Examining transdiagnostic vulnerabilities among HIV positive smokers seen at three inner city community based organizations

Investigators have proposed a “transdiagnostic vulnerability framework” that examines the relationship between smoking and broader emotional factors, including anhedonia, anxiety sensitivity, and distress tolerance. Because smoking and depression are more common in persons living with HIV and AIDS (PLWHA) than in the general population, understanding the relationship between smoking and mental health is critical. The following study aims to characterize levels of clinically significant depressive symptoms and these broader emotional factors as well as the relationship between these factors and smoking-related variables in a sample of PLWHA. This cross-sectional study employed convenience sampling to survey adult clients who attended one of three AIDS service organizations in New York City. The questionnaires assessed sociodemographic and HIV health care variables, tobacco use, and anxiety – and depression-related constructs. 150 PLWHA completed surveys. Among the 118 smokers, the prevalence of clinically depressive symptoms was 53%. Participants with clinically significant depressive symptoms had significantly higher mean anhedonia scores and anxiety sensitivity scores and lower mean distress tolerance total scores compared to participants without clinically significant depressive symptoms (p?相似文献   

AIDS in the hand patient: the team approach

Hand surgeons and therapists were faced with a new clinical entity in the 1980s with the emergence of hand and upper extremity infections in patients with AIDS and HIV disease. This entity has become a worldwide epidemic of vast proportions and has proven to be one of the major health concerns of the 1990s. It seems likely that treatment of patients with this devastating disease for hand infections or more routine upper extremity problems will become routine in the future. The reality of surgical treatment and hands-on rehabilitative therapy for patients with a life-threatening infectious disease has been a concern voiced publicly by very few health care professionals, yet discussed quietly among colleagues quite frequently. Our aim must be to provide the highest quality of health care to this group of hand patients, just as we do for all other patients, while at the same time providing the safest possible environment for all members of the health care team. It appears that there is a higher incidence of HIV infection among hand patients than is noted in the general public; therefore, the hand surgeon and medical team should pay particular attention to the rapidly advancing front of new information available regarding care for this challenging group of patients. Hand surgeons and therapists are entering the 1990s armed with a wealth of new and valuable information about HIV disease that has been produced by intensive basic science research and clinical observations accumulated over the last 10 years. The fears generated by the initial misinformation and lack of information concerning modes of transmission of HIV have generally been supplanted by a more rational approach to patient care, fostered by the more accurate scientific information currently becoming available. Unfortunately, the rational approach to the HIV-related political and socioeconomic issues has not yet overtaken the discrimination and stereotyping of the populace stricken with HIV disease. It remains the responsibility of the medical community to continue research efforts aimed at delineating the clinical deficiencies manifested by these patients and determining their effects on treatment regimens for both the unique and commonplace medical and orthopedic problems noted in this patient population.     

Fingertip injuries

Open fingertip injuries may be treated effectively by primary wound care followed by secondary intention wound healing. More sophisticated techniques of wound closure have only limited applicability and are associated with a significantly increased risk of failure.     

Evidence for Excitatory Amino Acid Neurotransmitters in Forward and Feedback Corticocortical Pathways within Rat Visual Cortex

It is a commonly accepted notion that cells which make projections between the multiple cortical areas found in the mammalian visual system are excitatory, but there is little direct evidence that this is the case. Here we demonstrate using retrograde tracing with D-[³H]aspartate that connections in the rat which project from lower to higher visual areas (i.e. forward) and those which project from higher to lower areas (i.e. feedback) may use excitatory amino acid neurotransmitters. Following injection into the primary visual cortex, clusters of retrogradely labelled cells were found in several extrastriate areas within the cytoarchitectonic subdivisions 18a (‘areas’ LM, AL, PX, FLX, RL, AX) and 18b (‘area’ MX), and in the retrosplenial cortex. In all of these areas D-[³H]aspartate-labelled cells were surrounded by diffuse label which may represent anterograde labelling of axon terminals. This suggests that both legs of reciprocal intracortical circuits have similar chemospecificity. To directly demonstrate excitatory amino acid localization in forward projections, D-[³H]aspartate was injected into extrastriate area LM. As expected, the results revealed retrogradely labelled neurons within area 17. Outside area 17, LM injections labelled neurons in AL, PX, FLX, RL, AX and MX. Taken in the context of the hierarchy of areas in rat cerebral cortex (Coogan and Burkhalter, J. Neurosci., 13, 3749–3772, 1993), these results show that D-[³H]aspartate labels: (1) forward connections from area 17 to LM, AL, PX, RL, AX and MX, (2) feedback connections from LM, AL, FLX, PX, RL, AX and MX to area 17, (3) feedback connections from AL, PX, RL, AX and MX to LM, and (4) lateral connections between FLX and LM. These findings strongly indicate that both forward and feedback connections as well as lateral connections at several different levels of the cortical hierarchy use excitatory amino acid neurotransmitters.     

Development of Forward and Feedback Connections between Areas V1 and V2 of Human Visual Cortex

We have determined the sequence in which forward connectionsbetween visual cortical areas V1 and V2, and feedback connectionsbetween V2 and V1 develop in humans. For this purpose Dii wasinjected into V1 and V2 of postmortem brains of different pre-and postnatal ages. The laminar distribution of labeled fibersand cell bodies In V1 and V2 Indicates that forward and feedbackconnections emerge shortly before birth. The development ofboth pathways proceeds over several postnatal months such thatthe laminar termination pat tern of forward connections appearsrelatively mature before feedback connections reach their matureform. At 31 weeks of gestation both forward and feedback connectionsoriginate exclusively from deep-layer neu rons, which extendaxons in deep layers only. By 9 d postnatal, forward connectionsfrom V1 to V2, n ad dition to layers 5 and 6, also arise fromneurons in layer 4B of V1. At this stage for the first timeforward fibers enter layer 4 at the topographically appropriatelocation of V2. At 9 d postnatal most feedback fibers from V2still occupy deep layers of Vi but many, through inter stitialgrowth, elaborate vertical sprouts at regular in tervals alongthe length of horizontal axons. As feedback connections mature,distal segments of horizontal axons are pruned beck to branchpoints and fibers assume L-shaped configurations. By 1 weeksof age forward fibers from V1 enter V2 through deep and superficiallayers and provide input to layers 3 and 4. At this stage feedbackfibers from V2 have entered layer 4B of V1. By 4 months of ageforward connections have assumed all the laminar characteristicsof mature connections; that is, they arise from layers 2/3,48, 5, and 6 of V1, and terminate In layers 3 and 4 of V2. Insharp contrast, at 4 months of age feedback connections to V1are still immature, showing terminations In layers 4B, 5, and6 but no input to layer 2/3. The protracted postnatal emergence of feedback con nectionsis similar to that of local long-range connec tions within layer2/3 of V1 (Burkhalter at al., i993). Since both of thsse circuitsare thought to provide in formation about the context in whichobjects are seen, it is interesting to speculate that the lateonset of texture segmentation in infants (Atkinson and Braddick.1992; Sireteanu and Rieth, 1992) may be related to the postnatal maturation of specific Intracortical circuits.     

Radionuclide bone scan as an aid in localizing lesions for bone biopsy

Two cases are cited as examples of the usefulness of bone scan-guided bone biopsies, using a lead marker for lesion localization, especially when the lesions are otherwise difficult to localize. This technique is quite useful in evaluating new solitary bone lesions in patients with a known primary malignancy.     

Bladder hernia simulating osseous metastatic lesion on radionuclide bone scan

A case of herniation of the urinary bladder is presented that simulated a metastatic lesion to the public bone on a radionuclide bone scan.     

Percutaneous catheter drainage of post-traumatic urinoma

We report a case that demonstrates that percutaneous catheter drainage may be considered as an alternative to surgical intervention in the treatment of urinomas, especially when there is no persistent ureteral obstruction.