西安市男男性行为人群感染HIV-1的分子流行病学研究

目的 了解西安市MSM感染HIV-1毒株亚型分布。方法 采集2010--2012年西安市确证的经男男同性传播的HIV感染者外周静脉血5ml,抗凝后分离血浆,提取总RNA,利用巢式反转录PCR扩增HIulgag和env基因,利用Mega5.2软件与国际参考序列进行拼接、比对、计算基因离散率和构建系统进化树;同时进行流行病学问卷调查,行为学调查重点包括性行为特征、吸毒史、献血史等。结果 168份样本中,165例gag与env序列分型结果 一致,分别为79例(47.0%)CRF01AE、74例(44.o%)CRF07BC、12例(7.1%)B亚型。3例gag与env序列分型结果不一致,分别为2例(1.2%)CRF01AE/A1、1例(0.6%)CRF07BC/CRF01AE。结论 西安市MSM感染HIV-1毒株亚型主要为CRF01AE、CRF07BC。     

浙江省男男性接触HIV-1感染者病毒基因特征分析

目的分析浙江省2004—2011年117名男男性接触者（MSM）HIV-1感染病毒的序列特征,了解HIV-1毒株类型和特征。方法从实验室留样的MSM HIV感染者血液中提取DNA或RNA,用巢式PCR或RT-PCR方法扩增gag、pol基因区片段,测定序列并分析。结果 117名MSM HIV感染者中,序列结果按户籍来源覆盖21个省（市、自治区）,感染毒株包括CRF01_AE 99名（84.62%）、B亚型7名（5.98%）、CRF07_BC 6名（5.13%）、CRF08_BC和CRF59_01B各1名（0.85%）。3名（2.56%）疑似01_B重组毒株与安徽感染者在系统进化树上聚集成可靠的次级进化簇（99%）,且具有类似重组断点模式。84个CRF01_AE毒株的pol区基因序列聚集成簇,形成多个可靠的次级进化簇（30个节点的bootstrap值高于70%）。结论浙江省MSM HIV感染者主要流行CRF01_AE毒株,该人群HIV感染率高,应加强监测。CRF59_01B和新的01B重组毒株在浙江首次检出。     

云南省2008-2009年HIV-1病毒株亚型分布

目的 了解云南省目前HIV-1流行株的基因型及其地区和人群分布。方法 收集2008-2009年云南省15个地市788例HIV感染者/艾滋病患者（HIV/AIDS）的血浆标本和背景信息,采用RT-PCR法分别扩增HIV-1 gag、pol全长基因（1584 bp和3147 bp）及env基因的C2V3片段（558 bp）,序列编辑后用Genotyping及Mega 5.03软件工具确定病毒基因型,分析HIV-1株的地区和人群分布特征。结果 788例标本获得1728条HIV-1基因序列,其中全长gag基因序列599条、全长pol基因序列564条、env基因C2V3区序列525条,确定617例基因亚型,构成比分别为CRF08 BC（50.2%）、CRF01 AE（25.0%）、未知重组（10.2%）、CRF07_BC（9.2%）、C亚型（2.9%）和B（B''）亚型（2.4%）。HIV-1株在云南省具有地域分布特征,可分为以临沧和昆明为代表的CRF08_BC为主的地区,以德宏和西双版纳为代表的CRF08_BC与CRF01 _AE构成比相近的地区;未知重组型在云南省少数民族中所占比例（17.0%）显著高于汉族（6.7%）;异性性传播感染者和静脉注射吸毒感染者的CRF08 BC亚型均占总数的50.0%以上,但前者CRF01_AE的构成比占约30.0%,后者未知重组型和CRF07 BC的比例分别达到约15。0%。未知重组病毒株呈现两种重组模式,分别为B（B''）/C重组和以CRF01 AE为母株嵌入B（B''）和/或C片段重组,并以前者为主（74.6%）。结论 云南省HIV-1株组成复杂,具有显著的地域、民族和传播途径相关的特征,并出现新型重组病毒株,应密切监测。     

深圳市男男性行为人群人类免疫缺陷病毒1型流行株的聚集性分析

目的研究深圳市男男性行为(MSM)人群人类免疫缺陷病毒1(HIV-1)亚型的聚集性,为艾滋病的预防治疗提供科学依据。方法 RT-PCR巢式扩增深圳市MSM人群HIV-1病毒的gag基因和env基因,结合HIV数据库和MEGA4.02软件分析测序结果,确定亚型;建立进化树,比较各亚型的组内基因离散率。结果深圳市MSM人群中HIV-1流行株以CRF01-AE为主,占53.0%,与CRF07-BC、CRF08-BC、B、C共同存在,各个亚型均形成了簇集(cluster);B亚型cluster的基因离散率最大(gag区:9.5%,env区:16.1%),CRF01-AE形成了3个独立的cluster。结论深圳市MSM人群中流行的HIV-1毒株是复杂的,并且不同亚型的毒株也有各自的变异,以CRF01-AE和B亚型最为典型,病毒基因的变异对病毒的表型,疾病的进程及耐药性的影响尚待进一步研究。     

一对男男性接触HIV感染者体内毒株基因序列的分析

目的应用分子流行病学方法,以分析2名具有高危性行为的男男性接触者(MSM)间HIV-1病毒传播关系。方法对2名人类免疫缺陷病毒(HIV)感染者进行流行病学调查。应用巢式RT-PCR扩增HIV-1 pol区和gag区基因,经DNA测序后,结合流行病学资料,用遗传进化系统树比对的方法分析两感染者体内HIV-1毒株的亲缘关系。结果该2名感染者体内HIV-1毒株所属亚型分别为HIV-1 CRF07_BC和CRF01_AE,gag和pol基因之间的基因距离分别为0.125和0.096。结论该2名男男性接触者间不存在HIV-1传播关系。     

克拉玛依市HIV-1 env gag pol基因特征变异研究

目的研究克拉玛依市HIV-1 env、gag、pol基因特征及不同亚型混合感染情况。方法巢氏PCR方法扩增2017年克拉玛依市HIV新发现病例env、gag、pol基因,结合已知亚型利用Mega软件分析测序结果。结果 48份样本env、gag、pol三种基因分别获得合格序列36份、35份和41份,CRF07_BC是三种基因分型的主要亚型,CRF01_AE排第二位。除此外还发现克拉玛依市存在其他亚型和重组型,HIV-1 pol基因有新型变异亚型CRF79_0107、URF_01B、URF_02B。有6份样本存在三种基因分型不完全一致情况,即不同亚型混合感染。结论克拉玛依市HIV-1防控形势相对于新疆其他地市更加严峻,预防和控制艾滋病在不同人群间相互传播、防止混合感染为目前首要任务。     

2018年临沂市MSM人群新感染 HIV-1病毒基因亚型分析

目的了解临沂市MSM人群新感染HIV-1病毒基因的流行亚型。方法收集2018年1～4月临沂市新感染的经男男性行为传播的未经治疗的HIV-1阳性血浆样本,应用巢式-聚合酶链反应(Nested-PCR)扩增病毒基因的pol区片段,进行基因测序和亚型分析。结果收集到符合条件的样本31例,成功扩增出29例感染者病毒的有效序列,共检出4种基因亚型:CRF07_BC、CRF01_AE、C、CRF55_01B,优势毒株为CRF01_AE(62.07%)和CRF07_BC(20.69%)亚型。结论本时段内临沂市新确证的MSM感染者毒株以CRF01_AE亚型为主,监测临沂市MSM人群HIV-1感染者毒株亚型分子流行病学特征,对临沂市艾滋病防治非常必要。     

北京市2006年HIV一1流行毒株的gag和env基因序列测定及亚型分析

目的监测2006年北京市北京户籍HIV感染者中HIV-1型流行病毒株的亚型分布特点和变化规律。方法采集北京市2006年新确认北京户籍HIV-1感染者的抗凝全血样品32份,分离血浆,提取病毒RNA,用巢式聚合酶链反应方法扩增病毒gag和env基因,并进行序列测定和亚型分析。结果系统进化分析表明北京户籍HIV-1感染者样品分别属于5个亚型,分别为B亚型9份,泰国B亚型2份、C亚型2份,流行重组型CRF07 BC亚型5份,流行重组型CRF01．AE亚型4份。结论北京市居民中已存在多种HIV-1亚型和流行重组型,应加强对HIV-1毒株亚型变异的监测,及时调整防治策略。     

海南省HIV-1基因亚型分析

目的 分析海南省人类免疫缺陷病毒-1(HIV-1)基因亚型,监测HIV毒株的流行状况.方法 从88份HIV-1抗体阳性的血浆中提取RNA,逆转录后采用PCR法扩增HIV-1基因序列中的env及pol基因,对扩增产物进行核苷酸序列测定,经比对分析而确定基因亚型.构建最大似然(ML)进化树,分析感染者间的传播链.结果 88份样品中,有83份样品被扩增出HIV-1的env及pol基因片段;共发现6种HIV-1亚型和重组型,其中CRF01-AE亚型70份,B'亚型8份,C亚型2份,B亚型和CRF08-BC、CRF01-AE/B'重组亚型各1份.在ML进化树上83份样品分成4个传播群(66/83)和非传播群(17/83),其中传播群1最庞大(59/83).结论 海南省HIV/AIDS的HIV-1基因亚型至少有6种,其中CRF01-AE为主要亚型,占84.33%(70/83),主要分布在静脉吸毒者及其性伴侣之间,形成了一个庞大的传播群.其次为B'亚型(9.6%).另外的4种亚型(6%)仅见单个病例.提示海南省静脉吸毒为主要的感染途径(67.5%);经性接触传播的亚型种类复杂多样,包括本次检出的全部亚型和重组株.     

湖北省HIV-1 B′亚型核心蛋白基因序列分析

目的 分析湖北省人类免疫缺陷病毒(HIV-1)主要流行株核心蛋白(gag)基因P17/24区序列特征,了解其流行特点和变异规律.方法 对湖北省HIV-1主要流行区域进行流行病学调查,应用巢式聚合酶链反应对102例HIV-1感染者的gag基因P17/24区进行扩增,对阳性扩增样本进行基因测序和序列分析.结果 湖北省共发现4种HIV亚型和重组亚型,B'亚型占82.69%,B'/C重组毒株、CRF01-AE重组毒株各占7.69%,C亚型占1.92%;基因序列分析显示,湖北省HIV-1 B'亚型与我国河南和云南省等地的毒株有较高的同源性;氨基酸序列变异分析显示,HIV-1 B'亚型毒株gag基因P17/24区发生不同程度的变异,P17突变位点较多,P24较为保守.结论 B'亚型依然是湖北省HIV优势流行株,HIV-1在湖北省有加快流行和进一步复杂化的趋势.     

有性才会有健康

性是基本的人权。根据我国著名的性学家史成礼教授的研究,性有“三大功能”:生育功能、享乐功能和健康功能。     

Communicating with people with dementia

It can be very difficult to communicate with people with dementia. Each case requires its own unique handling. Not every scenario is covered, as many times your own judgment is what will work, best according to the circumstances. These can change from dawn to evening and from day to day. Never assume things will be the way they were the last time you communicated. Be on your guard. Be adaptable. The article will help get you started to think of your own ways to communicate.     

Coping with Children with ADHD: Coping Styles of Mothers with Children with ADHD or Challenging Behaviours

Parents of children with Attention Deficit Hyperactivity Disorder (ADHD) can experience significant levels of stress in their parenting roles, however, little is known about the specific coping strategies used by these parents. This pilot study Investigated the coping strategies used by mothers of children with ADHD. A 34 item questionnaire was developed to identify maternal coping strategies. A cohort of 38 mothers of children with ADHD and a control group of 30 mothers of children without ADHD or any other disability/illness completed the questionnaire. Factor analysis of responses produced three factors: Aggressive/Confrontive Coping, Rational Coping, and Indirect Coping. These factors are similar to coping dimensions proposed by Folkman and Lazarus. Comparisons between the two groups of mothers revealed that mothers of children with ADHD used significantly more Indirect Coping.     

经方汗证治验

临床上汗证病情复杂,分自汗、盗汗、黄汗和但头汗出,治疗汗证方药诸多,有益气固表、养阴清热和清热除湿等方法,疗效不一。受恩师刘健主任教导和《伤寒论》《金匮要略》病脉证并治启发,以脉证并治、方证对应思想,浅谈桂枝加附子汤、黄芪芍药苦酒汤、柴胡桂枝干姜汤和三物黄芩汤治疗汗证的经验,为经方治疗汗证提供新思路。     

Working with patients with physical disabilities

Medical practices need to make a number of adaptations to ensure that their facilities and staff are accessible to patients and other office visitors with physical disabilities. This article describes 10 specific strategies for preparing your medical practice for patients with disabilities, both inside and outside your office. It describes minimum standards for office doorways, sidewalk inclines, ramps, reception areas, and other adaptations medical offices need to make. The article also describes specific do and don't advice for communicating with patients with physical disabilities. It suggests strategies for preparing written materials for disabled patients, for communicating verbally, and for providing healthcare education. Finally, it suggests an appropriate role for medical practice staff in the delivery of healthcare services to patients with physical disabilities.     

Qualitative research with people with intellectual disability

Qualitative research methods are gaining popularity in disability research, in particular as a way to explore the personal experience of disability. However, using these methods can be problematic with people traditionally regarded as vulnerable in the research relationship. People with intellectual disability are often so regarded. This paper discusses ethical concerns and issues of research credibility in qualitative research with this group of disabled people. An ethnographic study about the parenting experience of parents with intellectual disability is used to illustrate strategies to achieve credibility in qualitative studies in intellectual disability research.     

Problems with measuring satisfaction with social care

The measurement of customer satisfaction has become widespread in both healthcare and social care services, and is informative for performance monitoring and service development. Satisfaction with social care services is routinely measured with a single question on overall satisfaction with care, comprising part of the Adult Social Care Survey. The measurement of satisfaction has been problematised, and existing satisfaction measures are known to be under‐theorised. In this article, the process of making an evaluation of satisfaction with social care services is first informed by a literature review of the theoretical background, and second examined through qualitative interviews conducted in 2012–2013 with 82 service users and family carers in Hampshire, Portsmouth and Southampton. Participants in this study were from white British and South Asian backgrounds, and the influence of ethnicity in the process of satisfaction evaluation is discussed. The findings show that the majority of participants selected a positive satisfaction rating even though both positive and negative experiences with services were described in their narratives. It is recommended that surveys provide opportunity for service users and family carers to elaborate on their satisfaction ratings. This addition will provide more scope for services to review their strengths and weaknesses.