Preferences for professional versus informal care at end of life amongst African-American drug users with HIV/AIDS

With the advent of antiretroviral therapies, persons living with HIV/AIDS (PLHIVs) are living longer but with increased impairment and care needs. The purpose of this study was to assess whether a vulnerable population of PLHIVs preferred informal versus professional care when unable to care for themselves, and individual and support network factors associated with preference for informal care. The findings have potential implications for facilitating the population's informal care at end of life. Data were from the BEACON study, which examined social factors associated with health outcomes among former or current drug-using PLHIVs in Baltimore, MD. Structural equation modeling was used to identify individual and support network characteristics associated with PLHIVs' preference for informal (family or friends) compared to professional care. The structural equation model indicated preference for informal care was associated with female sex, greater informal care receipt, reporting one's main partner (i.e., boy/girlfriend or spouse) as the primary source of informal care, and a support network comprised greater numbers of female kin and persons supportive of the participant's HIV treatment adherence. Not asking for needed help to avoid owing favors was associated with preferring professional care. Findings suggest that interventions to promote informal end of life care should bolster supportive others' resources and skills for care provision and treatment adherence support, and should address perceived norms of reciprocity. Such intervention will help ensure community caregiving in a population with high needs for long-term care.     

A case of coronary microfistula: A newborn microfistula

Coronary artery fistula is an abnormal connection between a coronary artery and a cardiac chamber, a great artery or the vena cava. Although coronary artery fistulas are known to be congenital malformations they might occur due to infection, trauma or may be iatrogenic. We present a case with acquired coronary microfistula, without any history of interventional procedure.     

根管口直径及纤维桩长度对纤维桩振动频率和抗折性的影响

目的 探讨根管口直径及纤维桩长度对纤维桩振动频率和体外抗折性的影响.方法 选择2012年6月～2013年10月我院口腔外科门诊正畸治疗中拔除的78颗单根管前磨牙,随机均分为A、B两组,每组39颗.A组试件的纤维桩长度为8 mm,根管口直径分别为1.0、1.3、1.6 mm,B组试件的根管口直径为1.3 mm,纤维桩长度分别为8、10、12 mm.A组给予外激励作用并采集信号,经傅里叶转换,将加速度信号转变为振动频率;B组以压力测试仪测量样本瞬间折裂时的作用力数值.比较不同根管口直径对纤维桩振动频率和纤维桩长度对牙齿抗折性的影响.结果 A组纤维桩振动频率分别为(514.63±3.94)Hz、(469.88±4.39)Hz、(203.86±5.13)Hz,组间具有显著性差异(P＜0.01);B组抗折性的平均作用力分别为(892.63±42.81)N、(1197.63±54.62)N、(1282.33±52.82)N,组间抗折性具有显著性差异(P＜0.01).结论 根管口直径与纤维桩振动频率具有相关性,可反映纤维桩的粘结状态;在进行牙根管治疗时,预备纤维桩的长度以近似等于或略高于牙冠的长度为宜.     

Effects of High-Voltage Pulsed Radiofrequency on the Ultrastructure and Nav1.7 Level of the Dorsal Root Ganglion in Rats With Spared Nerve Injury

ObjectivesTo investigate the analgesic effect of high-voltage pulsed radiofrequency (HV-PRF) on the dorsal root ganglion (DRG) for neuropathic pain induced by spared nerve injury (SNI) in rats, especially the influence of this treatment on the DRG ultrastructure and voltage-gated sodium channel 1.7 (Nav1.7) level in the DRG.Materials and MethodsOne hundred fifty adult male Sprague-Dawley rats were randomly divided into five groups: Sham, SNI, Free-PRF, standard-voltage PRF (SV-PRF), and HV-PRF. The 45V-PRF and 85V-PRF procedures applied to the left L5 DRG were performed in SV-PRF group and the HV-PRF group, respectively, on day 7 after SNI, whereas no PRF was concurrently delivered in Free-PRF group. The paw mechanical withdrawal threshold (PMWT) was detected before SNI (baseline) and on days 1, 3, 7, 8, 10, 14, and 21. The changes of left L5 DRG ultrastructure were analyzed with transmission electron microscopy on days 14 and 21. The expression levels of Nav1.7 in left L5 DRG were detected by immunofluorescence and Western blot.ResultsCompared with the Free-PRF group, PMWT in the SV-PRF group and HV-PRF group were both significantly increased after PRF (all p < 0.05). Meanwhile, the PMWT was significantly higher in the HV-PRF group than that in the SV-PRF group on days 14 and 21 (all p < 0.05). There were statistically significant differences between the SV-PRF and Free-PRF groups (p < 0.05). Similarly, statistically significant difference was found between the HV-PRF and Free-PRF groups (p < 0.05). Especially, comparison of the SV-PRF group and the HV-PRF group revealed statistically significant difference (p < 0.05). The Nav1.7 levels were significantly downregulated in the SV-PRF group and HV-PRF groups compared to that in the Free-PRF group (all p < 0.01). A significantly lower Nav1.7 level was also found in the HV-PRF group compared to that in the SV-PRF group (p < 0.05).ConclusionsThe HV-PRF produces a better analgesic effect than SV-PRF applied to the DRG in SNI rats. The underlying mechanisms may be associated with improving the histopathological prognosis and the downregulation of Nav1.7 levels in the DRG.     

皮肤晚期糖基化终产物无创检测技术在社区糖尿病早期筛查中的应用价值

目的评估皮肤晚期糖基化终产物(AGEs)无创检测技术在社区糖尿病早期筛查中的应用价值。方法于2018年1月至2019年1月选取社区健康体检、既往无糖尿病病史者701例,根据口服葡萄糖耐量试验(OGTT)结果分为正常糖耐量组443例、糖调节受损组198例和初诊糖尿病组60例。采用糖尿病无创检测技术对各组患者上臂皮肤AGEs进行检测,同时测定空腹血糖(FPG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1c)、胰岛素、C肽、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、肌酐、尿素等指标。另将研究对象分为<45岁、45~59岁、≥60岁三个年龄段,比较不同糖调节状态人群在不同年龄段AGEs水平的变化。采用单因素方差分析比较各组间一般资料、生化指标及皮肤AGEs水平差异,并进行Pearson相关性分析和logistic回归分析。结果<45岁、45~59岁、≥60岁糖尿病前期和糖尿病患者AGEs值均高于正常糖耐量者(P<0.05)。皮肤AGEs水平与FPG和HbA1c相关(r=0.215、0.233,P<0.01)。AGEs是糖尿病前期和糖尿病风险的独立危险因素[优势比(95%可信区间):1.054(1.025~1.084)、1.116(1.071~1.163)]。糖尿病无创检测技术识别糖尿病的受试者工作特征(ROC)曲线下面积为0.721(95%可信区间:0.658~0.783),灵敏度为73.3%,特异度为61.3%;糖尿病无创检测技术识别糖尿病前期的ROC曲线下面积为0.601(95%可信区间:0.551~0.652),灵敏度为35.4%,特异度为87.1%。结论皮肤AGEs无创检测对评估糖尿病风险有一定应用价值,但可能不完全适用于糖尿病早期筛查。