人类乳头状瘤病毒与肺癌的病因关系研究（续）

为研究人类乳头状瘤病毒（ＨＰＶ）与肺癌发生的病因关系。采用聚合酶链（ＰＣＲ）技术对石蜡包埋肺鳞癌、肺腺、癌、肺鳞癌社鳞状化生上皮、正常支气管粘膜进行ＨＰＶ６／１１、８、１６、１８、３１／３３及３５型检测。结果表明：４种组织中，ＨＰＶＤＮＡ的总检出率分别为５８％、３３％、８０％和１３％，其中以ＨＰＶ１６型及ＨＰＶ１８型所占比例最高，ＨＰＶ感染与肺鳞癌和腺癌发生有一定的联系，鳞状上皮化生似可视为癌前病     

Effects of tolterodine ER on patient-reported outcomes in sexually active women with overactive bladder and urgency urinary incontinence

ABSTRACT

Objective: To assess the effects of tolterodine extended release (ER) on patient-reported outcomes (PROs) in sexually active women with overactive bladder (OAB) and urgency urinary incontinence (UUI).

Research design and methods: This multicenter, double-blind, placebo controlled trial included 411 women aged?≥18 years reporting OAB symptoms for ≥3 months; ≥8 micturitions per 24 hours (including ≥0.6 UUI episodes and ≥3 OAB micturitions) in 5-day bladder diaries at baseline, and being in a sexually active relationship for ≥6 months. Subjects randomized to placebo or tolterodine ER completed validated OAB- or incontinence-specific questionnaires, including the Patient Perception of Bladder Condition (PPBC), Overactive Bladder Questionnaire (OAB-q), Urgency Perception Scale (UPS), and the Incontinence Impact Questionnaire (IIQ) at baseline and week 12, as well as the Perception of Treatment Benefit and Treatment Satisfaction questions at week 12. This study is registered with ClinicalTrials.gov (identifier: NCT00143481)

Results: The mean age of enrolled women was approximately 48 years. Compared with placebo, the tolterodine ER group reported significant baseline to week 12 improvements in PPBC responses (p?=?0.0048); OAB-q Symptom Bother, total Health-Related Quality of Life (HRQL), and HRQL domain scores (all p?<?0.05); IIQ Emotional Health domain scores (p?<?0.05); proportions of subjects reporting treatment benefit (79 vs. 54%; p?<?0.0001) and satisfaction (78 vs. 59%; p?<?0.0001). Improvements on the UPS were not significantly different.

Conclusions: Tolterodine ER treatment was associated with improvements in multiple OAB- and incontinence-specific PROs in a sexually active, relatively young, and racially diverse population of women. The findings provide clinicians with new insights into the impact of OAB and its treatment on HRQL in this population, which has been underrepresented in previous OAB studies. Study limitations include a potential underestimation of the impact of OAB symptoms resulting from the exclusion of women who may not be sexually active because of their urinary symptoms.

Trial registration: ClinicalTrials.gov identifier: NCT00143481.     

Alcohol use and sexual risks for HIV infection among men and women receiving sexually transmitted infection clinic services in Cape Town, South Africa

OBJECTIVE: To examine the association of alcohol use and sexual risks for HIV infection in South Africa. METHOD: 149 men and 78 women receiving sexually transmitted infection (STI) clinic services in Cape Town, South Africa, completed measures of demographic characteristics, sexual behaviors, HIV risk reduction skills and substance use, including global measures (e.g., Alcohol Use Disorders Identification Test [AUDIT]) and situational measures of alcohol use. RESULTS: 52% of men (n = 72) and 17% of women (n = 13) indicated problem drinking (AUDIT score > or = 9). Problem drinking was associated with greater numbers of sex partners in the past month, history of condom failures and lifetime history of having an STI, as well as lower rates of practicing risk reduction skills. In a separate analysis controlling for global use of alcohol indexed by AUDIT scores, we found that alcohol use in sexual contexts was associated with greater numbers of sex partners, higher rates of unprotected intercourse and condom failures. CONCLUSIONS: Findings from this initial study of alcohol use and sexual risks in South Africa parallel those from other countries in sub-Saharan Africa. Although limited to STI clinic patients, the results suggest that effective HIV risk reduction interventions will require attention to alcohol use, particularly among South Africans at highest risk for HIV infection.     

剖宫产术后切口感染的高危因素及护理对策

目的:探讨剖宫产术后切口感染发生的高危因素及护理措施.方法:剖宫产术后产妇发生感染的64例作为观察组,剖宫产术无切口感染的产妇64例作为对照组,对剖宫产术后切口感染的原因进行调查,并采取有效护理措施.结果:两组患者在体质量指数、贫血水平、检查次数、胎膜早破、手术时间等方面的差异有统计学意义(P＜0.05).结论:预防和控制表浅伤口感染,是控制剖腹产术后切口感染的关键.     

Treatment of sexually transmitted bacterial diseases in pregnant women

Testing for and treating sexually transmitted diseases (STDs) in pregnant women deserves special attention. Treatment possibilities are limited because of potential risks for the developing fetus, and because effects can differ in pregnant compared with non-pregnant women, re-infection may be missed because of the intrinsic delicacy of contact-tracing during pregnancy and because pregnant women are more reluctant to take the prescribed medication in its full dose, if at all. However, the devastating effects of some of these genital infections far outweigh any potential adverse effects of treatment. Although active syphilis has become a rarity in most Western countries, it is still prevalent in South America, Africa and South-East Asia. Benzathine benzylpenicillin (2.4 million units once or, safer, twice 7 days apart) is the treatment of choice, although patients with syphilis of longer standing require 3 weekly injections as well as extensive investigation into whether there has been any damage due to tertiary syphilis. Despite declining rates of gonorrhea, the relative rate of penicillinase-producing strains is increasing, especially in South-East Asia. The recommended treatment is intramuscular ceftriaxone (125 or 250 mg) or oral cefixime 400 mg. Despite good safety records after accidental use, fluoroquinolones are contraindicated during pregnancy. An alternative to a fluoroquinolone in pregnant women with combined gonorrhea and chlamydial infection is oral azithromycin 1 or 2 g. Azithromycin as a single 1 g dose is also preferable to a 7 day course of erythromycin 500 mg 4 times a day for patients with chlamydial infection. Eradication of Haemophilus ducreyi in patients with chancroid can also be achieved with these regimens or intramuscular ceftriaxone 250 mg. Trichomonas vaginalis, which is often seen as a co-infection, has been linked to an increased risk of preterm birth. Patients infected with this parasite should therefore received metronidazole 500 mg twice daily for 7 days as earlier fears of teratogenesis in humans have not been confirmed by recent data. Bacterial vaginosis is also associated with preterm delivery in certain risk groups, such as women with a history of preterm birth or of low maternal weight. Such an association is yet to be convincingly proven in other women. The current advice is to treat only women diagnosed with bacterial vaginosis who also present other risk factors for preterm delivery. The treatment of choice is oral metronidazole 1 g/day for 5 days. The possible reduction of preterm birth by vaginally applied metronidazole or clindamycin is still under investigation. In general, both test of cure and re-testing after several weeks are advisable in most pregnant patients with STDs, because partner notification and treatment are likely to be less efficient than outside pregnancy and the impact of inadequately treated or recurrent disease is greater because of the added risk to the fetus. Every diagnosis of an STD warrants a full screen for concomitant genital disease. Most ulcerative genital infections, as well as abnormal vaginal flora and bacterial vaginosis, increase the sexual transmission efficiency of HIV, necessitating even more stringent screening for and treating of STD during pregnancy.     

Associations between dieting and smoking-related behaviors in young women

Many young women report smoking due to weight concerns, but little is known about the relationship between weight concerns and current smoking behavior. The present study examined smoking topography and the acute sensory and physiological responses to smoking in dieting and non-dieting young women. In addition, the effect of presentation of food cues on these responses was examined. Self-reported female current dieters (n=15) and non-dieters (n=15) attended two laboratory sessions (food cues present/food cues absent). Physiological and subjective responses were recorded pre- and post-cigarette at each session. Smoking topography was assessed by video analysis. Dieters scored higher than non-dieters on measures of weight control smoking, dietary restraint, and disinhibition. At both sessions, they smoked less of the cigarette, had shorter inhalation durations, longer inter-puff intervals, experienced smaller physiological effects and gave lower ratings of the sensory aspects of smoking than non-dieters. The presence of food cues did not alter smoking topography or sensory/physiological responses but the dieters reported a greater desire to smoke in the presence of food cues. These data suggest that sensory factors may be less important influences on smoking for weight control smokers than non-weight control smokers and that further investigation of the role of food cues in maintaining smoking behavior in weight control smokers is warranted.     

高同型半胱氨酸血症与青年女性缺血性卒中的关系

目的探讨高同型半胱氨酸血症(Hhcy)与青年女性缺血性卒中的关系。方法分析43例青年女性缺血性卒中患者的血清同型半胱氨酸(Hcy)水平,与同期45例青年女性非脑血管病患者进行比较;卒中组患者根据脑梗死灶面积大小分为3个亚组比较组间血清Hcy的差异。结果卒中组血清Hcy水平明显高于对照组(P<0.05);卒中组患者亚组间血清Hcy水平差异无统计学意义(P>0.05)。结论 Hhcy是青年女性缺血性卒中的一个重要危险因素,临床应将血清Hcy作为青年女性缺血性卒中的一项常规检测项目。     

Disposition of intravenous diazepam in young men and women

Summary The disposition of a single intravenous dose of diazepam (10 mg) was studied in 11 young, healthy subjects (6 males and 5 females on oral contraceptives). Plasma samples were obtained over 28 days and diazepam and N-desmethyldiazepam plasma concentrations and diazepam free fractions were determined. The salivary excretion of diazepam and N-desmethyldiazepam was studied over 72 h. A series of psychomotor performance tests were administered over the first 8 h. Interindividual variation in mean diazepam disposition over time is not principally related to variation in plasma protein binding; 93% of the variation in clearance is accounted for by variation in intrinsic clearance. Interindividual variation in diazepam disposition is modest but the plasma clearance of diazepam in women on oral contraceptives (median 14.0 ml/min) is significantly (p=0.004) less than in men (median 23.4 ml/min) and the area under the curve (AUC) of diazepam is highly correlated with the AUC of the principal active metabolite (r=0.90, p<0.001). The AUC of N-desmethyldiazepam (median 9.2 µg·h/ml) in women is greater (p=0.06) than in men (median 7.5 µg·h/ml). On chronic administration of diazepam, therefore, women taking oral contraceptives will have greater plasma concentrations per unit dose of both diazepam and N-desmethyldiazepam than men. The clearance of diazepam in control groups of 11 young men (median 23.8 ml/min) and 10 young women not taking oral contraceptives (median 26.8 ml/min) is not significantly different. Plasma and salivary concentratrions of diazepam are correlated (p<0.001) but the predictive value of this correlation is limited (r=0.70) since the ratio of salivary to plasma concentrations varies significantly over the day. The use of calculated free diazepam plasma concentrations does not improve the correlation (r=0.68) but the slope of this regression (1.00) is that predicted by theory.     

Recurrent urinary tract infection in women

Recurrent urinary tract infections (UTI) are common among young healthy women even though they generally have anatomically and physiologically normal urinary tracts. Women with recurrent UTI have an increased susceptibility to vaginal colonization with uropathogens, which is due to a greater propensity for uropathogenic coliforms to adhere to uroepithelial cells. Risk factors for recurrent UTI include sexual intercourse, use of spermicidal products, having a first UTI at an early age, and having a maternal history of UTIs. Inherited factors may be important in some women with recurrent UTI. Many factors thought to predispose to recurrent UTI in women, such as pre- and post-coital voiding patterns, frequency of urination, wiping patterns, and douching have not been proven to be risk factors for UTI. In contrast to the predominantly behavioral risk factors for young women, mechanical and/or physiological factors that affect bladder emptying are most strongly associated with recurrent UTI in healthy postmenopausal women. The management of recurrent UTI is the same as that for sporadic UTI except that the likelihood of infection with an antibiotic resistant uropathogen is higher in women who have received recent antimicrobials. Strategies to prevent recurrent UTI in young women should include education about the association of recurrent UTI with frequency of sexual intercourse and the usage of spermicide-containing products. Continuous or post-coital prophylaxis with low-dose antimicrobials or intermittent self-treatment with antimicrobials have all been demonstrated to be effective in managing recurrent uncomplicated UTIs in women. Estrogen use is very effective in preventing recurrent UTI in post-menopausal women. Exciting new approaches to prevent recurrent UTI include the use of probiotics and vaccines. Further understanding of the pathogenesis of UTI will lead to more effective and safer methods to prevent these frequent infections.     

Alcohol use and alcohol/marijuana use during the most recent sexual experience differentially predict characteristics of the sexual experience among sexually active young adult drinkers

IntroductionFew studies have examined associations between using alcohol only and using both alcohol and marijuana with sexual behavior on specific occasions. The current study examined alcohol and marijuana use during the most recent sexual experience in association with relationship characteristics, psychological issues, and condom use.MethodsYoung adult drinkers aged 18–25 who reported not using a condom during sex in the past month were recruited nationally. An analytic subsample (N = 378) was identified based on substance use during the most recent sexual experience [53% female, 70% Caucasian; mean age = 22.42 years (SD = 1.90)]. Using logistic regression, two dummy codes compared the alcohol use only group (n = 197) and the both alcohol and marijuana group (n = 95) to the group who used neither substance (n = 86). Participant sex, drinking frequency, and number of sexual partners were included as covariates.ResultsThe alcohol only group and the both alcohol and marijuana group had greater odds of being with a casual acquaintance and loss of respect compared to the group who used neither substance. The alcohol only group had greater odds of being with someone they just met and embarrassment compared to the group who used neither substance. No associations were found for condom use or emotional difficulties.ConclusionsPreventative interventions may need to address both alcohol and marijuana to more effectively reduce risky behaviors.