Pilot study to enhance HIV care using needle exchange-based health services for out-of-treatment injecting drug users

The introduction of highly active antiretroviral therapy (HAART) has resulted in marked reductions in mortality and acquired immunodeficiency syndrome (AIDS) incidence across all risk groups; however, the proportionate decrease among injecting drug users (IDUs) has been less impressive. Much of the disparity in benefit to IDUs has been a consequence of decreased access to and receipt of potent antiretroviral combinations. Strategies to increase access to and utilization of HAART have included entry into drug treatment and abstinence. Unfortunately, as few as 15%–20% of active drug users in the United States, and in many other countries, are in drug treatment at any one time. We report a pilot project among out-of-drug treatment IDUs infected with human immunodeficiency virus (HIV); HIV therapy was successfully provided to active heroin injectors using the Community Health Care Van (CHCV) at sites of needle exchange. Subjects were willing to initiate, but were not receiving, recommended HIV therapy and were not interested in formal drug treatment. Antiretroviral therapy regimens were selected and linked to heroin injection timing. Weekly visits were scheduled by CHCV staff to assess adverse side effects and encourage adherence. Of the 13 participants, the mean baseline HIV-1 RNA level and CD4 lymphocyte count were 162,369 (log 5.21) copies per milliliter and 265 cells per milliliter, respectively. By 6 months, the proportion whose HIV-1 RNA was below the limits of detection (<400 copies/mL) was 85% (N=11); 77% (N=10) had nondetectable levels by 9 months. By 12 months, 54% (N=7) had a persistently nondetectable viral load, and the net increase in CD4 lymphocyte count was 150 cells per milliliter. As an additional and unintended benefit of this pilot project, 9 (69%) subjects chose to enter drug treatment after achieving a nondetectable viral load. Entry into drug treatment was associated with durability of viral suppression. This small pilot study suggests that health services based on needle exchange may enhance access to HAART among out-of-treatment HIV-infected IDUs. In addition, it demonstrates that this population can benefit from this therapy with the support of a nontraditional, community-based health intervention.     

Ziehl-Neelsen-维多利亚蓝-碘绿复合染色法显示抗酸杆菌

目的 :探讨显示皮肤活检组织中抗酸麻风杆菌、弹力纤维和细胞等组织成分的复合染色法。方法 :运用Ziehl Neelsen(Z N)苯酚复红染色液、维多利亚蓝 (Victoriablue ,VB)染色液、碘绿 (iodinegreen ,IG)和马汀氏黄 (Mar tiusyellow ,MY)染色液对皮肤活检组织进行复合染色。结果 :组织内结核样结节中麻风杆菌显示为红色 ,细胞核呈淡绿色 ,细胞浆无色 ,结节周围的弹性纤维呈蓝色 ,基质呈淡黄色。结论 :Z N原法染色单一 ,对比效果差 ,应用碘绿、马汀氏黄和维多利亚蓝复合的改造染色液 ,能更好显示组织中的麻风杆菌 ,以及包绕于结核样结节周围的弹力纤维等成分 ,该方法是一种对比清晰 ,可靠的复合染色法     

The effect of pre-vertebroplasty tumor ablation using laser-induced thermotherapy on biomechanical stability and cement fill in the metastatic spine

A biomechanical study comparing simulated lytic vertebral metastases treated with laser-induced thermotherapy (LITT) and vertebroplasty versus vertebroplasty alone. To investigate the effect of tumor ablation using LITT prior to vertebroplasty on biomechanical stability and cement fill patterns in a standardized model of spinal metastatic disease. Vertebroplasty in the metastatic spine is aimed at reducing pain, but is associated with risk of cement extravasation in up to 10%. Six pairs of fresh-frozen cadaveric thoracolumbar spinal motion segments were tested in axial compression intact, with simulated metastases and following percutaneous vertebroplasty with or without LITT. Canal narrowing under load, pattern of cement fill, load to failure, and LITT temperature and pressure generation were collected. In all LITT specimens, cement filled the defect without extravasation. The canal extravasation rate was 33% in specimens treated without LITT. LITT and vertebroplasty yielded a trend toward improved posterior wall stability (P = 0.095) as compared to vertebroplasty alone. Moderate rises in temperature and minimal pressure generation was seen during LITT. In this model, elimination of tumor by LITT, facilitates cement fill, enhances biomechanical stability and reduces the risk of cement extravasation.     

鼻内镜下等离子射频治疗儿童腺样体肥大60例分析

目的探讨鼻内镜下运用等离子治疗仪行腺样体射频减容的优点。方法分析60例腺样体肥大儿童接受等离子手术前、后的临床资料,并对术前术后听力、夜间打鼾、鼻塞等症状恢复情况进行观察比较。结果术后腺样体明显缩小,A/N值小于0.6,鼻咽部结构显示良好,无咽鼓管损伤等并发症发生。随访1~2年,患儿症状消失或明显减轻,治疗有效率为100%。结论鼻内镜下运用等离子射频减容手术治疗腺样体肥大是一种安全有效、简单易行的手术方法,值得推广。     

焦痂提取液中丙二醛含量对线粒体呼吸及内膜能化作用的影响

大鼠背部20％光辐射Ⅲ度烧伤7天后的焦痂提取液及1:4、1:8稀释液能对正常大鼠肝线粒体呼吸产生明显的抑制作用,相同方法制成的正常皮提取液只呈轻度抑制,1:4稀释液已无抑制作用,两者丙二醛含量相差悬殊,丙二醛含量与抑制率呈相关,但进一步分析表明这种相关为共存现象,丙二醛含量增高不是呼吸率下降的直接原因。丙二醛增高与膜脂双层的破坏有关,内膜能化作用实验表明,当膜脂受到一定程度破坏时,能化作用受到抑制。然而在能化作用未表现异常时,呼吸率已呈一定程度抑制,故呼吸率抑制还受到提取液其他组分的影响。     

儿童白内障术后远期结果的研究进展

本文对近几年一些学者对儿童白内障远期随访结果进行了综述和评价。手术时机选择、儿童特殊的屈光变化以及如何精确测定儿童植入人工晶状体性能及屈光度都对儿童白内障术后远期视功能产生影响。慢性青光眼是儿童白内障术后远期丧失视力的主要原因。长期弱视治疗是获得手术成功的保证之一。因此，要真正获得有用的视功能，应重视儿童白内障手术后的后续治疗，并提议应建立完善的白内障术后追踪随访和弱视治疗机构。     

复方熊胆眼药水对实验性兔角膜白斑的疗效观察

本实验根据中医学对角膜瘢痕的认识以及历代中医应用中药熊胆治疗角膜翳的理论和方法,配制了复方熊胆眼药水.通过复方熊胆眼药水对实验性兔角膜白斑的疗效观察和光镜下兔角膜病理形态学检查,结果提示复方熊胆眼药水有显著的退翳作用,探讨该作用是通过消除角膜的慢性炎症,增加其局部组织代谢来实现的.指出复方熊胆眼药水对临床角膜瘢痕患者的治疗及角膜移植术前的辅助治疗是有积极意义的.     

小儿肱骨髁上骨折合并血液循环障碍的处理(附52例报告)

我院1968～1984年间收治小儿肱骨髁上骨折并血循环障碍52例采用非手术治疗的方法如下:对无急性缺血者采取臂丛麻醉,手法整复,鹰嘴骨牵引1～2周后,小夹板外固定,功能煅炼等中西医结合的处理,均获得满意的功能恢复,无一例发生缺血性肌挛缩。     

降低医疗保健服务中HIV/AIDS相关歧视研究:背景、问题及研究框架

医疗保健领域中艾滋相关偏见与歧视问题已得到国际社会及众多艾滋病防治领域工作者的广泛关注。在欧洲联盟资助下,设计并实施了一个为期1年的行动性研究以探索如何降低医疗保健领域的偏见与歧视。本文回顾了偏见与歧视的概念以及UNAIDS提出的医疗保健领域艾滋相关歧视的主要表现形式,提出了本研究中的偏见与歧视的操作定义及范畴,并给出了本研究的背景及框架。     

艾滋病与千年发展目标

通过艾滋病的流行和传播与其他发展目标的相互影响,论证遏制并扭转艾滋病蔓延的紧迫性,同时采取多途径确保千年发展目标的最终实现。