“I felt like a superhero”: The experience of responding to drug overdose among individuals trained in overdose prevention

BackgroundOverdose prevention programs (OPPs) train people who inject drugs and other community members to prevent, recognise and respond to opioid overdose. However, little is known about the experience of taking up the role of an “overdose responder” for the participants.MethodsWe present findings from qualitative interviews with 30 participants from two OPPs in Los Angeles, CA, USA from 2010 to 2011 who had responded to at least one overdose since being trained in overdose prevention and response.ResultsBeing trained by an OPP and responding to overdoses had both positive and negative effects for trained “responders”. Positive effects include an increased sense of control and confidence, feelings of heroism and pride, and a recognition and appreciation of one's expertise. Negative effects include a sense of burden, regret, fear, and anger, which sometimes led to cutting social ties, but might also be mitigated by the increased empowerment associated with the positive effects.ConclusionFindings suggest that becoming an overdose responder can involve taking up a new social role that has positive effects, but also confers some stress that may require additional support. OPPs should provide flexible opportunities for social support to individuals making the transition to this new and critical social role. Equipping individuals with the skills, technology, and support they need to respond to drug overdose has the potential to confer both individual and community-wide benefits.     

A型肉毒素内括约肌侧方注射+病灶扇形小切口切扩引流术治疗Ⅱ、Ⅲ期肛裂的临床研究

目的评价A型肉毒素内括约肌侧方注射+病灶扇形小切口切扩引流术治疗Ⅱ、Ⅲ期肛裂的安全性和有效性,探索其手术操作步骤及要点,介绍一种治疗肛裂的新手术方式。方法采用随机、平行、对照的临床试验方法,将纳入病例随机分为试验组和对照组,试验组行A型肉毒素内括约肌侧方注射+病灶扇形小切口切扩引流术,对照组行肛裂切除扩创术加部分内括约肌侧方切断术。将2组安全性指标(包括肛门狭窄、肛门失禁、急性尿潴留、术后疼痛的发生及直肠肛管测压结果)和有效性指标(包括痊愈率、手术时间、切口创面愈合时间、切口愈合分级、切口愈合后瘢痕面积大小)进行比较。结果 2组均无肛门狭窄和急性尿潴留发生;对照组肛门失禁评分高于试验组,但差异无统计学意义(P>0.05)。试验组术后(术后24 h、术后第1次排便及术后1周)疼痛评分明显低于对照组(P<0.01)。术前、术后直肠肛管测压结果 2组间比较差异无统计学意义(P>0.05)。试验组痊愈率高于对照组(P<0.05),手术时间及切口创面愈合时间均明显短于对照组(P<0.01),切口愈合优于对照组(P<0.05),切口愈合后瘢痕面积小于对照组(P<0.01)。结论 A型肉毒素内括约肌侧方注射+病灶扇形小切口切扩引流术具有治愈率高、切口愈合时间短、切口愈合后瘢痕面积小、操作快捷、手术微创化等优点;且在肛门外形和功能保护方面优于对照组,本术式具有较好的临床疗效和安全性。     

The effect of ginseng on sexual dysfunction in menopausal women: A double-blind,randomized, controlled trial

ObjectivesSexual problems constitute a largely-overlooked problem for women during menopause. The present study was conducted to determine the effect of Ginseng on sexual function (primary outcome), quality of life and menopausal symptoms (secondary outcomes) in postmenopausal women with sexual dysfunction.DesignThis randomized controlled trial was conducted on 62 women who were randomly assigned to the intervention/control groups using block randomization.InterventionThe intervention group received 500 mg of Panax Ginseng and the control group received placebo twice daily for four weeks.Main outcome measuresStandard questionnaires including the Female Sexual Function Index (FSFI), the Menopause-Specific Quality of Life (MENQOL) and the Greene Menopausal Symptom Scale were completed before and four weeks after the intervention.ResultsThere were no statistically significant differences between the two groups in terms of demographic characteristics and the baseline scores of sexual function, quality of life and menopausal symptoms (P > 0.05). After the intervention, the mean total score of FSFI (Adjusted Mean Difference = 6.32, 95% CI = 3.48 to 9.16, P < 0.001) was significantly higher in the intervention group compared to the control group. The mean total score of quality of life (AMD=-20.79, 95% CI=-25.83 to -15.75, P < 0.001) and menopausal symptoms (AMD=-8.25, 95% CI=-10.55 to -5.95, P < 0.001) were significantly lower in the treatment group than the control group.ConclusionGinseng has significant effects in improving sexual function and quality of life and mitigating menopausal symptoms. As a multipotent plant, Ginseng can be a suitable alternative for conventional therapies to promote the health of menopausal women.     

伤科接骨片联合双氯芬酸钠治疗闭合性足踝部骨折早期肿胀的疗效观察

目的探讨伤科接骨片联合双氯芬酸钠注射液治疗闭合性足踝部骨折早期肿胀的临床疗效。方法选取2016年12月—2017年12月天全县中医医院收治的100例闭合性足踝部骨折患者,按随机数字法分为对照组和治疗组,每组各50例。对照组患者肌肉注射双氯芬酸钠注射液,50 mg/次,2～3次/d。治疗组在对照组治疗的基础上以温开水或温黄酒送服伤科接骨片,4片/次,3次/d。两组患者均连续治疗4d。观察两组的临床疗效,比较两组的临床症状改善情况和视觉模拟评分法(VAS)评分。结果治疗后,对照组和治疗组的总有效率分别为82.00%、90.00%,两组比较差异具有统计学意义(P0.05)。治疗后,治疗组踝关节背伸、踝关节屈曲均明显大于对照组,消肿止痛时间、住院时间均明显短于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者VAS评分均显著降低,同组治疗前后比较差异具有统计学意义(P0.05);且治疗后治疗组患者VAS评分均明显低于对照组,两组比较差异具有统计学意义(P0.05)。结论伤科接骨片联合双氯芬酸钠注射液治疗闭合性足踝部骨折早期肿胀具有较好的临床疗效,可改善临床症状,缓解疼痛,具有一定的临床推广应用价值。     

灯盏细辛注射液联合丁苯酞治疗急性脑梗死的临床研究

目的探讨灯盏细辛注射液联合丁苯酞氯化钠注射液治疗急性脑梗死的临床疗效。方法选取2017年3月—2018年11月洛阳市第三人民医院收治的90例急性脑梗死患者为研究对象,按照随机数字表法将患者分为对照组和治疗组,每组各45例。对照组静脉滴注丁苯酞氯化钠注射液,25 mg/次,2次/d。治疗组在对照组治疗的基础上静脉滴注灯盏细辛注射液,30 mL加入到250 mL生理盐水中充分稀释,30 mL/次,1次/d。两组患者均连续治疗14 d。观察两组患者的临床疗效,同时比较两组治疗前后的神经功能缺损评分(NIHSS)、日常生活活动能力评定量表(ADL)评分和血管内皮功能指标。结果治疗后,对照组和治疗组的总有效率分别为75.56%、91.11%,两组比较差异具有统计学意义(P0.05)。治疗后,两组NIHSS评分显著降低,ADL评分显著升高,同组治疗前后比较差异具有统计学意义(P0.05);治疗后,治疗组NIHSS评分显著低于对照组,ADL评分显著高于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组的内皮素-1(ET-1)、血管生成素(Ang-1)、血管内皮生长因子(VEGF)水平明显降低,一氧化氮(NO)明显升高,同组治疗前后比较差异具有统计学意义(P0.05);治疗后,治疗组血管内皮功能指标水平显著优于对照组,两组比较差异具有统计学意义(P0.05)。结论灯盏细辛注射液联合丁苯酞氯化钠注射液治疗急性脑梗死具有较好的临床疗效,能改善患者的神经功能和血管内皮功能指标,具有一定的临床推广应用价值。     

加味四妙勇安汤联合前列地尔注射液治疗下肢动脉闭塞90例临床研究

目的:观察加味四妙勇安汤联合前列地尔注射液治疗下肢动脉闭塞疗效。方法:将90例下肢动脉闭塞症患者随机分为治疗组和对照组,各45例。治疗组给予加味四妙勇安汤联合前列地尔注射液治疗,加味四妙勇安汤每日1剂,水煎服,连用3周;对照组给予前列地尔注射液治疗。其它情况处理,两组同样对待。前列地尔注射液2 m L+生理盐水10 m L缓慢静注,连续治疗两周为1个疗程,每20天1个疗程,共治疗4个疗程,其他治疗两组相同。观察两组患者治疗结束后临床疗效、血浆血脂及两组病人治疗前后症状变化。结果:治疗组患者总有效率为97.8%,高于对照组的88.9%,比较两组患者的总有效率,经检验后得出差异有统计学意义(χ2=4.94,P=0.026)。两组患者治疗结束后的总胆固醇、低密度脂蛋白均较治疗前有所降低,而高密度脂蛋白较治疗前则有所升高,与对照组相比差异具有统计学意义(P<0.05)。两组患者的ABI值也较治疗前有所升高,但治疗组ABI升高值明显大于对照组,差异具有统计学意义(P<0.03)。两组患者症状体征积分比较,差异具有统计学意义(P<0.001)。结论:加味四妙勇安汤联合前列地尔注射液治疗下肢动脉闭塞症临床疗效肯定,可能通过降低患者的血浆血脂而起作用。     

肉毒毒素注射引起的不良反应

肉毒毒素注射引起的不良反应,是药物本身的组成成分引起的与用药目的无关的有害反应,与医生注射方式和注射技术无关。尽管肉毒毒素生产厂家的药品说明书上也有提示,但其所提供的信息不够全面,也未必能引起医生的足够重视。目前文献上多为散发病例。为此作者对过去20年有关肉毒毒素注射引起的过敏反应、肉瘤样肉芽肿、眼睑水肿、流感样症状等相关不良反应的临床表现、发病机制与治疗方法进行综述。     

‘For me… it's a miracle’: Injecting beauty among kathoeis in a provincial Thai city

BackgroundThe Thai term kathoei refers to non-gender-normative females, males and intersexual individuals at different stages of the transitional spectrum with recognized social and cultural roles in society. Nevertheless, kathoeis are only tolerated in Thai society. Many kathoeis seek social acceptance through beauty and turn to the off-label injection of various ‘beauty drugs’.MethodsThe first author conducted an ethnographic study of injection parties at a wedding studio in a Central Thai provincial city between April and September 2011. Data were gathered through participant observation, focus group discussions and narrative interviews with six participants. All data were collected and analyzed in Thai, and later translated.ResultsWhile injection parties provide opportunities for kathoeis to socialize, bond, and share experiential knowledge on chemically assisted transformation, they also reproduce ideologies of gender, beauty and sexuality that reinforce the notion that if a kathoei is to maintain her beauty, she must use medicines more frequently and in higher doses.ConclusionInjection parties among Thai kathoeis feature drug use that is entirely reasonable in terms of their own lay knowledge. Empowering kathoeis, by providing accessible information on chemicals and health in a way that reflects the complexity and diversity of their practices, would be one way to reduce health risks. Society must give more long-term options to kathoeis to build their sense of self, based on things besides being beautiful.