Leveraging social capital: multilevel stigma,associated HIV vulnerabilities,and social resilience strategies among transgender women in Lima,Peru

Introduction : In Peru, transgender women (TW) experience unique vulnerabilities for HIV infection due to factors that limit access to, and quality of, HIV prevention, treatment and care services. Yet, despite recent advances in understanding factors associated with HIV vulnerability among TW globally, limited scholarship has examined how Peruvian TW cope with this reality and how existing community‐level resilience strategies are enacted despite pervasive social and economic exclusion facing the community. Addressing this need, our study applies the understanding of social capital as a social determinant of health and examines its relationship to HIV vulnerabilities to TW in Peru. Methods : Using qualitative methodology to provide an in‐depth portrait, we assessed (1) intersections between social marginalization, social capital and HIV vulnerabilities; and (2) community‐level resilience strategies employed by TW to buffer against social marginalization and to link to needed HIV‐related services in Peru. Between January and February 2015, 48 TW participated (mean age = 29, range = 18–44) in this study that included focus group discussions and demographic surveys. Analyses were guided by an immersion crystallization approach and all coding was conducted using Dedoose Version 6.1.18. Results : Themes associated with HIV vulnerability included experiences of multilevel stigma and limited occupational opportunities that placed TW at risk for, and limited their engagement with, existing HIV services. Emergent resiliency‐based strategies included peer‐to‐peer and intergenerational knowledge sharing, supportive clinical services (e.g. group‐based clinic attendance) and emotional support through social cohesion (i.e. feeling part of a community). Conclusion : This study highlights the importance of TW communities as support structures that create and deploy social resiliency‐based strategies aimed at deterring and mitigating the impact of social vulnerabilities to discrimination, marginalization and HIV risk for individual TW in Peru. Public health strategies seeking to provide HIV prevention, treatment and care for this population will benefit from recognizing existing social capital within TW communities and incorporating its strengths within HIV prevention interventions. At the intersection of HIV vulnerabilities and collective agency, dimensions of bridging and bonding social capital emerged as resiliency strategies used by TW to access needed healthcare services in Peru. Fostering TW solidarity and peer support are key components to ensure acceptability and sustainability of HIV prevention and promotion efforts.     

Clinicopathological correlation in biopsy-proven atherosclerotic nephropathy: implications for renal functional outcome in atherosclerotic renovascular disease.

BACKGROUND: Atherosclerotic renovascular disease (ARVD) is commonly associated with renal failure. It is now recognized that intrarenal damage, (ischaemic or atherosclerotic nephropathy) is a major contributor to the renal impairment in these patients. In this study the impact of histological changes upon renal functional outcome was investigated in patients with atherosclerotic nephropathy. METHODS: The Hope Hospital renal biopsy database (1985-1998) was interrogated for patients with histology compatible with atherosclerotic nephropathy. Case-note review enabled the assessment of several clinical parameters and outcomes, including change in creatinine clearance per year (DeltaCrCl (ml/min/year)), blood pressure control, dialysis need, and death. Renal parenchymal damage was analysed by morphometric analysis (of interstitial fibrosis and glomerulosclerosis) and a semi-quantitative chronic damage score (score 0-3 (normal-severe) for each of glomerulosclerosis, interstitial fibrosis, tubular atrophy, and arteriolar hyalinosis; maximum=12). Patients were stratified into two groups who had either deteriorating (group 1) or stable (group 2) renal function during follow-up. RESULTS: Twenty-five patients (age 64.7+/-10.5, range 43-83 years; 17 male, eight female) were identified. Sixteen patients had undergone angiography; two had significant (>50%) renal artery stenosis. Mean follow-up was 25.6+/-14.8 (range 5-50) months. Group 1 patients had DeltaCrCl -7.4+/-6.8 ml/min/year, n=14 and group 2 patients had DeltaCrCl 4.8+/-7.0 ml/min/year, n=11. Four patients in group 1 developed end-stage renal disease and five patients died (three in group 1 and two in group 2). At study entry, group 1 patients had worse renal function (CrCl 27.6+/-17.6 vs 36.0+/-33.9, NS), greater proteinuria (1.2 vs 0.5 g/24 h, NS), and higher systolic blood pressure (167.1+/-30.8 mmHg vs 150.6+/-37.8, NS) compared with group 2 patients. Group 1 patients showed more glomerulosclerosis (51.6 vs 24.9%, P:<0.01), greater proportional interstitial volume (44.9 vs 33.9%, P:<0.02), and higher overall chronic damage score (P:<0.05) than those in group 2. There was a significant correlation between renal functional outcome and chronic damage score, glomerulosclerosis and proportional interstitial volume for the entire patient cohort. CONCLUSION: In patients with atherosclerotic nephropathy the severity of histopathological damage is an important determinant and predictor of renal functional outcome.     

Maximum Preservation of the Media in Carotid Endarterectomy

Carotid endarterectomy (CEA) is intended to remove atheromatous plaque by dissecting a plane between the intima and the media (circular medial fibers), but this may not be the optimal dissection plane. The present technique is based on identifying the plane that divides the media from the plaque, so preserving the media on the adventitia as much as possible. This plane is more difficult to find and follow than the easy-to-dissect plane usually located between the media and the adventitia, because the plaque invades the media and so the dividing plane is located within the media. In this prospective observational study, CEA was performed in 22 patients to histologically examine the excised plaques and small samples of the whole arterial wall, and evaluate the clinical outcomes. Plaque had invaded the luminal part of the media in the whole arterial wall sample of 80% of cases. Thin medial layers covering > 80% of the surface of the plaque were found in 16 of 22 plaques (73%). Some atheromatous component was sometimes left in the preserved media, rather than completely removed with the media. No morbidity or mortality had occurred by discharge. Only 1 small ipsilateral infarction (4.5%) and no restenosis of greater than 50% were detected during the mean follow-up period of 7 years. Since the plaque usually invades the media, the optimum dissection plane may be located within the media, dividing it into two layers. The presence of some remnant atheromatous components in the preserved media was not associated with surgical complications or restenosis.     

The role of Randall plaques on kidney stone formation

Randall’s plaque is microscopically a plaque of calcium deposited in the interstitial tissue of the renal papilla. These plaques are thought to serve as a nidus for urinary stone formation. Large amounts of Randall’s plaque are unique to idiopathic calcium oxalate stone formers. Although Randall’s plaques can be found in other stone formers, only in idiopathic calcium oxalate stone formers, the detailed mechanism of stone overgrow on plaque was thoroughly studied. Calcification is invariably located in the basement membrane of the loops of Henle and from there plaques spread through the interstitium toward urothelium. Within the basement membrane, mineral deposits are individual laminated particles in which zones of crystal and organic matrix overlay each other. In the interstitium, the particles appear to fuse on the collagen bundles to form a syncytium of crystal islands in an organic sea. By loss of integrity of urothelium, regions of plaque are exposed to urine. The exposed surface will touch and be covered by molecules of urine origin, including osteopontin, Tamm Horsfall protein, and crystals formed under urine supersaturations, resulting in a ribbon of alternating matrix and crystal. Eventually crystallization escapes from matrix modulation and crystals extend outward into the space of urine and begin to form a calcium oxalate stone proper. Randall’s plaque plays an important role and is prerequisite of kidney stone formation in idiopathic calcium oxalate stone formers.     

颈动脉支架成形术前应用非增强多对比高分辨磁共振斑块成像评估价值研究

目的 分析非增强多对比高分辨磁共振成像技术在颈动脉支架成形术（CAS）术前评估中的应用价值。方法 回顾性分析2017年1 月至2018 年3月在复旦大学附属中山医院接受颈动脉狭窄接受治疗的181例病人资料,通过单因素和多因素Logistic回归分析明确颈动脉斑块性质与CAS术后脑梗死病灶的关系。结果 共纳入接受CAS手术病人181例,其中术后63例（34.8%）出现无症状性新发弥散加权成像（DWI）病灶,2例（1.1%）出现有症状性脑梗死。病人Logistic回归分析结果显示颈动脉斑块内出血是预测CAS术后的无症状DWI病灶的独立危险因素（IPH）（亚急性期IPH vs. 无IPH：OR=9.393;95%CI 4.431~19.911）。结论 术前应用非增强多对比高分辨磁共振成像对斑块成分进行评估可以发现斑块不稳定成分,对CAS手术病例的选择有重要的潜在价值。     

整脊推拿结合化痰祛瘀方治疗颈源性眩晕伴颈动脉斑块43例

目的:观察整脊推拿结合中药化痰祛瘀方治疗颈源性眩晕伴颈动脉斑块的的效果及安全性。方法:伴有颈动脉斑块的颈源性眩晕患者按随机数字表法分为两组,对照组45例采用基础治疗联合中药化痰祛瘀方,观察组43例在对照组基础上结合整脊推拿干预,治疗后统计比较两组眩晕指征和血脂改善情况。结果:治疗后两组患者眩晕、耳鸣、恶心欲呕、头痛、视力障碍、猝倒发作、颈项不适、反应迟钝等症状的恢复率比较,差异有统计学意义(P<0.01);治疗结束后观察组的总有效率为95.35%,明显优于对照组的77.78%,差异有统计学意义(P<0.05);疗程结束后两组患者血脂均较治疗前有所改善(P<0.05),观察组中的总胆固醇(TC)、低密度脂蛋白(LDL)明显低于对照组,高密度脂蛋白(HDL)明显高于对照组,差异均有统计学意义(P<0.05),但三酰甘油(TG)和对照组比较差异无统计学意义(P> 0.05)。结论:整脊推拿结合化痰祛瘀方治疗颈源性眩晕伴颈动脉斑块,在改善眩晕相关指征和血脂方面疗效较好。     

血浆同型半胱氨酸与缺血性脑血管病患者颈动脉粥样硬化斑块的关系研究

目的探讨血浆同型半胱氨酸(Hcy)浓度与缺血性脑血管病患者颈动脉粥样硬化斑块的关系。方法选择2017年1月～2018年6月治疗的缺血性脑血管病患者307例作为研究对象,所有患者均行颈动脉彩色多普勒超声检查,根据超声检查结果分为三组:A组(稳定斑块)、B组(不稳定斑块)、C组(无斑块);对其血浆Hcy浓度进行检测,采用SPSS Pearson相关性分析软件对血浆Hcy浓度与颈动脉粥样硬化斑块的关系进行分析。结果 307例患者中,C组68例(占比22.15%),有颈动脉斑块239例(占比77.85%),其中,B组81例(占比33.89%),A组158例(占比66.11%)。此外,D组112例(占比46.86%),E组127例(占比53.14%);A组与B组的血浆Hcy浓度显著高于C组(P0.05);B组的血浆Hcy浓度显著高于A组(P0.05);D组的血浆Hcy浓度显著高于E组(P0.05);SPSS Pearson相关性分析结果表明:血浆Hcy浓度与颈动脉粥样硬化斑块呈正相关(P0.05)。结论血浆Hcy浓度与缺血性脑血管病患者颈动脉粥样硬化斑块的形成以及稳定性均存在密切关联,加强血浆Hcy浓度测定可评估患者预后,指导临床治疗。     

颈动脉粥样硬化性狭窄患者应用颈动脉内膜剥脱手术治疗的效果及对患者TESS评分的影响

目的探讨颈动脉粥样硬化性狭窄患者应用颈动脉内膜剥脱手术治疗效果及对患者TESS评分影响。方法选取2017年1月～2019年1月我院收治的98例颈动脉粥样硬化性狭窄患者,随机分为两组,各49例。对照组进行颈动脉支架植入术(CAS)治疗,研究组进行颈动脉内膜剥脱手术(CEA)治疗。比较两组患者治疗效果、手术、住院时间、住院费用、围术期及随访不良事件发生率。结果两组总有效率比较,差异无统计学意义(P0.05);两组患者围术期不良事件发生率比较,差异无统计学意义(P0.05);研究组住院费用低于对照组(P0.05),但研究组住院时间和手术时间长于对照组(P0.05);经随访,两组TESS评分比较,差异无统计学意义(P0.05),但研究组术后再狭窄发生率低于对照组(P0.05)。结论颈动脉支架植入术和颈动脉内膜剥脱术具有相似治疗效果,在安全性方面没有明显差异。但颈动脉内膜剥脱术可减少住院费用,降低术后再狭窄发生率,具有较高的临床价值,应进一步推广应用。     

双联抗血小板治疗伴易损斑块的轻度症状性颈动脉狭窄的疗效和安全性

目的：探讨阿司匹林联合氯吡格雷治疗伴易损斑块的症状性颈动脉狭窄患者的疗效和安全性。方法利用颈动脉超声检查筛选205例存在颈动脉易损斑块,且颈动脉狭窄＜50％的缺血性卒中患者,随机分为阿司匹林治疗组（单抗组）102例和阿司匹林联合氯吡格雷治疗组（双抗组）103例,比较两组治疗90 d内外周血基质金属蛋白酶－9（MMP －9）的变化,以及卒中和血管性意外事件的发生率。结果治疗21 d后,双抗组血液中M M P －9浓度下降值高于单抗组[（77．26±13．71）ng／ml比（96．86±16．52）ng／ml ,P＜0．01]。双抗组90 d内脑梗死总复发率和同侧复发率均低于单抗组（3．88％比11．76％,P ＝0．035;1．94％比8．82％,P ＝0．029）,两组对侧脑梗死复发率差异无统计学意义（1.94％比2．94％,P＝0．643）。双抗组同单抗组相比,出血事件（0．97％比0,P＞0．05）和急性冠脉综合征的发生率（1．94％比5．88％, P ＝0．145）差异均无统计学意义。结论对于伴易损斑块的症状性颈动脉狭窄患者,阿司匹林联合氯吡格雷双联抗血小板治疗相对阿司匹林单抗治疗更具优势。     

Dual-Energy Computed Tomography as an Adjunct in the Evaluation of Peripheral Chronic Total Occlusions: A Feasibility Study

This study investigated the role of dual-energy computed tomography (CT) for lesion characterization in patients with peripheral arterial disease manifesting with chronic total occlusions (CTOs). Forty-one symptomatic patients with CTOs underwent dual-energy CT angiography before endovascular treatment. The lesions were subsequently analyzed in a dedicated workstation, and 2 indexes—dual-energy index (DEI) and effective Z (Z_eff)—were calculated, ranging from 0.0027 to 0.321 and from 6.89 to 13.02, respectively. Statistical analysis showed a significant correlation between the DEI and Z_eff values (P < .001). The interobserver intraclass correlation coefficient was 0.91 for the mean Z_eff values and 0.86 for the mean DEI values. This technique could potentially provide useful information regarding the composition of a CTO.