The effect of highly active antiretroviral therapy on cervical cytologic changes associated with oncogenic HPV among HIV-infected women.

OBJECTIVE: Cervical intraepithelial neoplasia (CIN), a common condition among HIV-infected women, has been linked to HIV load and immune status. Highly active antiretroviral therapy (HAART) improves immunologic and virologic status. This study was undertaken to determine the relationship between HAART use and CIN. DESIGN: Cohort study. The Women's Interagency HIV Study (WIHS) in five cities in the USA (Bronx/Manhattan, New York; Brooklyn, New York; Chicago, Illinois; Los Angeles, California; San Francisco Bay area, California; Washington, District of Columbia). METHODS: HIV-infected women were followed every 6 months with Papanicolaou smears and cervicovaginal lavage for human papillomavirus (HPV) DNA testing. To characterize exposures that changed over time and to capture the dynamic nature of cytologic changes, Papanicolaou smear findings from each participant's consecutive visits were defined as a pair. We determined the proportion of all pairs that exhibited either regression or progression, according to HAART exposure, HPV results and Papanicolaou smear status. As participants could contribute multiple pairs, inferences were based on robust methods to adjust for correlated observations. RESULTS: Women with persistent HPV infection were more likely to have progression of their lesions. After adjustment for CD4 cell count and Papanicolaou smear status, women on HAART were 40% (95% confidence interval, 4-81%) more likely to demonstrate regression and less likely (odds ratio, 0.68; 95% confidence interval, 0.52-0.88) to demonstrate progression CONCLUSIONS: HAART altered the course of HPV disease in HIV-infected women, reducing progression and increasing regression. As HPV disease is a common sex-specific manifestation of HIV disease this effect of HAART would be a major additional benefit from this modality of therapy.     

Severe Combined Immunodeficiency (SCID)-Associated Dyschromia with Subsequent Repigmentation: A Report of Two Patients

Abstract:  Severe combined immunodeficiency (SCID) often presents with mucosal infections, cutaneous infections and eczematous rashes. We present two patients with history of SCID diagnosed at an early age who experienced diffuse dyschromia associated with their bone marrow and stem cell transplants. Dyschromias may be caused by numerous factors including medications, genetics, environmental contacts, or as a sequela of underlying chronic disease. These case reports describe progressive repigmentation to original skin color after the occurrence of dyschromia in two patients with SCID.     

Trauma to the elbow and forearm

Elbow and forearm trauma constitute a significant percentage of upper extremity injuries. A thorough understanding of the anatomy and mechanism of injury is necessary for obtaining the most accurate radiographic interpretation in both the pediatric and adult populations. Proper radiographic positioning and choice of the best imaging modality are crucial to ensure the best orthopedic treatment and reduce the incidence of post-treatment complications.     

Radiology of wrist and hand injuries in athletes

Traumatic injuries are a major cause of hand and wrist pain in athletes. Wrist injuries include fractures, dislocations, and instability patterns. Hand injuries include tendon injuries, ligamentous injuries, and fractures. In this article we have presented the radiographic appearance of the more common of these injuries.     

氯沙坦减少高血压患者终点事件的研究(LIFE STUDY)

标　　题　应用ＡＴⅡ受体拮抗剂抗高血压治疗作　　者　ＫｊｅｌｄｓｅｎＳＥ,ＯｍｖｉｋＰ.　　参考文献　ＴｉｄｓｓｋｒＮｏｒＬａｅｇｅｆｏｒｅｎ,1996,116:504～507研究疾病　高血压病。目　　的　评估氯沙坦对心血管死亡率及非致死性心肌梗死和非脑卒中发生率的影响,同时评估该药对充血性心力衰竭或心绞痛所致的总死亡率和住院率的影响,以及长期应用氯沙坦对发生新诊断糖尿病的影响。设　　计　随机、三盲、对照研究。病人资料　8300例年龄55～80岁、收缩压在160～200ｍｍＨｇ、舒张压在95～115ｍｍＨｇ的高血压患者,ＥＣＧ上有左室…     

How serious of a problem is staff turnover in substance abuse treatment? A longitudinal study of actual turnover

In the substance abuse treatment field, the annual turnover rate is cited as being anywhere between 19% and 50% (J.A. Johnson & P.M. Roman, 2002; S.L. Gallon, R.M. Gabriel, J.R.W. Knudsen, 2003; H.K. Knudsen, J.A. Johnson, & P.M. Roman, 2003; A.T. McLellan, D. Carise, & H.D. Kleber, 2003). However, no research to date has evaluated these claims by tracking turnover longitudinally using organizational turnover data from substance abuse treatment centers. This research presents the results of a longitudinal study designed to systematically examine actual turnover among counselors and clinical supervisors. Twenty-seven geographically dispersed treatment organizations, serving a wide range of clients in the public and private sector, provided data for the study over a 2-year time span (2008–2009). The annual turnover rate was 33.2% for counselors and 23.4% for clinical supervisors. For both groups, the majority of turnover was voluntary (employee-initiated). Specific reasons for turnover were largely consistent across the two groups, with the most common reason being a new job or new opportunity. The findings are discussed in terms of the unique employment context of substance abuse treatment. Practical recommendations are also discussed to help stem the tide of turnover in the field of substance abuse treatment.     

Knee injuries: high-resolution MR imaging

Recent technologic advances have made high-resolution magnetic resonance (MR) imaging of the knee a clinical reality. Ten healthy volunteers and 30 patients with suspected knee injuries were imaged using receive-only surface coils and two-dimensional multisection or three-dimensional selective acquisition techniques. Arthroscopic and/or surgical correlation was available in 15 patients. Tears of the cruciate ligament, medial collateral ligament, and meniscus are illustrated. Nonorthogonal views of the anterior cruciate ligament are useful for demonstrating both femoral and tibial attachments in the same section. The posterior cruciate ligament is usually well seen on sagittal views. T2-weighted images are helpful for demonstrating collateral ligament tears and meniscal tears when joint effusion is present. Thin sections (1-5 mm) are necessary to define many meniscal and cruciate tears. High-resolution, thin-section MR imaging can be used to diagnose soft-tissue injuries of the knee and has the potential to become a major imaging method in the evaluation of knee injuries.