Role of boyfriends and intimate sexual partners in the initiation and maintenance of injecting drug use among women in coastal Kenya

IntroductionGender dynamics and interpersonal relations within intimate partnerships are known to determine health behaviors, including substance use, within couples. In addition, influence from intimate partners may occur in the context of wider social ecological determinants of health behavior. The aim of this study was to document the role of intimate partners in influencing injecting drug use among women in Kenya, where injecting drug use is on the rise.MethodsWe performed secondary data analysis of an existing dataset from a 2015 qualitative study involving 45 women who inject drugs and 5 key stakeholders in coastal Kenya. Primary data had been collected via a combination of in-depth interviews and focus group discussions exploring sexual, reproductive, drug use, and other social contexts of women who inject drugs. The process by which intimate partners influenced women's initiation of drug use, transition to injecting practices, and maintenance of injecting drug use were identified using thematic analysis.ResultsBoyfriends and intimate either facilitated or restrained women's drug-injecting. On the one hand, young women's entry into drug use was prompted by relationship problems, or a need to acquiesce with their drug-using boyfriends. Once women started injecting, intimate partners facilitated ongoing drug-injecting by financing the acquisition of drugs, peddling drugs to their women, or sharing their drugs with their women. The social capital that peddlers held insulated women from police arrests, and encouraged women to seek and sustain intimate relations with well-connected peddlers. Men's influences over women were driven by an underlying patriarchal drug acquisition and economic power. On the other hand, boyfriends and intimate partners who were non-injectors or non-drug users sought to moderate women's injecting drug use by encouraging them to inject less, to smoke or snort instead of injecting, or to enroll into rehabilitation. These moderating influences were most prominent when couples were pregnant. Despite men being a source of practical and emotional support, women were frequently unable limit or alter their injecting drug use, due to its addictive nature. Men's disagreement with women's ongoing injecting strained relationships, and occasionally led to separation.ConclusionsSome boyfriends facilitated women's injecting drug use, while others moderated it, supporting assertions that intimate relationships can both be a site of injecting risks or protection. At the micro-level, these findings highlight an opportunity for couple-based interventions, leveraging on non-drug injecting males as a resource to support women adopt safer injecting practices. At a macro level, incorporating livelihood interventions into harm reduction programs is required in order to mitigate economic-based influence of male intimate partners on women's injecting drug use. At both levels, gender transformative approaches are essential. To gain a comprehensive understanding of women's injecting drug use, future studies drug use should explore women's contexts beyond micro influences and consider their wider macro-structural determinants.     

颈动脉内膜切除术后脑过度灌注综合征影像学研究进展

脑过度灌注综合征（CHS）是颈动脉内膜切除术（CEA）及支架植入术后少见但严重的并发症。临床主要依靠临床症状及相关影像学检查诊断CHS。快速、准确地诊断CHS并早期及时干预是决定预后的重要因素。本文对CHS影像学研究现状进行综述。     

纤维蛋白原与急性冠脉综合征患者冠状动脉病变严重程度的关系研究

背景急性冠脉综合征(ACS)患者纤维蛋白原升高与患者预后不良有关,但其对ACS患者冠状动脉病变严重程度的影响尚不清楚。目的探讨纤维蛋白原与ACS患者冠状动脉病变严重程度的关系。方法选取2019年1—5月首都医科大学附属北京天坛医院重症监护病房收治的ACS患者108例,根据SYNTAX评分分为轻度病变组(SYNTAX评分<23分,n=74)和中重度病变组(SYNTAX评分≥23分,n=34)。比较两组患者一般资料〔包括性别、年龄、体质指数(BMI)、高血压发生情况、糖尿病发生情况、脑血管疾病发生情况、冠心病病史、吸烟史〕、实验室检查指标〔包括脑钠肽(BNP)、总胆固醇、粒细胞/淋巴细胞比值、平均血小板体积、纤维蛋白原、同型半胱氨酸、估算的肾小球滤过率〕;纤维蛋白原与ACS患者SYNTAX评分的相关性分析采用Pearson相关分析;ACS患者冠状动脉病变严重程度的影响因素采用多因素Logistic回归分析。结果(1)两组患者男性比例、年龄、BNP、纤维蛋白原比较,差异有统计学意义(P<0.05);两组患者BMI、高血压发生率、糖尿病发生率、脑血管疾病发生率、有冠心病病史及吸烟史者所占比例、总胆固醇、粒细胞/淋巴细胞比值、平均血小板体积、同型半胱氨酸、估算的肾小球滤过率比较,差异无统计学意义(P>0.05)。(2)Pearson相关分析结果显示,纤维蛋白原与ACS患者SYNTAX评分与呈正相关(r=0.348,P<0.05)。(3)多因素Logistic回归分析结果显示,年龄〔OR=1.119,95%CI(1.021,1.226)〕、纤维蛋白原〔OR=3.458,95%CI(1.038,11.523)〕是ACS患者冠状动脉病变严重程度的影响因素(P<0.05)。结论纤维蛋白原与ACS患者冠状动脉病变程度呈正相关,是ACS患者冠状动脉病变严重程度的独立影响因素。     

急性冠脉综合征经皮冠状动脉介入治疗患者出院后血脂状况调查

目的 调查急性冠脉综合征经皮冠状动脉介入(PCI)治疗后患者低密度脂蛋白胆固醇(LDL-C)的水平及达标状况。方法 采用回顾性调查方法,纳入121例经PCI治疗的急性冠脉综合征患者,出院后常规服用他汀类药物,2019年7月于天坛医院心内科冠心病介入门诊复诊,记录患者出院后1~3个月、3~6个月、6~12个月及1年以上的肝肾功能、甘油三酯(TG)、总胆固醇(TC)、LDL-C和高密度脂蛋白胆固醇(HDL-C)水平,并计算LDL-C的达标率。结果 患者出院后1~3月、3~6个月、6~12个月及一年以上肝肾功能均无明显变化。出院后1~3个月、3~6个月、6~12个月、1年以上TG、TC水平无显著差异(P>0. 05);HDL-C水平略有差异(P=0. 047),分别为(1. 04±0. 18)mmol/L、(1. 15±0. 25) mmol/L、(1. 11±0. 21) mmol/L、(1. 11±0. 23) mmol/L;LDL-C的水平分别为(1. 97±0. 83)mmol/L、(1. 94±0. 69) mmol/L、(1. 88±0. 76) mmol/L、(2. 05±0. 55) mmol/L,差异具有统计学意义(P=0. 014);LDL-C的达标率分别为46. 3%、47. 8%、57. 2%、37. 6%,达标率在出院后6~12个月最高,1年后的达标率有下降趋势。结论 急性冠脉综合征经PCI治疗后患者的LDL-C的达标率还有待提高,长期的血脂管理需要加强。     

16G穿刺针用于囊腔冲洗及无水乙醇硬化治疗甲状腺胶质潴留囊肿

目的观察16G穿刺针用于超声引导下囊腔冲洗及无水乙醇硬化治疗甲状腺胶质潴留囊肿的价值。方法回顾性分析44例接受超声引导下经皮穿刺冲洗及无水乙醇硬化治疗的甲状腺潴留性胶质囊肿患者,根据穿刺针规格分为16G组(n=20)与18G组(n=24),比较组间患者一般资料及手术时间差异,记录术后当天及1、6个月囊肿缩小率。结果18G组中3例应用18G穿刺针治疗失败,改用16G穿刺针后完成治疗,最终16G组与18G组治疗成功23例及21例;组间患者年龄、性别、术前囊肿最大径和体积(即单次硬化治疗无水乙醇用量)差异均无统计学意义(P均>0.05),而手术时间差异有统计学意义(P<0.05)。术后不同时间点16G组囊肿缩小率均高于18G组(P均<0.01)。16G组术后6个月囊肿体积缩小率较术后当日及1个月明显升高(P均<0.05),术后1个月囊肿体积缩小率与术后当日差异无统计学意义(P>0.05)。18G组不同时间点囊肿体积缩小率差异无统计学意义(P>0.05)。结论采用16G穿刺针行超声引导下囊腔冲洗及无水乙醇硬化治疗甲状腺胶质潴留囊肿可缩短治疗时间,且有利于提高效果。     

Study on Preparation and Interfacial Transition Zone Microstructure of Red Mud-Yellow Phosphorus Slag-Cement Concrete

Open stockpiling and the continual production of industrial solid wastes such as red mud (RM) and yellow phosphorus slag (YPS) have caused serious environmental pollution issues. Additionally, concrete prepared easily and with high strength is a widely applied building material. Therefore, replacing part or all of the cement for preparing concrete with RM and YPS will greatly reduce this kind of solid waste and, thus, decrease environmental pressures. This study investigated the best ratio for the replacement of concrete with RM and YPS, testing the mechanical properties as well as the morphology, material composition, and microporous structure of the interface transition zone (ITZ). The results showed for the concrete prepared with ordinary Portland cement replaced by 10.00 wt.% RM and 18 wt.% YPS, compared to ordinary Portland cement concrete, the compressive strength of concrete with basalt aggregate and dolomite aggregate increased by 25.04% and 27.27%, respectively, when the concrete was cured with steam for 28 days. Furthermore, it had a smaller average pore diameter and crystal size in the ITZ. The aggregate and matrix were more closely intertwined. This was because RM had a low cementitious activity and mainly had a filling effect when added to concrete, while the highly active silica in YPS could react with the Ca(OH)₂ crystal (CH) produced from cement hydration to form calcium silicate hydrate (CSH) gel, improving the mechanical properties and microstructure of the concrete.     

Microstructural evolution and mechanical properties of WC–6CO cemented carbide prepared via SPS: incorporation of YSZ as a reinforcer

WC–Co based alloys are widely applied cemented carbide materials due to unique and outstanding properties. In this study, a series of WC–6Co cemented carbides are quickly prepared via SPS and the effects of Zr₂O₃-7 wt% Y₂O₃(YSZ) on the properties of the as-prepared samples are also investigated. The results show that with the increase of the YSZ amount, the density, flexural strength and fracture toughness of the samples were particularly improved to a certain extent, but the Vickers hardness was slightly reduced. Combined with the evolution of microstructure and analysis of property changes, it can be speculated that the mechanism of YSZ additive promoting sintering can be attributed to the formation of solid solution and subsequent activation sintering process. Consequently, YSZ was preliminarily proved to be a potential enhancer for the WC–Co based cemented carbides.

WC–Co based alloys are widely applied cemented carbide materials due to unique and outstanding properties.     

伽玛刀放射外科治疗神经纤维瘤病Ⅱ型相关听神经瘤的临床疗效

目的探讨伽玛刀放射外科对神经纤维瘤病Ⅱ型（neurofibromatosis Ⅱ,NF 2）相关听神经瘤的长期临床疗效及其在综合治疗中的作用。方法收集1994年12月~2008年12月行伽玛刀治疗并随访1年以上的60例NF 2患者，其中男27例，女33例，年龄12~59岁，中位年龄30岁。60例患者的120个听神经瘤中，14个单纯行开颅手术，13个处于动态观察中，其余93个听神经瘤中74个单纯行咖玛刀治疗，19个开颅术后再行咖玛刀治疗。结果中位随访时间为100个月（12~245个月），NF 2相关听神经瘤的肿瘤控制率为77%，3、5、10及15年累积肿瘤控制率分别为96%、94%、80%及70%。远期听力保留率为25%，3、5、10及15年累积听力保留率分别为89%、81%、47%及19%。结论伽玛刀放射外科治疗能长期控制中小体积NF 2型相关听神经瘤的生长，但肿瘤控制率及听力保留率低于散发的单侧听神经瘤。Wishart型较Gardner型发展快疗效差，基因表型是影响预后的显著因素。