average tumor diameter was 6.5 ± 1.2 cm, and the average age of the patients was 48 ± 13 years. Results All the operations were successfully completed. The average operation time was 95 ± 15 min, the average amount of blood loss was 50 ± 15 mL, and the average postoperative hospital stay was 2.6 ± 1.3 days. No tumor recurrence was found after 1 year of follow-up. Conclusion Retroperitoneal laparoscopic surgery is effective for the treatment of complex adrenal tumors, but it requires good surgical skills. Surgeons skilled in laparoscopic technology can safely carry out retroperitoneal laparoscopic surgery for complex adrenal tumors.

Adolescent girls and young women (AGYW) remain underserved and at risk for HIV acquisition in Ethiopia. However, there is significant risk heterogeneity among AGYW with limited consensus on optimal strategies of identifying vulnerable AGYW. This study assessed the utility of venue-based sampling approaches to identify AGYW at increased risk for HIV infection. Venue mapping and time-location-sampling (TLS) methods were used to recruit AGYW from three sub-cities of Addis Ababa, February–June 2018. Interviewer-administered surveys captured socio-demographic and behavioral characteristics. Measures of AGYW vulnerability were assessed geographically and described by venue type. A total of 2468 unique venues were identified, of which 802 (32%) were systematically selected for validation and 371 (46%) were eligible including many sites that would traditionally not be included as venues in need of HIV prevention services. Overall, 800 AGYW were enrolled across 81 sampled venues. AGYW reached were largely out-of-school (n = 599, 75%) with high proportions of AGYW reporting transactional sex (n = 101, 12.6%), food insecurity (n = 165, 20.7%) and migration (n = 565, 70.6%). Taken together, these data suggest the utility of TLS methods in reaching vulnerable, out-of-school AGYW in Addis Ababa, Ethiopia. Electronic supplementary material The online version of this article (10.1007/s10461-019-02537-1) contains supplementary material, which is available to authorized users.

Background: Adrenocortical oncocytoma is a rare type of adrenocortical carcinoma. Its clinical characteristics and biological behaviour need to be further evaluated after the accumulation of cases.Case presentation: We report a case of adrenocortical oncocytic carcinoma in an Asian male with scoliosis. We performed an operation on this patient. Because the patient's scoliosis was limited during the operation and the tumor protruded into the chest, we decided to adopt open surgery in the supine position. During the operation, we found a tumor about 8 cm in diameter in the right adrenal region. There was local adhesion with the surrounding tissues. The surface blood vessels of the tumor were distended. After careful dissection and ligation of the blood vessels around the tumor, the adrenal tumor was completely dissociated and removed. The patient recovered well, and his hypertension was controlled after surgery. Pathological results confirmed the diagnosis of adrenocortical oncocytic carcinoma. Pathological features showed that the tumor cells were arranged in nests, with pathological mitosis, abundant cytoplasm, eosinophilia, and invasion of adipose tissue. Immunohistochemistry showed that Ki67 index was more than 15%. Conclusions: The incidence rate of eosinophilic adrenocortical carcinoma is very low. CT scans and other imaging examination methods are not specific. For larger adrenal tumors, the diagnosis of this disease should be considered. For patients with adrenal cortical carcinoma who have not yet metastasized, we can achieve sound treatment effects and reduce recurrence by removing the tumor, retroperitoneal fat around the tumor and locoregional lymph nodes.

Key Points Question Are publication language (English and Chinese) and trial results associated with duplicate publication of randomized clinical trials conducted in mainland China? Findings This cohort study included 470 Chinese-sponsored randomized clinical trials identified from clinical trial registries and published between 2008 and 2019. Approximately 12% of those randomized clinical trials have at least 1 duplicate publication; most are published in a different language than the main article. When main articles are published in Chinese, those with positive findings are more likely to have subsequent duplicate publication than those with negative findings. Meaning Results of this study suggest that publishing randomized clinical trials in different languages may impede identification of duplicates and be associated with duplicate publication bias., Importance Duplicate publications of randomized clinical trials are prevalent in the health-related literature. To date, few studies have assessed the interaction between duplicate publication and the language of the original publication. Objective To assess the existence of duplicate publication and the extent to which duplicate publication is associated with the language of the original publication. Design, Setting, and Participants In this retrospective cohort study, eligible randomized clinical trials were retrieved from trial registries, and bibliographic databases were searched to determine their publication status. Eligible randomized clinical trials were for drug interventions from January 1, 2008, to December 31, 2014. The search and analysis were conducted from March 1 to August 31, 2019. The trial registries were either primary registries recognized by the World Health Organization or the Drug Clinical Trial Registry Platform sponsored by the China Food and Drug Administration. Exposures Individual randomized clinical trials with positive vs negative results. Main Outcomes and Measures Journal articles were classified as main articles (determined by largest sample size and longest follow-up among all journal articles derived from that randomized clinical trial) and duplicates. The duplicates were classified into 4 types: (1) unreferenced subgroup analysis (article did not disclose itself as a subgroup analysis or reference its main article); (2) unreferenced republication (article did not disclose itself as a replicate of the main article or reference it); (3) unreferenced interim analysis (article did not disclose itself as an interim analysis or reference its main article); and (4) partial duplicate (article did not disclose its sharing a subset of participants with other articles or reference them). Results Among 470 randomized clinical trials published by August 2019 as journal articles, 55 (11.7%) had 75 duplicates, of which 53 (70.7%) were cross-language duplicates. Of the 75 duplicates, 33 (44.0%) were unreferenced republications, 25 (33.3%) unreferenced subgroup analyses, 15 (20.0%) unreferenced interim analyses, and 2 (2.7%) partial duplicates. When the main article of a randomized clinical trial was published in Chinese, those with positive findings were 2.48 (95% CI, 1.08-5.71) times more likely to have subsequent duplicate publication than those with negative findings. Conclusions and Relevance In this study, most duplicates were cross-language duplicates and the most common type was unreferenced republication of the main article. Duplicate publication bias exists when the main articles of randomized clinical trials were published in Chinese, potentially misleading readers and compromising journals and evidence synthesis., This cohort study of Chinese-sponsored randomized clinical trials assesses incidence of duplicate publication and the extent to which duplicate publication is associated with the language of publication.

Four new purified polysaccharides (PAP) were isolated and purified from the Enteromorpha prolifera by alkali extraction, and further characterization was investigated. Their average molecular weights of PAP-1, PAP-2, PAP-3, and PAP-4 were estimated as 3.44 &times, 104, 6.42 &times, 104, 1.20 &times, 105, and 4.82 &times, 104 Da, respectively. The results from monosaccharide analysis indicated that PAP-1, PAP-2, PAP-3 were acidic polysaccharides and PAP-4 was a neutral polysaccharide. PAP-1 and PAP-2 mainly consist of galacturonic acid, while PAP-3 and PAP-4 mainly contained rhamnose. Congo red test showed that no triple helical structure was detected in the four polysaccharides. The antioxidant activities were investigated using 1,1-diphenyl-2-picrylhydrazyl (DPPH), Superoxide, and 2, 2&prime, azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) radical assay. In vitro antitumor activities were evaluated by 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. PAP-1 exhibited relatively stronger antioxidant activities among the four polysaccharides in a dose-dependent manner. At a concentration of 1.00 mg/mL, the antioxidant activities of PAP-1 on the DPPH radical scavenging rate, superoxide anion radical scavenging rate, and ABTS radical rate at 1.00 mg/mL were 56.40%, 54.27%, and 42.07%, respectively. They also showed no significant inhibitory activity against MGC-803, HepG2, T24, and Bel-7402 cells. These investigations of polysaccharides provide a scientific basis for the use of E. prolifera as an ingredient in functional foods and medicines.

Background Adolescent sexual debut and non-consensual sex have been linked to higher sexual risk and STI infection in adulthood among men who have sex with men (MSM) in high-income countries. This study aimed to examine adolescent and non-consensual anal sexual debut among Chinese MSM and to evaluate factors associated with adolescent sexual debut and non-consensual anal sex. Methods A cross-sectional study was conducted recently among Chinese men assigned male sex at birth, ≥18 years old, and who had ever engaged in anal sex with a man. Participants answered questions regarding socio-demographics, condomless sex, age at anal sexual debut with a man, and whether the first anal sex was consensual. Factors associated with an adolescent sexual debut ( Results Overall, 2031 eligible men completed the survey. The mean age of sexual debut was 20.7 (SD = 4.3) years old. 17.6% (358/2031) of men reported adolescent sexual debut, and 5.0% (101/2031) reported a non-consensual sexual debut. The adolescent sexual debut was associated with having more male sexual partners (adjusted OR 1.10, 95% CI 1.06–1.15) and condomless anal sex in the last three months (AOR = 1.71, 95% CI 1.34–2.18). MSM whose sexual debut was non-consensual were more likely to have condomless anal sex (AOR = 1.76, 95% CI 1.17–2.66), and to have reported an adolescent sexual debut (AOR = 2.72, 95% CI 1.75–4.21). Conclusions Many Chinese MSM reported adolescent sexual debut and non-consensual sex, both of which are associated with sexual risk behaviors and drive STI transmission. These findings highlight the need for designing tailored interventions for MSM who experienced adolescent sexual debut and non-consensual sex at debut.

BACKGROUND Social network–based strategies can expand HIV/syphilis self-tests among men who have sex with men (MSM). Sexual health influencers are individuals who are particularly capable of spreading information about HIV and other sexually transmitted infections (STIs) within their social networks. However, it remains unknown whether a sexual health influencer can encourage their peers to self-test for HIV/syphilis. OBJECTIVE The aims of this study were to examine the impact of MSM sexual health influencers on improving HIV/syphilis self-test uptake within their social networks compared to that of nonsexual health influencers. METHODS In Zhuhai, China, men 16 years or older, born biologically male, who reported ever having had sex with a man, and applying for HIV/syphilis self-tests were enrolled online as indexes and encouraged to distribute self-tests to individuals (alters) in their social network. Indexes scoring >3 on a sexual health influencer scale were considered to be sexual health influencers (Cronbach α=.87). The primary outcome was the mean number of alters encouraged to test per index for sexual health influencers compared with the number encouraged by noninfluencers. RESULTS Participants included 371 indexes and 278 alters. Among indexes, 77 (20.8%) were sexual health influencers and 294 (79.2%) were noninfluencers. On average, each sexual health influencer successfully encouraged 1.66 alters to self-test compared to 0.51 alters encouraged by each noninfluencer (adjusted rate ratio 2.07, 95% CI 1.59-2.69). More sexual health influencers disclosed their sexual orientation (80.5% vs 67.3%, P=.02) and were community-based organization volunteers (18.2% vs 2.7%, PPPP CONCLUSIONS Being a sexual health influencer was associated with encouraging more alters with less testing access to self-test for HIV/syphilis. Sexual health influencers can be engaged as seeds to expand HIV/syphilis testing coverage.

BACKGROUND: WHO recommends that men who have sex with men (MSM) receive gonorrhoea and chlamydia testing, but many evidence-based preventive services are unaffordable. The pay-it-forward strategy offers an individual a gift (eg, a test for sexually transmitted diseases) and then asks whether they would like to give a gift (eg, a future test) to another person. This study examined the effectiveness of a pay-it-forward programme to increase gonorrhoea and chlamydia testing among MSM in China.METHODS: We did a randomised controlled superiority trial at three HIV testing sites run by MSM community-based organisations in Guangzhou and Beijing, China. We included MSM aged 16 years or older who were seeking HIV testing and met indications for gonorrhoea and chlamydia testing. Restricted randomisation was done using computer-generated permuted blocks. 30 groups were randomised into three arms (1:1:1): a pay-it-forward arm in which men were offered free gonorrhoea and chlamydia testing and then asked whether they would like to donate for testing of prospective participants, a pay-what-you-want arm in which men were offered free testing and given the option to pay any desired amount for the test, and a standard-of-care arm in which testing was offered at ¥150 (US$22). There was no masking to arm assignment. The primary outcome was gonorrhoea and chlamydia test uptake ascertained by administrative records. We used generalised estimating equations to estimate intervention effects with one-sided 95% CIs and a prespecified superiority margin of 20%. The trial is registered with ClinicalTrials.gov, NCT03741725.FINDINGS: Between Dec 8, 2018, and Jan 19, 2019, 301 men were recruited and included in the analysis. 101 were randomly assigned to the pay-it-forward group, 100 to the pay-what-you-want group, and 100 to the standard-of-care group. Test uptake for gonorrhoea and chlamydia was 56% (57 of 101 participants) in the pay-it-forward arm, 46% (46 of 100 participants) in the pay-what-you-want arm, and 18% (18 of 100 participants) in the standard-of-care arm. The estimated difference in test uptake between the pay-it-forward and standard-of-care group was 38·4% (95% CI lower bound 28·4%). Among men in the pay-it-forward arm, 54 of 57 (95%) chose to donate to support testing for others.INTERPRETATION: The pay-it-forward strategy can increase gonorrhoea and chlamydia testing uptake among Chinese MSM and could be a useful tool for scaling up preventive services that carry a mandatory fee.FUNDING: US National Institute of Health; Special Programme for Research and Training in Tropical Diseases, sponsored by UNICEF, UNDP, World Bank, and WHO; the National Key Research and Development Program of China; Doris Duke Charitable Foundation; and Social Entrepreneurship to Spur Health.

Background Social media and secondary distribution (distributing self-testing kits by indexes through their networks) both show strong promise to improve human immunodeficiency virus (HIV) self-testing uptake. We assessed an implementation program in Zhuhai, China, which focused on the secondary distribution of HIV/syphilis self-test kits among men who have sex with men (MSM) via social media. Methods Men aged ≥16 years, born biologically male, and ever had sex with another man were recruited as indexes. Banner ads on a social media platform invited the participants to apply for up to 5 self-test kits every 3 months. Index men paid a deposit of US$15/kit refundable upon submitting a photograph of a completed test result via an online submission system. They were informed that they could distribute the kits to others (referred to as “alters”). Results A total of 371 unique index men applied for 1150 kits (mean age, 28.7 [standard deviation, 6.9] years), of which 1141 test results were returned (99%). Among them, 1099 were valid test results; 810 (74%) were from 331 unique index men, and 289 tests (26%) were from 281 unique alters. Compared to index men, a higher proportion of alters were naive HIV testers (40% vs 21%; P < .001). The total HIV self-test reactivity rate was 3%, with alters having a significantly higher rate than indexes (5% vs 2%; P = .008). A total of 21 people (3%) had a reactive syphilis test result. Conclusions Integrating social media with the secondary distribution of self-test kits may hold promise to increase HIV/syphilis testing coverage and case identification among MSM.

Background: Early sexual debut and non-consensual sex have been linked to higher sexual risk and STI infection in adulthood among men who have sex with men (MSM) in high-income countries. This study aimed to examine early and non-consensual sexual debut among Chinese MSM and to evaluate factors associated with early sexual debut and non-consensual sex. Methods: A cross-sectional study was conducted in 2016 among Chinese men assigned male sex at birth, ≥18 years old, and who had ever engaged in anal sex with a man. Participants answered questions regarding socio-demographics, condomless sex, age at anal sexual debut with a man, and whether the first anal sex was consensual. Factors associated with an early sexual debut (Results: Overall, 2031 eligible men completed the survey. The mean age of sexual debut was 20.7 (SD=4.3) years old. 17.6% (358/2031) of men reported early sexual debut, and 5.0% (101/2031) reported a non-consensual sexual debut. The early sexual debut was associated with having more male sexual partners (adjusted OR 1.10, 95% CI 1.06–1.15) and condomless anal sex in the last three months (AOR=1.71, 95% CI 1.34-2.18). MSM whose sexual debut was non-consensual were more likely to have condomless anal sex (AOR=1.76, 95% CI 1.17-2.66), and to have reported an early sexual debut (AOR=2.72, 95% CI 1.75-4.21). Conclusions: Many Chinese MSM reported early sexual debut and non-consensual sex, both of which are associated with sexual risk behaviors and drive STI transmission. These findings highlight the need for designing tailored interventions for MSM who experienced early sexual debut and non-consensual sex at debut.

Background In China, while the overall HIV prevalence has been decreasing within key populations, the epidemic among men who have sex with men (MSM) is still on the rise. This study aims to assess the HIV incidence rate and identify driving forces of HIV seroconversion among MSM in a closed cohort. Methods This study is a secondary analysis of a large trial of HIV testing promotion among Chinese MSM in 2016–2017. Sexual behaviors, HIV testing activities, and HIV serostatus were measured at baseline and follow-up every 3 months. HIV seroconversion in this study was defined as a self-reported HIV-positive test result. Participants who reported testing for HIV at least twice during different follow-up periods were included. Subgroup analysis and Cox regression were used to examine the correlates with HIV seroconversion. Results Overall, 347 participants were included in this study, with a mean age of 25.3 ± 6.1, and 71.2% were migrants. The sociodemographic characteristics of the included participants were similar to the rest of the participants in the trial (n = 1034); 7.2% (25/347) of participants seroconverted during the study period, resulting in an incidence rate of 15.56/100 person-years. In subgroup analysis, the HIV incidence rate was higher among migrants than nonmigrants (incidence rate ratio, 1.26; 95% confidence interval [CI], 0.47–3.87). In the time-dependent Cox regression model, bisexual MSM had a higher risk of contracting HIV than gay men (adjusted hazard ratio, 2.19; 95% CI, 1.02–4.72). Conclusions Our findings suggest a high HIV incidence rate among Chinese MSM. Further expansion of pre-exposure prophylaxis and other effective HIV prevention interventions are urgently needed.

This cohort study evaluates the existence of language and indexing biases among Chinese-sponsored randomized clinical trials on drug interventions., Key Points Question Do language and indexing biases exist among Chinese-sponsored randomized clinical trials on drug interventions? Findings This cohort study included 891 eligible Chinese-sponsored randomized clinical trials identified from English- and Chinese-language clinical trial registries. Among 470 published trials as of August 2019, positive trial findings were more commonly published in English-language journals and indexed in English-language bibliographic databases than negative trial findings. Meaning These findings suggest that language and indexing biases may lead to distorted, more positive results of drug interventions when synthesizing evidence., Importance Language and indexing biases may exist among Chinese-sponsored randomized clinical trials (CS-RCTs). Such biases may threaten the validity of systematic reviews. Objective To evaluate the existence of language and indexing biases among CS-RCTs on drug interventions. Design, Setting, and Participants In this retrospective cohort study, eligible CS-RCTs were retrieved from trial registries, and bibliographic databases were searched to determine their publication status. Eligible CS-RCTs were for drug interventions conducted from January 1, 2008, to December 31, 2014. The search and analysis were conducted from March 1 to August 31, 2019. Primary trial registries were recognized by the World Health Organization and the Drug Clinical Trial Registry Platform sponsored by the China Food and Drug Administration. Exposures Individual CS-RCTs with positive vs negative results (positive vs negative CS-RCTs). Main Outcomes and Measures For assessing language bias, the main outcome was the language of the journal in which CS-RCTs were published (English vs Chinese). For indexing bias, the main outcome was the language of the bibliographic database where the CS-RCTs were indexed (English vs Chinese). Results The search identified 891 eligible CS-RCTs. Four hundred seventy CS-RCTs were published by August 31, 2019, of which 368 (78.3%) were published in English. Among CS-RCTs registered in the Chinese Clinical Trial Registry (ChiCTR), positive CS-RCTs were 3.92 (95% CI, 2.20-7.00) times more likely to be published in English than negative CS-RCTs; among CS-RCTs in English-language registries, positive CS-RCTs were 3.22 (95% CI, 1.34-7.78) times more likely to be published in English than negative CS-RCTs. These findings suggest the existence of language bias. Among CS-RCTs registered in ChiCTR, positive CS-RCTs were 2.89 (95% CI, 1.55-5.40) times more likely to be indexed in English bibliographic databases than negative CS-RCTs; among CS-RCTs in English-language registries, positive CS-RCTs were 2.19 (95% CI, 0.82-5.82) times more likely to be indexed in English bibliographic databases than negative CS-RCTs. These findings support the existence of indexing bias. Conclusions and Relevance This study suggests the existence of language and indexing biases among registered CS-RCTs on drug interventions. These biases may distort evidence synthesis toward more positive results of drug interventions.

It is highly important to clarify the high-temperature mechanical properties in the design of cold-formed steel (CFS) structures under fire conditions due to the unique deterioration feature in material properties under fire environment and associated reduction to the mechanical performance of members. This paper presents the mechanical properties of widely used steels for cold-formed steel structures at elevated temperatures. The coupons were extracted from original coils of proposed full annealed steels (S350 and S420, with nominal yielding strengths 280 MPa and 350 MPa) and proposed stress relieving annealed steels (G500, with nominal yielding strength 500 MPa) for CFS structures with thickness of 1.0 mm and 1.2 mm, and a total of nearly 50 tensile tests were carried out by steady-state test method for temperatures ranging from 20 to 700°C. Based on the tests, material properties including the yield strengths, ultimate strengths, the elasticity modulus, and the stress-strain curve were obtained. Meanwhile, the ductility of steels for CFS structures was discussed. Then, the temperature-dependent retention factors of yield strengths and elasticity modulus were compared to those provided by design codes and former researchers. Finally, a set of prediction equations of the mechanical properties for steels for CFS structures at elevated temperatures was proposed depending on existing tests data.

Background Social network–based strategies can expand HIV/syphilis self-tests among men who have sex with men (MSM). Sexual health influencers are individuals who are particularly capable of spreading information about HIV and other sexually transmitted infections (STIs) within their social networks. However, it remains unknown whether a sexual health influencer can encourage their peers to self-test for HIV/syphilis. Objective The aims of this study were to examine the impact of MSM sexual health influencers on improving HIV/syphilis self-test uptake within their social networks compared to that of nonsexual health influencers. Methods In Zhuhai, China, men 16 years or older, born biologically male, who reported ever having had sex with a man, and applying for HIV/syphilis self-tests were enrolled online as indexes and encouraged to distribute self-tests to individuals (alters) in their social network. Indexes scoring >3 on a sexual health influencer scale were considered to be sexual health influencers (Cronbach α=.87). The primary outcome was the mean number of alters encouraged to test per index for sexual health influencers compared with the number encouraged by noninfluencers. Results Participants included 371 indexes and 278 alters. Among indexes, 77 (20.8%) were sexual health influencers and 294 (79.2%) were noninfluencers. On average, each sexual health influencer successfully encouraged 1.66 alters to self-test compared to 0.51 alters encouraged by each noninfluencer (adjusted rate ratio 2.07, 95% CI 1.59-2.69). More sexual health influencers disclosed their sexual orientation (80.5% vs 67.3%, P=.02) and were community-based organization volunteers (18.2% vs 2.7%, P Conclusions Being a sexual health influencer was associated with encouraging more alters with less testing access to self-test for HIV/syphilis. Sexual health influencers can be engaged as seeds to expand HIV/syphilis testing coverage.

Stigma against people with hepatitis B virus (HBV) is a barrier to prevention, diagnosis, and treatment of HBV in China. Our study examined an innovative intervention to reduce HBV stigma among men who have sex with men (MSM) in China. We extracted data from a randomized controlled trial conducted in May 2018, where the intervention consisted of crowdsourced images and videos to promote viral hepatitis testing and reduce HBV stigma. HBV stigma was assessed using a 20-item scale at baseline and four weeks post-enrollment. Participants were divided into three groups based on their exposure to intervention: full exposure, partial exposure, and no exposure. Linear regression was used to determine associations between baseline stigma and participant characteristics. Data from 470 MSM were analyzed. Mean participant age was 25 years old and 56% had less education than a college bachelor’s degree. Full exposure to intervention was associated with significant stigma reduction (adjusted beta = −3.49; 95% CI = −6.11 to −0.87; p = 0.01), while partial exposure led to stigma reduction that was not statistically significant. The mean stigma score was 50.6 (SD ± 14.7) at baseline, and stigma was most prominent regarding physical contact with HBV carriers. Greater HBV stigma was associated with not having a recent doctor’s visit (adjusted beta = 4.35, 95% CI = 0.19 to 8.52; p = 0.04). In conclusion, crowdsourcing can decrease HBV stigma among MSM in China, and may be useful in anti-stigma campaigns for vulnerable populations in low- and middle-income countries.

Background Early sexual debut and non-consensual sex among men who have sex with men (MSM) may contribute to adult high-risk behaviors and STI transmission. Most knowledge about early MSM sex comes from high-income countries. This study examined the prevalence and factors associated with the early sexual debut and non-consensual sex at sexual debut among Chinese MSM. Methods An online cross-sectional study was conducted among MSM who were born as a male, ≥16 years-old, and ever engaged in anal sex with a man in China in 2016. Participants answered questions regarding sociodemographics, condomless sex, and HIV testing history. Early sexual debut was defined as having anal sex before 18. Non-consensual sex was defined as “where a person do sexual things to you that you did not want them to do.” Multivariable logistic regression was used to identify factors associated with the early sexual debut and non-consensual sex. Results Overall, 2105 men completed the survey. Among them, 85.9% were never married, and 35.4% had high school or less education. The mean age of sexual debut was 20.82 (SD=5.30) years. About one-fifth (20.1%, 424/2105) of men experienced early sexual debut, and 4.9% (104/2105) experience non-consensual sex at sexual debut. Results from multivariable logistic regression models showed that early sexual debut was associated with having more male partners in the last three months (adjusted OR 1.08 [95% CI 1.04–1.13]) and condomless sex in the last three months (1.49 [1.18–1.89]). MSM whose sexual debut was non-consensual were more likely to have tested for HIV (1.56 [1.01–2.42]), have had recent condomless sex (1.70 [1.13–2.56]), and to experience early sexual debut (2.54 [1.65–3.89]). Conclusion Many Chinese MSM experience early sexual debut and non-consensual sex at sexual debut. Given the limited coverage of sexual health education in China, this has implications for expanding education and research about sexuality among youth. Disclosure No significant relationships.

Background Knowing the HIV incidence is essential for providing timely intervention among key populations. However, HIV incidence data from men who have sex with men (MSM) in China are limited. In this study, we aim to measure HIV incidence among MSM in eight cities and investigate correlates with incidence. Methods This study is a secondary analysis of a stepped-wedged randomized control trial focusing on promoting HIV testing among Chinese MSM. MSM from eight cities in Guangdong and Shandong Province were recruited and followed from July 2016 to August 2017. Sexual behaviors and HIV testing activity were measured at baseline and during follow-up survey every three months. Participants who reported to have tested HIV at least twice during different follow-up periods were included in this analysis. We defined the seroconversion as a negative HIV testing result followed by a positive result during any of the follow up. We used Cox regression to examine correlates with HIV seroconversion. Results Of the 1381 participants recruited at baseline, 360 MSM had HIV tests at least twice. At baseline, 87.5% (315/360) were never married and 32.8% (118/360) never disclosed their sexual orientation to anyone other than their sexual partners. During the 12-month follow-up period, 56.67% (204/360) had multiple male partners, 15.3% (55/360) had female partners and 14.7% (53/360) had bisexual behaviors. Overall, 25 men had seroconversion, and the HIV incidence rate was 15.0/100 person-year. The Cox regression model showed higher seroconversion risk was associated with a higher number of female sexual partners (HR=3.59, 95%CI: 1.32–9.80). The association between seroconversion and bisexual behavior was marginally significant (HR=2.05, 95%CI: 0.98–4.29). Conclusion HIV incidence is very high among MSM in our study based in China. It was associated with multiple sexual partners, as well as bisexual behaviors. Interventions to prevent HIV transmission, targeting on sexual behavior change are needed. Disclosure No significant relationships.

Background Gonorrhea and chlamydia testing is poor among Chinese MSM with HIV risk. Furthermore, gonorrhea and chlamydia testing programs are poorly funded and unlinked to HIV testing services. Pay-it-forward offers an individual a gift (e.g. an STD test) and then asks whether they would like to give a gift to another person. This study assesses the effectiveness of a pay-it-forward program in increasing gonorrhea/chlamydia testing among MSM compared to standard of care. Methods We conducted a cluster randomized controlled trial at three HIV testing sites run by MSM community-based organizations in Beijing and Guangzhou (NCT03741725). We included MSM aged 16 or older who had met indications for testing based on US CDC guidelines. Twenty clusters of 10 men each were randomized into pay-it-forward and standard of care arms. In pay-it-forward, men were offered free testing and then given the option to donate money toward future participants’ tests; in standard of care, testing was offered at the standard price of 150RMB (US$22). The primary outcome was dual gonorrhea/chlamydia test uptake ascertained by administrative record. Generalized estimating equations were used to assess the population-averaged effect of the pay-it-forward intervention. This analysis focuses on the primary comparison between pay-it-forward and standard of care. Results Overall, 201 participants were recruited. Most participants were younger than 30 years old (67.5%, 127/188) and had college or above education (85.1%, 165/194). 43.1% (69/160) reported condomless anal sex in the last three months. Gonorrhea/chlamydia testing rates were 56.4% (57/101) in pay-it-forward and 18.0% (18/100) in standard of care. Gonorrhea/chlamydia testing rates were three times higher in pay-it-forward compared to standard of care (RR:3.14, p Conclusion Findings suggest that pay-it-forward increases gonorrhea/chlamydia testing and may inform the integration of STD and HIV testing services among MSM. Disclosure No significant relationships.

Ewing's sarcoma (ES) is a highly aggressive malignant bone and soft tissue neoplasm. The purpose of our study was to identify candidate biomarkers of ES and uncover their potential molecular mechanisms.The gene expression profiles of GSE45544 and GSE73166 were downloaded from Gene Expression Omnibus (GEO) database. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes pathway (KEGG) enrichment analyses were performed based on the Database for Annotation, Visualization and Integrated Discovery (DAVID) database, protein-protein interaction (PPI) network was constructed, and hub genes of the differentially expressed genes (DEGs) were identified by Cytoscape software.586 DEGs in total were identified in ES, and the top up-regulated genes were extremely potent as ES biomarkers. GO function analysis data showed that these DEGs were significantly enriched in DNA translation, nucleus, and protein binding. KEGG pathway analysis revealed that DEGs were enriched in the pathways involved in cancer, HTLV-I infection, viral carcinogenesis, ribosome, and cell cycle. PPI network showed that most of the hub genes were for ribosomal proteins, associated in some way with the biological process of ES.In conclusion, we identified the DEGs and hub genes which could promote our comprehension of detailed mechanisms involved in the development of ES.

The tranexamic acid (TXA) can reduce surgical perioperative blood loss. However, the optimal regimen of tranexamic acid remains controversial. The purpose of this meta-analysis was to compare the efficacy and safety of combined intravenous and topical tranexamic acid versus intravenous use alone in primary total knee and hip arthroplasty.PubMed, EMbase, Cochrane library and OVID were searched. Eligible randomized controlled trials (RCTs) evaluating combined intravenous and topical TXA versus intravenous alone in primary total knee and hip arthroplasty were included. The relative risk (RR) or the mean difference (MD) for dichotomous or continuous data was calculated respectively, and heterogeneity was analyzed by chi-square and IA total of five RCTs met the inclusion criteria were included. The meta-analysis indicated that there was statistically significant difference favoring the combined group in total blood loss(MD = -160.90, 95% CI[-201.26, -120.54]), P 0.00001), hemoglobin drop (MD = -0.41, 95% CI[-0.73,0.08], P = 0.01), transfusion requirements(RR = 0.29, 95% CI[0.12,0.70], P = 0.006) and length of hospital stays (MD = -0.21, 95%CI[-0.40, -0.02], P = 0.03). Both groups showed similar outcomes regarding thromboembolic complications(RR = 0.84, 95% CI[0.26,2.70], P = 0.76).Based on our study, Combined use of intravenous and topical TXA is more effective than intravenous TXA alone in primary total knee or hip arthroplasty without increasing the risk of thromboembolic complications. Further high quality studies with more patients are needed in future studies.

Osteoarthritis (OA) affects over 100 million individuals around the world. In this study, we mainly explore the functional role of miR-381a-3p in the regulation of OA. The expression of miR-381a-3p was studied in human articular cartilage and synovium of OA. Furthermore, the level of miR-381a-3p was analyzed in the OA rat model. MiR-381a-3p was overexpressed or inhibited with specific miR mimics or inhibitors. RT-PCR was applied to determine the levels of inflammatory factors such as TNFα, COX-2, iNOS, IL-6, and IL8. Bioinformatic predictions were applied to determine the possible target genes. Dual luciferase reporter assay was used to explore whether IκBα was the target gene of miR-381a-3p. The level of miR-381a-3p was significantly increased in the human articular cartilage and synovium of OA compared with normal control. Meanwhile, miR-381a-3p was enhanced in the OA rat model. Overexpression of miR-381a-3p significantly enhanced the levels of TNFα, COX-2, iNOS, IL-6 and IL8. IκBα was predicted as the target gene of miR-381a-3p. Dual luciferase reporter assay showed that miR-381a-3p could significantly decrease the luciferase activity of pmirGL-IκBα-3'UTR. In summary, enhanced miR-381a-3p expression contributed to the injury of OA mainly by inhibiting the expression of IκBα.

Introduction to Pay-It-Forward pamphlet (English version). This is the English version of the pamphlet used by study organizers to introduce pay-it-forward to eligible men. (PPTX 311 kb)

Introduction to Pay-It-Forward pamphlet (English version). This is the English version of the pamphlet used by study organizers to introduce pay-it-forward to eligible men. (PPTX 311 kb)

Survey instrument (English version). This is the English version of the survey for our study. (DOCX 74 kb)

Introduction to Gonorrhea and Chlamydia pamphlet (English version). This is the English version of the pamphlet used by study organizers to introduce Gonorrhea and Chlamydia to eligible men. (PPTX 779 kb)

Survey instrument (English version). This is the English version of the survey for our study. (DOCX 74 kb)

Informed consent form (English version). This is the English version of the informed consent form for our study. (DOCX 47 kb)

Multilingual abstracts in the five official working languages of the United Nations. (PDF 541 kb)

Multilingual abstracts in the five official working languages of the United Nations. (PDF 541 kb)

Informed consent form (English version). This is the English version of the informed consent form for our study. (DOCX 47 kb)