无偿献血中心检测出抗HIV阳性1例

目前,我国已实行了无偿献血制度,关于无偿献血人群是否存在HIV感染,笔者在1999～2001年期间检出HIV抗体阳性者5人其中已被确诊1人,现报告如下:     

Antisocial personality disorder, HIV risk behavior and retention in methadone maintenance therapy

In a sample of 55 consecutive methadone maintenance admissions to our clinic, 42% were diagnosed with antisocial personality disorder (ASPD) using the National Institute of Mental Health Diagnostic Interview Schedule NIMH DIS. Individuals with ASPD exhibited greater risk for HIV infection as defined by more sexual contacts, needle use and equipment sharing. Data at 1 year follow-up were obtained on this group of patients. The objective was to compare the ASPD and non-ASPD groups with regards to demographics, drug abuse history, outcome and retention in treatment. There were no significant differences between the groups on any demographic or treatment outcome variables. Survival analysis indicated that there were no group differences in treatment retention. In conclusion, although there were no differences in treatment outcome between ASPD and non-ASPD groups it is possible that ASPD patients who drop out of treatment will be at higher risk for contracting and spreading HIV within the IV drug using population. These data also suggest that in this population the diagnosis of ASPD using primarily behavioral traits as measured in the NIMH-DIS-III, has little utility in predicting treatment outcome.     

Assessing the needs and quality of life of patients with HIV infection: development of theHIVOverview ofProblems-EvaluationSystem (HOPES)

Objective: To develop and evaluate the psychometric properties (reliability, validity etc.) of a comprehensive Quality of Life (QOL) tool, for patients infected with the human immunodeficiency virus (HIV), that was adapted from a previously validated cancer tool. Design: Cross-sectional, patient completed written surveys and interviews. Setting: The Medical Centers serving HIV infected patients in the Los Angeles community including UCLA, community physicians, Veterans Affairs Medical Centers, and a County hospital: and additional data contributed from Johns Hopkins University Medical Center CMV Retinitis Clinic. Patients: Patients (n=318) with HIV infection including asymptomatic (37%), ARC (20%), AIDS (25%) and AIDS with Cancer (18%) receiving health services at one of the above sites. Measurements: The patients self-administered the newly developed instrument, the HOPES (HIVOverview ofProblems-EvaluationSystem), other QOL related tools including the Medical Outcomes Study instrument adapted for HIV (MOS-HIV) the Profile of Mood States (POMS), the Perceived Adjustment to Chronic Illness Scale (PACIS), and the Physical Activity Scale (PAS). Brief interview to assess the Karnofsky Performance Status Score (KPS). Measured sociodemographic characteristics included age, sex, race, HIV risk factor, education etc. Assessed medical history, current medications, HIV clinical classification. Main results: The sociodemographic and medical characteristics of the sample resemble those of the general population with HIV infection in this geographic area: 96% male, 28% nonwhite, 84% homosexual contact as risk factor, 75% receiving antiretroviral therapy. The adaptation of the cancer QOL instrument to HIV appears to have face and content validity according to patients and health professionals who care for HIV infected patients. Analyses of the psychometric properties found that the HOPES has a similar structure to its parent instrument following factor analyses which results in five summary scales representing the Physical, Psychosocial, Medical Interaction, Sexual and Significant Other/Partners domains in addition to a Global Score. Internal consistency of 35 subscales is high with a mean alpha coefficient of 0.82. Correlations of the HOPES summary scales with other QOL instruments are in the predicted directions. Comparing patients within the HIV clinical diagnostic categories on the HOPES Global, Physical, and Psychosocial Summary Scales indicates that Asymptomatic Patients have better QOL than symptomatic patients. This finding is also found in the other QOL instruments which provides evidence of construct validity. Conclusions: The HOPES is an excellent tool for identifying the problems and needs of patients with HIV infection and for assessing their quality of life. It is reliable, valid and acceptable to patients. The tool may be especially useful in developing a normative data base.This paper is dedicated to the memory of Jimmy Stophel who died of AIDS and whose sense of humour improved the quality of many people's lives.This research was supported in part by the UCLA AIDS Clinical Research Center and CARES Consultants. To obtain information about the HOPES, please contact C. A. Coscarelli Schag, CARES Consultants, 2210 Wilshire Blvd., Suite 359, Santa Monica, CA 90403, USA.     

N-乙酰半胱氨酸的抗菌活性及对细菌生物被膜的抑制作用

N-乙酰半胱氨酸(N-acetylcysteine,NAC)是临床常用化痰药.除此之外,NAC还有一定的抗菌活性,可以抑制细菌的黏附,减少细胞外多糖蛋白复合物的产生,破坏已生成的生物被膜,对被膜下细菌也有一定的杀菌作用,并与某些抗菌药物存在协同作用,引起国内外学者越来越多的关注.研究结果提示临床上可以将NAC与抗生素联合应用治疗某些感染性疾病尤其是慢性呼吸道感染,不过尚需进一步大样本临床研究来证明.     

阿奇霉素和鱼腥草治疗小儿下呼吸道感染

目的　探讨静脉点滴阿奇霉素和鱼腥草治疗小儿下呼吸道感染的临床疗效及其安全性。方法　采用随机对照分组研究 ,观察组使用阿奇霉素 5～ 10mg/kg ,每日 1次 ,加鱼腥草 1～ 3ml/ (kg·d) ,每日 1次静脉滴注 ,疗程 5～ 7d。对照组选用头孢拉定 5 0～ 10 0mg/ (kg·d)加利巴韦林 10mg/ (kg·d)静脉滴注 ,每日 2次 ,疗程 5～ 7d。结果　观察组痊愈率和有效率分别为 72 .5 %和 89.8% ,而对照组的痊愈率和有效率分别为 4 5 .3%和 73.6 % (P <0 .0 1) ,观察组和对照组的不良反应发生率分别为 13.5 %和 10 .8% (P >0 .0 5 )。结论　阿奇霉素加鱼腥草静脉滴注治疗小儿下呼吸道感染临床疗效确切 ,不良反应较少     

Synthesis of 14C‐labeled piperidines and application to synthesis of [14C]SCH 351125, a CCR5 receptor antagonist

1‐Benzyl‐4‐hydroxy[2‐¹⁴C]piperidine, a useful intermediate in labeled compound synthesis, was prepared from [¹⁴C]formaldehyde in high yield. The distribution pattern of ¹⁴C in the product is consistent with a mechanism involving reversible iminium ion formation and rapid equilibration of the iminium ion through a cationic aza‐Cope rearrangement. These steps precede the rate‐determining intramolecular cyclization step. SCH 351125 is a potent, selective CCR5 receptor antagonist with potential as a treatment for HIV infection. [¹⁴C]SCH 351125, required for metabolism studies, was prepared from 1‐benzyl‐4‐hydroxy[2‐¹⁴C]piperidine in six steps. [¹⁴C]SCH 351125 is a mixture of four atropisomers. Preparation of [¹⁴C]SCH 351125 besylate salt of the desired atropisomer pair is also described. Copyright © 2007 John Wiley & Sons, Ltd.     

头孢替唑钠与头孢哌酮治疗小儿急性细菌性下呼吸道感染的临床疗效比较

目的:评价头孢替唑钠治疗小儿急性细菌性下呼吸道感染的临床有效性、安全性。方法:轻、中度急性细菌性下呼吸道感染患儿115例分成2组,头孢替唑组58例,予头孢替唑钠20～80mg/(kg·d),溶于10%葡萄糖溶液中,分2次静脉滴注。头孢哌酮组57例,予头孢哌酮50～150mg/(kg·d),分二次静脉滴注。两组均以7~10d为一疗程。结果:头孢替唑钠组与头孢哌酮组的临床有效率分别为93%与91%(P>0.05),细菌清除率分别为92%与89%(P>0.05)。两组均无明显的不良反应。结论:头孢替唑可作为治疗小儿轻、中度急性细菌性下呼吸道感染有效和安全的抗生素。     

Prosthetic joint infectionsin the elderly

Total joint arthroplasty is among the most remarkable advances in orthopaedic surgery for the elderly, enabling themto regain physical function and be free of pain. Although uncommon, infection of the prosthetic joint causes serious morbidity leading to poor functional outcome with a mortality approaching 8% in the elderly. Most infections occur through inoculation of the prosthesis at the time of implantation and are due to Gram-positive cocci, although a third of the episodes are due to Gram-negative bacilli from a secondary focus. The management presents a major clinical and therapeutic challenge due to systemic and local comorbid conditions in the elderly. Medical and surgical treatment decisions for infected joint prosthesis are complex and should be individualized in each case. Optimal nutrition is essential for a successful outcome. Adverse reactions to medications are more common in the elderly due to end organ dysfunction and drug-drug interactions.     

1993年云南省瑞丽等地吸毒者艾滋病病毒感染定群研究

１９９３年３月对已建立一年的吸毒者定群研究现场──云南省德宏州瑞丽市、陇川县及潞西县再次进行调查。本次调查７５５例吸毒者及１０２例配偶。从１９９２年进入定群研究ＨＩＶ阴性的８９例静脉吸毒者中，１９９３年又采到血样有５４例，其中９例血清转阳。瑞丽市、陇川县及潞西县１９９２年和１９９３年静注者血清阳转率（／百观察人年）分别为４３．２％及４０．０％，１２．２％及１２．２％，０％及０％。１９９３年新进入定群研究的１１６例静注者中，采集到血样的有１０４例，发现ＨＩＶ阳性３８例。上述三市县１９９２年及１９９３年入定群研究的静注者的ＨＩＶ感染率分别为８１．８％及８５．７％，４４．６％及４０．０％，５．１％及０％。可以看出血清阳转率的高低与ＨＩＶ感染率高低相吻合。ＨＩＶ阳性者的配偶１９９０、１９９２及１９９３年的ＨＩＶ感染率分别为３．１％、９．８％和７．４％，有上升趋势。潞西县ＨＩＶ阳性者少，静脉注射出现时间晚，但近年来静脉吸毒者比例上升快，值得注意。