玻璃酸钠联合利多卡因关节腔注射对膝关节骨关节炎疼痛影响观察

目的 观察玻璃酸钠联合利多卡因行关节腔注射对膝关节骨关节炎疼痛的临床治疗效果。方法将90例膝关节骨关节炎患者随机分为试验组（EG）、对照组（CG）两组，每组为45例，两组在年龄及性别等方面无明显差异。试验组行玻璃酸钠和利多卡因联合注射，对照组行玻璃酸钠和生理盐水联合注射，每周1次，连续5周为1个疗程。对比观察两组治疗后8min时疼痛变化。结果试验组在注射后8min时疼痛缓解情况与对照组比较差异具有统计学意义（P〈0．05）。结论玻璃酸钠联合利多卡因行关节腔内注射可迅速缓解运动疼痛，缓解速度优于单用玻璃酸钠和生理盐水     

Effects of GRF (1-29) NH2 on short-term memory: neuroendocrine and neuropsychological assessment in healthy young subjects

Recent studies seem to indicate that the somatotropinergic system (STS) (GRF-SS-GH-SM axis) may be involved in the neuromodulation of higher activities of the central nervous system (CNS). In an attempt to demonstrate the influence of the STS on memory functions in humans, we have investigated the effects of acute administration of exogenous GRF vs. placebo on short-term memory (STM) in healthy young subjects. We gave GRF(1-29)NH2 (150 micrograms; i.v.) to a group of subjects (EG) (N = 17) and placebo (0.9% saline, 1 ml; i.v.) to a different group of subjects (CG) (N = 6). Prior to testing we presented a list of 20 neutral words (A1), and 2 hours after injection the same list (A2) and another list (B) of similar characteristics were presented in order to evaluate cognitive performance (CP). Basal CP (A1 list) was similar in EG and CG. Differences between EG and CG were found for both A2 (EG = 14.76 +/- 1.55 words vs. CG = 11.83 +/- 1.34 words, p less than 0.01) and B lists (EG = 12.17 +/- 1.68 words, p less than 0.005). According to the basal serum GH levels, EG subjects were divided into 2 subgroups: EG1 (N = 6), with high basal GH levels (11.57 +/- 4.47 ng/ml) and EG2 (N = 11), with low basal GH levels (1.55 +/- 1.71 ng/ml), similar to CG (1.3 +/- 1.53 ng/ml). GRF-induced GH response showed maxima 15 (28.15 +/- 11.71 ng/ml) and 30 min (28.09 +/- 17.07 ng/ml) after injection in EG1 and at 45 min (15.52 +/- 14.45 ng/ml) in EG2.(ABSTRACT TRUNCATED AT 250 WORDS)     

乌苯美司对放射治疗的鼻咽癌患者宿主免疫机能的影响及辅助治疗作用

评价乌苯美司对鼻咽癌宿主免疫机能的影响及其治疗作用。71例鼻咽癌患者随机分为试验组：放射治疗加乌苯美司（30mg／d，口服，连用6月）；对照组：单纯放射治疗。其中试验组43例，对照组28例。结果可供评价的67例中，试验组40例，对照组27例。放疗后3月及6月，试验组免疫综合疗效好于对照组，其中放疗后6个月，有统计学差异（P＜0，05）;试验组IL2水平、NK细胞活力及OKT4／T8比值较治疗前显著提高（P＜0.05），而对照组上述各指标既IL2外，与治疗前比较均无明显改善，两组比较有统计学意义（P＜0．05）。试验组SIL－2R水平较治疗前显著降低（P＜0．05），与对照组比较有显著差异。实验表明乌苯美司有可能作为一种新的免疫调节剂用于鼻咽癌的综合治疗．但仍需扩大观察并作较长期的随访。     

Factors Contributing to Retention of Not-in-Treatment Drug Users in an HIV/AIDS Outreach Prevention Project

SUMMARY

Studies have attempted to identify the characteristics of substance-abusing clients that are related to premature termination from alcohol and drug treatment. Few studies, however, have looked at predictors of loss to follow-up among drug users participating in HIV/AIDS prevention projects. This paper develops and tests models of program retention employing data from approximately 250 not-in-treatment drug users enrolled in an outreach based HIV risk reduction program. Logistic regression was used to fit a model which included measures of: (1) demographic characteristics including: age and ethnicity; (2) social environmental factors including: living situation and type of network connection; (3) risk behaviors including: composite scores for drug use in the past 30 days and history of Sexually Transmitted Diseases (STDs); and (4) program factors including: outreach workers' knowledge of clients and number of intervention sessions received. Findings suggest that social environmental and program factors are most predictive of client retention in the program. Implications for ways in which to monitor retention of out-of-treatment drug users participating in AIDS prevention programs are addressed.     

30例酒依赖患者的人格特征及治疗干预

目的:探讨酒依赖患者人格特征及相应的干预措施。方法:对30例酒依赖患者(实验组)和30例正常者(对照组),采用中国科学院心理研究所宋维真教授主持修订的调查表问卷(MMPI)进行调查比较,探讨酒依赖形成的原因,并根据其不同人格特点进行治疗。结果:实验组的诈分量表、效正量表分与对照组相比差异有显著性(P<0.01),10个临床子量表中,有5项,即精神衰弱、心理变态、偏执、精神分裂、轻躁症分值均高于对照组,差异有显著性(P<0.01);疑病、社会内向亦有明显差异(P<0.05)。30例患者中有3例图像呈86/68、78/87两点高分组合,3例图像呈Pa图像,符合分裂症样偏执症状为主的反应;4例量表Ma高分呈轻躁狂样反应;6例量表Hs、Pt高分,呈神经症样反应;7例呈46/64两点高分组合和Pd高分,符合人格障碍样反应。不同形式的治疗干预促进了患者的康复。结论:酒依赖患者有明显的人格障碍,并具有比较广泛而多样的特征,心理状况明显偏离于正常人。给予恰当的干预措施,对酒依赖患者早日康复有良好的促进作用。     

Strategies for Accessing and Retaining Asian Drug Users in Research Studies

SUMMARY

Based on a research project that investigates drug use and HIV risk behaviors among Asian drug users in San Francisco, this paper describes barriers and strategies for accessing, recruiting, and retaining Asian drug users. It also presents culturally appropriate and group specific strategies and underlying cultural norms that outreach workers use to build rapport with targeted drug users and community members. The paper describes culturally appropriate strategies for outreach workers and project staff to recruit and retain Asian drug users. These strategies acknowledge diversities within the targeted ethnic groups and offer flexibility to create other strategies specific to targeted Asian drug users.     

Linking female sex workers with substance abuse treatment

We evaluated mobile street-based outreach as a modality for linking street-walking female sex workers with substance abuse treatment in New York City. Sex workers (N = 179) approaching an existing outreach facility were randomly assigned to receive usually provided services, or to receive an enhanced version of these services. Among the 144 women successfully followed for 6 months, 35.0% were detoxified; 43.1% of the 78 current heroin users received methadone maintenance; and 35.4% of the followed-up clients received some other type of treatment. Intervention group differences in these outcomes were not significant. Detoxification during followup was associated with heroin dependence and lifetime detoxification. Methadone maintenance (among heroin users) was associated with Hispanic ethnicity and legally mandated treatment. Other types of treatments were negatively associated with the degree of involvement in the sex trade. We conclude that a variety of factors affect motivation for substance abuse treatment among female sex workers, and that street-based outreach is a highly effective modality for linking this population with much needed treatment.     

Effect of cardiac beta-adrenergic blockade or denervation on cardiotoxicity of digoxin and an aminosugar cardenolide

This study examined the role of cardiac beta-adrenergic receptors and cardiac sympathetic and vagal nerves in the cardiotoxicity of 3-beta-0-(4-amino-4,6-dideoxy-beta-D-glucopyranosyl) digitoxigenin hydrochloride (ASI-254). Vagally intact dogs received a constant rate intravenous infusion of either digoxin or ASI-254 in the presence and absence of practolol. Practolol pretreatment increased the dose of digoxin required to produce arrhythmias and markedly altered the pattern of toxicity, but did not alter the lethal dose. The terminal event was cardiac standstill rather than ventricular fibrillation as seen in digoxin control dogs. Practolol did not alter the toxic dose of ASI-254 and produced little change in the pattern of cardiotoxicity; both control and practolol-treated dogs died in cardiac standstill. Surgical sympathectomy did not alter the toxic dose of ASI-254, the character of toxicity, or the lethal dose compared to neurally intact dogs. However, vagal innervation may play a role in determining the type of cardiotoxicity produced by ASI-254. Vagotomy alone did not alter the toxic or the lethal dose of ASI-254; vagotomy did, however, alter the character of cardiotoxicity and terminal event. Our results indicate that ASI-254 infused intravenously does not interact with sites, central or peripheral, which activate the sympathetic nervous system. ASI-254 administered into the lateral ventricles produced signs of increased cardiac sympathetic nervous system activity. Tachycardia and arrhythmias produced by ICV ASI-254 appear to be neurally mediated since ganglionic blockade blunted these effects. These results suggest that ASI-254 is capable of interacting with central sympathetic nervous system structures, but in contrast to digoxin, access to these structures from intravenous administration is limited.     

艾迪注射液联合鸦胆子油乳剂腹腔内注射治疗肝癌恶性腹腔积液临床分析

目的观察艾迪注射液联合鸦胆子油乳剂腹腔内注射治疗肝癌恶性腹腔积液的疗效。方法将56例肝癌恶性腹腔积液患者随机分为两组,艾迪联合鸦胆子油乳剂治疗组和5-氟尿嘧啶（5-FU）对照组,艾迪联合鸦胆子油乳剂治疗组每周一次腹腔内注射,对照组采用5-氟尿嘧啶（5-FU）腹腔内注射,每周一次。两组均最多不超过4次,观察疗效及毒副反应。结果艾迪联合鸦胆子油乳剂治疗组总有效率高于对照组,副作用发生率低于对照组,差异均有统计学意义（P〈0.05）。结论艾迪联合鸦胆子油乳剂治疗肝癌恶性腹腔积液疗效好、副作用轻,患者易于接受。     

Drug Use Patterns of Substance Abusing Women: Gender and Ethnic Differences in an AIDS Prevention Program

SUMMARY

The social context of drug use defines women's experiences of addiction and their patterns of use. Gender relations and roles, ethnic identity, poverty, and local circumstances, including drug-related epidemics such as the human immunodeficiency virus (HIV) and sexually transmitted diseases (STDs), constitute powerful social forces that create a unique set of risky conditions for women drug users. This paper presents findings from a community-based AIDS prevention research project for 1,022 out-of-treatment drug users recruited through street outreach and targeted sampling. Data from a baseline risk behavior assessment and in-depth interviews on contexts of women's drug use show different patterns of use when comparing women to men, and among women comparing African Americans, Puerto Ricans, and Whites. Related differences in prevalence of HIV, STDs, and other consequences of drug use and addiction also are presented. Implications of these findings are discussed in terms of the development of drug treatment and harm reduction programs that are appropriate for women of different ethnic backgrounds.     

Hepatitis services at an injecting drug user outreach clinic

AIMS: To provide a culturally appropriate, accessible and affordable hepatitis outreach clinic for injecting drug users, a traditionally hard-to-reach population. METHODS: The community-based clinic, a collaborative project between the Wellington Drugs and Health Development Project and Capital Coast Health, was established in Wellington in 1997. Characteristics of the first 100 injecting drug users with hepatitis C assessed through the clinic are presented. RESULTS: Of 51 patients found to be hepatitis C positive, five have received hepatitis C treatment, four at the outreach and one at a base hospital. 25 have been vaccinated for hepatitis B. The clinic has established trust and rapport with the injecting-drug-user community. CONCLUSIONS: The hepatitis outreach clinic is an innovative project, crossing the primary/secondary interface of health services provision and providing personal health services within a public health initiative. The success of this model indicates potential value in offering outreach hepatitis clinics for injecting drug users in the major cities to close a gap in health service provision.     

A randomized controlled trial of monetary incentives vs. outreach to enhance adherence to the hepatitis B vaccine series among injection drug users

BACKGROUND: Injection drug users (IDUs) are at high-risk for hepatitis B virus (HBV) and HIV. Due to concerns about non-adherence to multi-dose vaccine regimens however, IDUs are severely under-immunized against HBV and have been excluded from phase III trials of multi-dose candidate HIV vaccines in the United States. METHODS: Through a randomized controlled trial, we compared the effectiveness of monetary incentives versus outreach to improve IDUs' adherence to the 3-dose hepatitis B vaccine. In 1998-1999, HBV-susceptible IDUs were recruited from San Francisco streets. Eligible participants received their first dose of vaccine and were randomized to either receive monthly monetary incentives (n=48) or maintain weekly contact with an outreach worker (n=48) during the 6-month vaccine series. RESULTS: All 3 doses of vaccine were received by 33 (69%) of IDUs in the monetary incentive arm and 11 (23%) in the outreach arm (odds ratio=13.8; 95% confidence interval, 2.9, 128; P<0.0001). In a multivariate model, receiving monetary incentives was independently associated with vaccine completion (AOR=10.3; 95% CI=3.7, 29.0). CONCLUSIONS: Among IDUs, monetary incentives are superior to outreach in achieving adherence to the multi-dose hepatitis B vaccine series. Monetary incentives may be adapted to future multi-dose candidate HIV vaccine trials in IDUs.     

Factors Associated with the Initiation of Cocaine and Heroin among Problem Drug Users—Reflections on Interventions

Objective: This study identifies self-reported factors facilitating initiation of cocaine and heroin among young problem users in Amsterdam to enable interventions to be targeted at issues personally relevant for this population. Method: A qualitative study using in-depth interviews to obtain retrospective drug use histories. Recruitment took place both directly (by street outreach, outreach at methadone outposts) and indirectly (by respondent-driven sampling). The study started in the year 2001 and included 50 problem drug users, aged 18–30, of whom 72% were male, 64% were polydrug users, and 36% were homeless. Results: The seven most common self-reported factors facilitating initiation of cocaine and heroin are desire for affect regulation, drug availability, curiosity, desire to be part of a group, misinformation, desire for energy, and starting because it has a depressant effect. Conclusion: Some factors perceived to facilitate initiation of cocaine and/or heroin revealed in this study are hardly addressed by current prevention programs and could inform future initiatives. Programs can be targeted at young people who we identified to be at high risk. Research using quantitative methods is likely to be valuable in determining the relative importance of mentioned factors for different groups of young people. The study's limitations are noted.     

The Effectiveness of a Mutual-Help Group Activity for Drug Users and Family Members in Japan

Aims: To understand the efficacy of a mutual-help group activity for drug users and family members in terms of: (a) family members' behavioral changes (b) treatment engagement rate of the drug users, and (c) life satisfaction of family members. Methods: A total of 186 family members answered questionnaires. Results: Attending the group changed the family members' behaviors. The treatment engagement rates within 1, 6, and 12 months for untreated drug users were 23.2%, 39.2%, and 52.3%, respectively. The well-being (Subjective Well-Being Inventory [SUBI]) of long-term group members is higher than that of short-term group members.     

肠内营养在脑血管意外患者营养支持治疗中的作用

目的探讨肠内营养在脑血管意外患者营养支持治疗中的临床价值。方法将我院收治的48例脑血管意外患者,随机分成两组,其中24例采用肠内营养支持(实验组),24例采用肠外营养支持(对照组),比较肠内营养与肠外营养支持治疗脑血管患者的营养指标及并发症。结果两组患者在营养支持治疗10d后血红蛋白、转铁蛋白、淋巴细胞计数、血浆总蛋白等指标无显著性差异,但实验组腹胀、腹泻、消化道出血、高血糖的发生率低于对照组(P<0.05)。结论早期肠内营养支持治疗可更好地改善患者营养状况,并发症较肠外营养少,在脑血管意外患者的支持治疗中有重要的临床价值。     

The effect of methadone maintenance on positive outcomes for opiate injection drug users

This study examined outcome variables for 160 opiate injection drug users (IDUs) who entered methadone maintenance between baseline and 6-month follow-up. Outcome variables of interest included drug use, productivity, and HIV risk behaviors. Participants were recruited through street outreach in Denver, CO, from 2000 through 2004 using targeted sampling. The sample was primarily men, White (48%), averaged 39 years of age, and had been injecting drugs for an average of nearly 20 years. Significant improvements were found in univariate tests. Logistic regression revealed that spending more time in treatment was a significant predictor of positive outcomes on drug use and HIV risk behaviors. The results underscore the importance of retaining IDUs in methadone maintenance to maximize their treatment success. Results from this study show that time in treatment can affect many aspects of the participant's life in a positive way, including reduction of HIV risk.     

静脉吸毒人群前瞻性研究队列随访方法的应用

目的:探讨我国静脉吸毒人群前瞻性研究的方法.方法:于2002年11月,在四川省凉山地区从社区招募了HIV抗体阴性的静脉吸毒人群前瞻性研究队列333人.分析队列本底的静脉吸毒人群社会人口学和HIV高危行为特征,以及在6个月队列保持中各种随访跟踪方法的使用情况.结果:队列6个月随访阶段的保持率为74.8%(249/333)和HIV阳转率为4.04/100人年(95%CI: 0.50-7.59).通过种子通知、种子预约、种子或他人寻找和工作人员寻找为本研究队列6个月随访的主要方法.结论:在静脉吸毒人群研究队列随访中可考虑采用多种联系方式,其中通过外勤工作人员以及种子帮助来联系参加者为主要的队列随访方法.     

The toxicokinetics of 1,3-butylene glycol versus ethanol in the treatment of ethylene glycol poisoning.

Ethylene glycol (EG) is a toxic chemical found in antifreeze and heat exchangers. Standard therapy for EG intoxication in administration of ethanol (ETOH) to inhibit its metabolism by alcohol dehydrogenase (ADH). Studies indicate 1,3-butylene glycol (BG) binds to ADH more efficiently than EG and is orally less toxic than EG or ETOH. Male rats were divided into 5 groups of 6 animals. Groups received by oral intubation a single dose of EG (32 mmole/kg), BG (39 mmole/kg) initially and every 6 h up to 72 h, ETOH (39 mmole/kg) initially and every 6 h up to 72 h, or EG initially and then either BG or ETOH every 6 h up to 72 h. Administration of ETOH produced hepatotoxicity and pulmonary pathology as indicated by changes in clinical chemistry, urinalysis, and histopathology, while BG did not. Neither ETOH nor BG produced any apparent nephrotoxicity. ETOH produced ataxia, lethargy and central nervous system depression while BG did not. BG produced a higher concentration of urinary EG indicating a better inhibition of ADH metabolism of EG. Ethanol produced a higher EG blood concentration than BG. Ethanol's higher EG blood concentration may be partially attributed to dehydration and a decreased urine output as well as inhibition of ADH metabolism. Ethanol produced mortality in all animals prior to 72 h. The EG/ETOH combination produced mortality more quickly due to additive toxicity of the combination. Lack of any significant toxicity produced by BG and the production of significant toxicities by ETOH indicates that BG is potentially a better antidote than ETOH.     

Comparative ability of digoxin and an aminosugar cardiac glycoside to bind to and inhibit Na+,K+-adenosine triphosphatase. Effect of potassium

We compared the abilities of digoxin and aminogalactose digitoxigenin (ASI-222) to bind to, or inhibit, purified dog heart Na+,K+-ATPase in the presence of 1, 10, or 80 mM potassium chloride. Changing the potassium concentration from 1 to 10 mM increased the dose producing 50% inhibition of enzyme activity (IC50) by 9- and 2.5-fold for digoxin and ASI-222 respectively. Raising the potassium concentration to 80 mM increased the IC50 for digoxin 3-fold but did not alter significantly the IC50 for ASI-222. Equilibrium binding studies showed that this enzyme exhibited a single class of specific binding sites for both digoxin and ASI-222. Raising the potassium concentration did not affect the maximum number of binding sites (Bmax) but increased the apparent dissociation constant (KD) for digoxin. Potassium differentially affected the affinity and number of binding sites for ASI-222; raising the potassium concentration from 1 to 10 mM did not affect the Bmax or the KD, but raising it to 80 mM increased both. The effect of i.v. infusion of potassium chloride upon cardiac upon cardiac arrhythmias produced by i.v. infusion of digoxin or ASI-222 in anesthetized dogs was also determined. Infusion of potassium chloride reversed the cardiac arrhymias due to digoxin to normal rhythm, but not those due to ASI-222. In conclusion, the interaction of digoxin and the polar digitalis agent, ASI-222, with dog heart Na+,K+-ATPase was differentially affected by potassium. These agents also also produced cardiac arrhythmias, which were differentially affected by potassium.     

Impacts of intensified police activity on injection drug users: Evidence from an ethnographic investigation

In an effort to dismantle the open drug market and improve public order, a large-scale police initiative named the Citywide Enforcement Team (CET), began in Vancouver's Downtown Eastside (DTES) on 7th April 2003. This research sought to assess the CET's impact upon drug consumption activities as well as access to sterile syringes and health services among injection drug users (IDUs). Ethnographic research methods including participant observation and semi-structured interviews were employed. Interviews were conducted with 30 individuals recruited from an ongoing cohort study of IDUs and nine individuals who provide health services to drug users. In addition, an ongoing participant-observation program investigating public drug use in the DTES yielded data during the period of the CET, as well as seven months prior to its commencement. With regard to drug use patterns, intensified police presence prompted ‘rushed’ injections, injecting in riskier environments, discouraged safer injection practices, and increased unsafe disposal of syringes. Service providers indicated that the CET negatively impacted contact between health services and IDUs, as outreach was compromised due to the displacement of IDUs. Police activities also negatively influenced IDUs’ access to syringes and their willingness to carry syringes, and syringe confiscation was reported. The intensification of police activities led to less drug related activity in the area where the drug market was traditionally concentrated, but widespread displacement of drug use activities to other locations also occurred. The adverse impact of concentrated police activities upon urban drug problems and the implications for both public order and public health should be recognized.