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A retrospective study was performed to evaluate the diagnostic yield for lung cancer from histological biopsy specimens and from washings and brushings for cytological examination taken at fibreoptic bronchoscopy. The Any patient with an inadequate follow up (because of lost records, for example) or with insufficient data was excluded from the study.The two most common reasons for bronchoscopy were an abnormal chest radiograph (493 cases) and haemoptysis (104 cases). Other reasons for bronchoscopy included dyspnoea, stridor, chronic cough, and hypercalcaemia of unknown cause.Because this was a restrospective study, all combinations of cytological and histological procedures were found to have been used. In most cases, however, washings, brushings, and biopsy specimens were taken, especially when a tumour was visible. The sequence when all three procedures were performed was always washing, biopsy, and then brushing immediately before extraction of the bronchoscope. Washings were obtained by lavage with 20-40 ml of normal saline and aspiration into a trap. No set number of biopsy specimens was taken.When no lesion was seen endoscopically, "blind" cytology was performed by lavaging as described and brushing the appropriate segment as determined by the posteroanterior and lateral chest radiographs. Occasionally "blind" biopsy was also performed, the biopsy forceps being directed into the appropriate segment.Brushings were smeared on to two to four slides and immediately fixed in 9500 alcohol. Washings were taken to the cytology laboratory and centrifuged at 1500 rev/min for five minutes, the supernatant was poured off, and the sediment of material was pipetted on to several slides and fixed with 95% alcohol.Cytological specimens were stained routinely by the Papanicolaou technique. Specimens were interpreted by the cytopathologist with-

Background: Chinese men who have sex with men (MSM) rarely receive gonorrhea/chlamydia testing. The purpose of this pilot study was to evaluate a pay-it-forward strategy to increase gonorrhea/chlamydia testing among MSM. Pay-it-forward has one person receive a gift, then asks the same person if they would like to give a gift to another person. Methods: We used a quasi-experimental pragmatic study to compare a pay-it-forward model to standard of care at two HIV testing sites for MSM. A pay-it-forward program was implemented for three months, during which men were offered free gonorrhea/chlamydia testing and given the option of donating money toward testing for future participants. Both sites then switched to standard of care for three months, offering dual testing at the standard price. We compared test uptake and financial costs in the two groups. Findings: 408 men were included in this study. 203 men were offered pay-it-forward, and 205 were offered standard of care. Overall, 109 (109/203, 53·7%) men received gonorrhea/chlamydia testing in the pay-it-forward group and 12 (12/205, 5·9%) men received gonorrhea/chlamydia testing in the standard of care group (adjusted odds ratio 19·73, 95%CI 10·02–38·85). This was a first gonorrhea or chlamydia test for 86% (104/121) of men. 89% (97/109) of men in the pay-it-forward group donated some amount. The incremental unit cost per test in the pay-it-forward group was 67 USD, compared to 503 USD in the standard of care group. Interpretation: Pay-it-forward may be a sustainable model for expanding integrated HIV testing services among MSM in China.

Deposition was assessed by a dual headed gamma camera after inhalation of the drug. Results-The total mean (SD) percentage deposition of the drug in the normal subjects was 21-6% (8.9%) with the MDI alone, 20-9% (7-8%) with the AMDI with spacer, and 12-4% (3-5%) with the DPI. For the patients, the mean percentage deposition was 18-2% (7.8%) with the MDI alone, 19-0% (8-9%) with the MADI and spacer, and 11-4% (5-0%) with the DPI. Bronchodilatation achieved by the patients was similar with all three techniques. Mean peripheral lung deposition was significantly greater with a spacer device than when the MDI was used alone in both normal subjects (49.4% (6-1%) v 44-1% (9.9%)) and patients (38-6% (11.1%) v 30-4% (9.4%)).