肉毒毒素注射引起的不良反应

肉毒毒素注射引起的不良反应,是药物本身的组成成分引起的与用药目的无关的有害反应,与医生注射方式和注射技术无关。尽管肉毒毒素生产厂家的药品说明书上也有提示,但其所提供的信息不够全面,也未必能引起医生的足够重视。目前文献上多为散发病例。为此作者对过去20年有关肉毒毒素注射引起的过敏反应、肉瘤样肉芽肿、眼睑水肿、流感样症状等相关不良反应的临床表现、发病机制与治疗方法进行综述。     

‘For me… it's a miracle’: Injecting beauty among kathoeis in a provincial Thai city

BackgroundThe Thai term kathoei refers to non-gender-normative females, males and intersexual individuals at different stages of the transitional spectrum with recognized social and cultural roles in society. Nevertheless, kathoeis are only tolerated in Thai society. Many kathoeis seek social acceptance through beauty and turn to the off-label injection of various ‘beauty drugs’.MethodsThe first author conducted an ethnographic study of injection parties at a wedding studio in a Central Thai provincial city between April and September 2011. Data were gathered through participant observation, focus group discussions and narrative interviews with six participants. All data were collected and analyzed in Thai, and later translated.ResultsWhile injection parties provide opportunities for kathoeis to socialize, bond, and share experiential knowledge on chemically assisted transformation, they also reproduce ideologies of gender, beauty and sexuality that reinforce the notion that if a kathoei is to maintain her beauty, she must use medicines more frequently and in higher doses.ConclusionInjection parties among Thai kathoeis feature drug use that is entirely reasonable in terms of their own lay knowledge. Empowering kathoeis, by providing accessible information on chemicals and health in a way that reflects the complexity and diversity of their practices, would be one way to reduce health risks. Society must give more long-term options to kathoeis to build their sense of self, based on things besides being beautiful.     

Spatial accessibility of drug treatment facilities and the effects on locus of control,drug use,and service use among heroin-injecting Mexican American men

BackgroundThis study explores the spatial accessibility of outpatient drug treatment facilities and the potential relationship with drug use-related outcomes among Mexican American heroin users.MethodsSecondary data on 219 current and former heroin-injecting Mexican American men aged 45 and older were drawn from a research study in Houston, Texas. We used geographic information systems (GIS) to derive two spatial accessibility measures: distance from one's place of residence to the closest drug treatment facility (in minutes); and the number of facilities within a 10-minute driving distance from one's place of residence. Exploratory logistic regression analyses examined the association between the spatial accessibility of drug treatment facilities and several drug use-related outcomes: internal locus of control (LOC); perceived chances and worries of injecting in the next six months; treatment utilization; and location of last heroin purchase.ResultsParticipants with greater spatial access to treatment programs were more likely to report a higher chance of injecting in the near future. However, while current heroin users were more worried about injecting in the next six months, greater spatial access to treatment programs seemed to have a buffering effect. Finally, those who lived closer to a treatment programs were more likely to have last purchased heroin inside the neighborhood versus outside the neighborhood. Spatial accessibility was not associated with internal LOC or treatment utilization.ConclusionThe findings showed that the presence of outpatient treatment facilities—particularly services in Spanish—may influence perceived risk of future heroin use and purchasing behaviors among Mexican American men. Implications for future spatially-informed drug use research and the planning of culturally and linguistically responsive drug treatment programs are discussed.     

丹参川芎嗪注射液对老年患者全膝关节置换术后谵妄的影响

目的 观察丹参川芎嗪注射液对老年患者全膝关节置换术后谵妄(POD)的影响。方法 选取2019年2—10月宁波市第一医院接受单侧全膝关节置换术的老年患者68例,所有患者被分为研究组和对照组,每组各34例。研究组患者给予加入了10 mL丹参川芎嗪注射液的5%葡萄糖溶液250 mL;对照组患者给予250 mL 5%葡萄糖溶液。记录所有患者术前合并症、手术时间、总失血量、总输血量。术前第3天(T1)、手术当天(T2)、术后第1天(T3)、术后第2天(T4)、术后第3天(T5)检测患者脑氧饱和度(rSO2)、动脉血氧分压(PaO2)、血红蛋白(Hb)水平。T3、T4、T5时点采用谵妄分级量表(DRS)评估患者POD发生率及DRS严重程度。结果 两组患者中合并术前认知障碍、COPD、脑卒中病史患者例数及手术时间、总失血量、总输血量比较,差异无统计学意义(P0.05)。T1～T5时,两组患者PaO2及Hb水平比较,差异无统计学意义(P0.05),T1、T2时两组患者rSO2水平比较,差异无统计学意义(P0.05)。T3～T5时,研究组患者rSO2水平显著高于对照组,DRS严重程度评分均低于对照组(P0.05)。T3、T4时,研究组POD发生率低于对照组(P0.05)。结论 在全膝关节置换术中,丹参川芎嗪注射液可提高老年患者术后r SO2,降低术后POD发生率,还能减轻其严重程度。     

To Establish A Body of Evidence on Safety for Postmarketing Chinese Medicine: A New Research Paradigm

The issue of safety evaluation on postmarketing Chinese medicines has become a hot topic in mainland China recently. Researchers and decision-makers can obtain a variety of evidence resources about safety in order to evaluate the safety profile for postmarketing Chinese medicines. A registry study on ten Chinese medicine injections for postmarketing surveillance has come to the end. From such a study observing more than 300,000 patients for more than 4 years, a theoretical research question emerges, that is, how to identify and evaluate safety evidence systematically. We put forward a brand new research paradigm on the theory level, which is to establish a body of evidence on safety evaluation for postmarketing Chinese medicine. Therefore, multiple information sources were explored and extracted from preclinical experiments for toxicity, postmarketing clinical trials for effificacy and safety evaluation, registry study for surveillance, retrospective data analysis from hospital information system and spontaneous response system, and case reports and systematic review from literature. Greater efforts for this idea and cooperation with experts in this fifield both in China and abroad are urgently needed.     

Tecatas An Ethnotheoretical Look at Mexican American Female Injecting Drug Users

Ethnotheory is suggested as a way to study the roles Mexican American female injecting drug users play. It is suggested that ethnotheory extends present theoretical models used to explain and modify female IDUs' behavior; provide insights on female IDUs' roles useful for the development of effective intervention strategies; and suggests a type of ethnographic data collection that uncovers the subject's view of reality. Three detailed ethnographic excerpts from Mexican American female IDUs illustrate how female IDUs manage the array of roles they play and how information gained through ethnotheory is useful in the design of culturally relevant interventions.     

注射A型肉毒素治疗慢性每日头痛的观察与护理

目的 观察A型肉毒素治疗慢性每日头痛(CDH)的疗效.方法60 例患者随机分为观察组和对照组.观察组采用A型肉毒素,对照组采用利多卡因加醋酸泼尼松龙注射液,两组同时进行头部固定位点和痛点一次性注射.随后在12周的不同时间段内,通过电话回访或嘱患者就诊了解情况.结果 观察组患者头痛的程度、频率、持续的时间缓解率为96.7％(P＜0.01),明显高于对照组86.6％ (P＞0.05).两组患者中除有1例出现眉毛下垂,无其他不良反应.结论 A型肉毒素注射治疗慢性每日头痛的同时,配合严密的护理观察,能使治疗安全有效进行.取得明显疗效.