The development of internal pressure standards for in-house elastic wave velocity measurements in multi-anvil presses.

Ultrasonic systems are powerful tools to determine elastic wave velocities of minerals and materials at high pressure and temperature and have been extensively developed in recent decades. However, accurate measurement of sample length is required to convert travel times into wave velocities, limiting their use to synchrotron facilities or room temperature experiments in laboratories. We have made use of a close collaboration between the Bayerisches Geoinstiut and the P61B end-station beamline (PETRA III - DESY) to install ultrasonic systems and develop a novel dual travel time method for in situ pressure determination without the need for synchrotron radiation. Our method relies on the travel times of elastic waves through a reference material; it requires a thermocouple and is non-intrusive, with the reference material replacing the backing plate of the high-pressure assembly. Pressures obtained from this dual travel time method show excellent agreement with those obtained from x-ray diffraction using synchrotron radiation on standard materials. Our novel method enables in situ pressure determination at varying temperatures during in-house ultrasonic interferometry experiments. This allows us not only to determine the elastic behavior of minerals and materials but also to investigate phase diagrams, solidus, or liquidus conditions at varying pressures and temperatures during in-house experiments. During the installation of the pulse-echo ultrasonic system, we identified critical parameters for obtaining reliable data. While these requirements are well-known to experts, this study presents a comprehensive review of the different characteristics of ultrasonic systems, providing user-friendly guidelines for new users installing and operating such systems in high-pressure and high-temperature conditions.

[Outcomes of partial pubectomy assisted anastomotic urethroplasty for male patients with pelvic fracture urethral distraction defect].

OBJECTIVE: To summarize the clinical outcomes of partial pubectomy assisted anastomotic urethroplasty for male patients with pelvic fracture urethral distraction defect (PFUDD) and discuss the skills of partial pubectomy. METHODS: The clinical data of 63 male patients with PFUDD were retrospective reviewed. The procedure of the anastomotic urethroplasty was as follows: (1) circumferentially mobilizing the bulbar urethra; (2) separating the corporal bodies; (3) performing the urethral anastomosis after partial pubectomy and exposure of the healthy two ends of the urethra. RESULTS: The mean age of the patients was (39.2±15.6) years (range: 15-72 years). The median time between incidents and operation was 15 months (range: 3-240 months) and the mean length of stricture was (3.85±0.91) cm (range: 1.5-5.5 cm). All the patients had undergone suprapubic cystostomy in acute setting. Thirteen patients (20.6%) were re-do cases and the patients who had undergone dilation, direct vision internal urethrotomy (DVIU), and open primary realignment were 22 (34.9%), 8 (12.7%), and 8 (12.7%), respectively. Assisted with partial pubectomy, the anastomotic urethroplasty had been successfully performed in all the patients. The mean time of operation was (160.2±28.1) min (110-210 min), and the mean evaluated blood loss was (261.1±130.3) mL (100-800 mL). There were 3 cases (4.8%) with perioperative blood transfusions. The postoperative complications were bleeding and urinary tract infection, which were controlled conservatively. The mean maximum urine flow rate was (23.7±7.4) mL/s (15.0-48.2 mL/s) after removing the catheters 4 weeks after urethroplasty. The median follow-up was 23 months (12-37 months). The urethroscopy showed 2 cases of stricture recurrences and 1 case of iatrogenic penile urethral stricture due the symptoms of urinary tract infection and decreased urine flow and all of them were successfully managed with dilation. CONCLUSION: Partial pubectomy can effectively reduce the gap between the ends of the urethra and promote tension-free anastomosis during the anastomotic urethroplsty for patients with PFUDD. The skills of the procedure include good exposure of the anterior surface of pubic symphysis between the separated corporal bodies, carefully mobilizing and securing the deep dorsal vein of the penis, removing the partial pubic bone and the harden scar beneath the pubic bone for good exposure of the proximal urethral end.

[Combined transperineal and transpubic urethroplasty for patients with complex male pelvic fracture urethral distraction defect].

OBJECTIVE: To evaluate the clinical effects and characteristics of combined transperineal and transpubic urethroplasty for patients with complex pelvic fracture urethral distraction defect (PFUDD). METHODS: We retrospectively reviewed the clinical data of 17 male patients with complex posterior PFUDD from January 2010 to December 2019. The complications included urethrorectal fistulas in 2 patients (11.8%), urethroperineal fistula in 1 patient (5.9%). Ten patients had undergone previous treatments: dilatation in 3 patients (17.6%), internal urethrotomy in 1 patient, failed urethroplasty in 6 patients (35.3%), of whom 2 patients had two times of failed urethroplasties. All the patients were performed with urethroplasty by combined transperineal and transpubic approach with removing the entire pubic bone followed by the anastomosis. RESULTS: The mean age of the patients included in this study was 35.5 (range: 21-62) years. The mean length of stricture was 5.5 (range: 4.5-7.0) cm, the mean follow-up was 27 (range: 7-110) months, the mean time of operation was 190 (range: 150-260) min, the mean evaluated blood loss was 460 (range: 200-1 200) mL. There were 5 patients who needed blood transfusion intraoperatively or postoperatively. Wound infection was seen in 4 out of 17 patients and thrombosis of lower extremities in 1 out of 17 patients. The last follow-up showed that the mean postoperative maximum urinary flow rate was 22.7 (range: 15.5-40.7) mL/s. After removing the catheter, one patient presented with decreased urinary flow and symptoms of urinary infection. Cystoscopy showed the recurrent anastomotic stricture, which was cured by internal urethrotomy. In our series, the success rate of the combined transperineal and transpubic urethroplasty was 94.1% (16/17). CONCLUSION: Combined transperineal and transpubic urtheroplasty can achieve a tension free anastomosis after removing the entire wedge of pubis in some patients with complex PFUDD. However, this procedure should be completed in a regional referral hospital due to the complexity of the operation and the high percentage of complications.

[Clinical characteristics and prognosis of renal cell carcinoma patients with bone metastases].

Objective: To determine the status of bone metastasis (BM) and prognosis factors of patients with renal cell carcinoma (RCC) in our center. Methods: The clinical and medical records of RCC patients with BM, who were admitted to the Department of Urology, Bone Oncology and Spine Surgery, Beijing Jishuitan Hospital from August 2009 to August 2017 were collected. The gender, age, time of BM, location of BM, numbers of BM, presence or absence of visceral metastasis, pathological types of BM were investigated. The patients were followed up regularly, and the survival curves were analyzed by Kaplan-Meier method. Cox proportional hazard regression model was used to estimate the prognostic factors. Results: A total of 51 RCC patients with bone metastasis were collected. The age of patients ranged from 38 to 76 (58.6±8.2) years old, including 39 males (76.5%) and 12 females (23.5%). The ratio of male to female was 3.25∶1. The patients were followed up for 8 to 109 months, with a median follow-up time of 30 months. The follow-up rate was 90.2%. Thirty-one (60.8%) patients died at the last follow-up, with a median overall survival (OS) time of 25 months. The median OS was 38 months and 20 months in the solitary BM group (26 cases, 51.0%) and BM ≥ 2 group (25 cases, 49.0%), respectively. The difference between the two groups was statistically significant (P=0.021). The median OS was 30 months, 69 months and 17 months in the axis BM group (22 cases, 43.1%), appendicular BM group (19 cases, 37.3%) and both the axis and appendicular BM group (10 cases, 19.6%), respectively. The difference between the groups was statistically significant (P=0.012). The median OS was 22 months and 38 months in the patients with (15 cases, 29.4%) and without (36 cases, 70.6%) visceral metastases groups, respectively. The difference between the two groups was statistically significant (P=0.007). Univariate and multivariate Cox regression analysis showed that the numbers of BM (HR=3.130, 95%CI: 1.502-6.520, P=0.035) and visceral metastasis (HR=4.699, 95%CI: 1.810-9.545, P=0.001) were independent prognostic factors for RCC with BM. Conclusions: Solitary BM, no visceral metastasis are good prognostic factors for RCC with BM. For these patients, radical resection of BM is feasible to improve survival rate.

[Single-stage repair of penile urethral stricture using combined dorsal onlay oral mucosa grafting with ventral onlay penile skin flap].

OBJECTIVE: To evaluate the clinical effect of single-stage repair of penile urethral stricture using combined dorsal onlay oral mucosa grafting with ventral onlay penile skin flap. METHODS: We retrospectively reviewed the clinical database of 22 male patients with penile urethral stricture who received single-stage repair using combined dorsal onlay oral mucosa grafting with ventral onlay penile skin flap from November 2015 to October 2018. All the cases had no complications, such as skin fistula. The causes of stricture included iatrogenic (14/22, 63.6%), inflammation (2/22, 9.1%) and idiopathic (6/22, 27.3%). A ventral urethrotomy was made in the segment of stricture and extended proximally and distally until the normal calibre urethra was encountered. The oral mucosa graft was secured to the corpus spongiosum in dorsal onlay fashion or underlying corpora cavernosum after resection of the severe scarred urethra. Then the prepared Orandi fasciocutaneous penile skin flap was secured to edges of corpus spongiosum or oral mucosa graft. A 16 F or 14 F Foley catheter was left in situ for a minimum of 3 weeks, at which time a urethrogram was performed to look for extravasation, and the urethroscopy was performed if necessary. Success was defined as an open urethra with Qmax≥15 mL/s and no need for further surgical intervention. RESULTS: all the 22 patients with a mean age of 52.6 (18-73) years underwent the combined tissue-transfer technique. The mean length of the penile urethral stricture was 5.3 (2.5-10.0) cm and the mean preoperative Qmax was 6.7 mL/s. the mean length of oral mucosa grafts and fasciocutaneous skin flaps were 5.5 (3.2-10.5) cm and 6.0 (3.5-11.0) cm, respectively. The mean operation time was 225 (150-420) minutes and the mean evaluated blood loss was 53 (20.0-110.0) mL. The grafts included buccal mucosa (19/22, 86.4%) and lingual mucosa (3/22, 13.6%). The mean postoperative Q max was 21.2 (15-32) mL/s. A case of skin fistula and 2 cases of recurrent stricture were found, so the technique success rate was 81.8% (18/22) at a mean follow-up of 20.5 (5-51) months. The perioperative complications included 2 cases of infection and skin necrosis, which healed well after conservative treatment. CONCLUSION: Single-stage repair of penile urethral stricture using combined dorsal onlay oral mucosa grafting with ventral onlay penile skin flap appears to be an excellent option to repair penile urethral stricture with unsalvageable urethral plate and the penile skin is available. The present clinical series showed a successful rate of 81.8% (18/22).

Total intravenous anaesthesia versus inhaled anaesthesia for endoscopic sinus surgery: a meta-analysis of randomized controlled trials.

BACKGROUND: Total intravenous anaesthesia (TIVA) with propofol, compared to inhaled anaesthesia (IA), has been proposed to reduce bleeding and improve surgical field quality during endoscopic sinus surgery (ESS), but prior meta-analyses have not been conclusive. We performed an updated meta-analysis to determine the benefit of TIVA versus IA during ESS. METHODOLOGY: PubMed, EMBASE, and Cochrane Library were searched for randomized controlled trials (RCTs) comparing TIVA versus IA. Demographic and outcome data were extracted from articles meeting selection criteria and analysed. RESULTS: We included 12 RCTs for a total of 560 patients. Preoperative characteristics were similar between the two groups. Compared to IA, TIVA improved surgical visibility, estimated blood loss (EBL), and operative time. In a subgroup analysis with remifentanil as the short-acting opioid, TIVA improved surgical visibility, EBL, and operative time. These benefits were not seen with fentanyl as the short-acting opioid. CONCLUSIONS: TIVA with propofol, in comparison to IA, may improve surgical field quality, reduce blood loss, and decrease operative time for ESS. Remifentanil is the preferred short-acting opioid for TIVA in ESS.

["3-step" strategy of transperineal anastomotic urethroplasty for the simple pelvic fracture urethral distraction defect in male patients].

OBJECTIVE: To evaluate the clinical effect of "3-step" strategy of transperineal anastomotic urethroplasty for the simple pelvic fracture urethral distraction defect in male patients. METHODS: We retrospectively reviewed the clinical data of 162 male patients with simple traumatic posterior urethral stricture or stenosis admitted from January 2014 to October 2015. All had no complex complications, such as urethroperineal fistulas or urethrorectal fistulas. Before referral to Department of Urology, Beijing Jishuitan Hospital, 64 patients had undergone previous treatments: urethroplasty in 30 patients (18.5%), early urethral realignment in 17 patients (10.5%) and 17 patients (10.5%) who had undergone internal urethrotomy. The remaining 98 patients received the suprapubic cystostomy in the acute setting. All of them had received transperineal anastomotic urethroplasty with "3-step" strategy. Step 1, the bulbar urethra was circumferentially mobilized and tension-free anastomosis could be performed after the scar was completely incised and removed. Step 2, if after step 1 a tension-free anastomosis could not be achieved, were routed the distal urethra between the separated corporal bodies. Step 3, if the anastomosis still seemed to be under tension, we could perform pubectomy, partial or total removal, to get a better exposure of the apex of the prostate-membranous urethra. RESULTS: The mean age of the patients included in this study was 36.3 years (rangingfrom 16-74 years). The mean time between incidents and operation was 13.5 months (ranging from 3-124 months) and the mean length of stricture was 2.7 cm (ranging from 0.5-6.5 cm).The mean time of operation was 92 (45-240) min and the mean evaluated blood lose was 120 (60-800) mL. Three patients (1.9%) received blood transfusing during or after the operations. The numbers of the patients who completed step 1, step 2 and step 3 were 50(30.9%), 74(45.7%) and 38(23.5%), respectively. There were 4 (2.5%) patients who needed the combined transpubic and transperineal approach for tension-free anastomosis after removing an entire wedge of anterior pubis. The mean follow-up was 19.5 months and 18 patients' strictures recurred with manifestation of decreased stream of dysuria. The overall success rate was 88.9%(144/162). CONCLUSION: Based on the "3-step" strategy of transperineal anastomotic urethroplasty, patients with simple PFUDD can achieve a tension-free anastomosis. The present clinical data showed a successful rate of 88.9% (144/162).

Group B Streptococcus Infections Caused by Improper Sourcing and Handling of Fish for Raw Consumption, Singapore, 2015-2016.

We assessed microbial safety and quality of raw fish sold in Singapore during 2015-2016 to complement epidemiologic findings for an outbreak of infection with group B Streptococcus serotype III sequence type (ST) 283 associated with raw fish consumption. Fish-associated group B Streptococcus ST283 strains included strains nearly identical (0-2 single-nucleotide polymorphisms) with the human outbreak strain, as well as strains in another distinct ST283 clade (57-71 single-nucleotide polymorphisms). Our investigations highlight the risk for contamination of freshwater fish (which are handled and distributed separately from saltwater fish sold as sashimi) and the need for improved hygienic handling of all fish for raw consumption. These results have led to updated policy and guidelines regarding the sale of ready-to-eat raw fish dishes in Singapore.

Use of direct oral anticoagulants in patients on immunomodulatory agents.

Immunomodulatory agents (IMiDs) are used to treat multiple hematologic malignancies. Their use is also associated with increased risk of venous thromboembolism (VTE). Direct oral anticoagulants (DOACs) have been increasingly utilized but due to their relative novelty, their role in malignancy has only been recently investigated. The objective of this study was to assess the safety and efficacy of DOACs in patients receiving IMiDs. This was a retrospective study of patients at our institution treated with an IMiD and concomitant warfarin or DOAC between January 1, 2010 and December 31, 2015. Information on demographic and clinical characteristics was collected. Separate encounters were collected for each specific combination of IMiD and anticoagulant. Bleeding and thrombotic events were recorded. There were four bleeding events in the DOAC group; all were non-major. There were six bleeding events in the warfarin group, two of which were major (gastrointestinal bleeding (GIB) and subarachnoid hemorrhage (SAH)) and four of which were non-major. Of the two major bleeds in this group, neither event occurred with concomitant antiplatelet therapy. There was one thrombotic event in the DOAC group, which was a myocardial infarction, suspected to be related to carfilzomib. There were no thrombotic events in the warfarin group. This was a retrospective, single-institution study assessing the safety and efficacy of DOACs as compared to warfarin in patients on IMiDs. DOACs may represent an attractive alternative to warfarin for VTE prophylaxis in patients on IMiDs but prospective studies in this population are warranted.

A microRNA-152 that targets the phosphatase and tensin homolog to inhibit low oxygen induced-apoptosis in human brain microvascular endothelial cells.

Brain damage caused by perinatal asphyxia is dangerous for neonatal infants, but the mechanism by which it occurs remains elusive. In this study, microRNA-152 (miR-152) expression was induced by low oxygen levels in rat models of hypoxia brain damage, as well as in human brain microvascular endothelial cells (HBMECs) cultured in vitro. Analysis of the sequence of miR-152 revealed that the phosphatase and tensin homolog gene (PTEN) is probably the target of miR-152 both in humans and rats. When HBMECs were transfected with miR-152 mimics, PTEN expression was inhibited at both the mRNA and protein levels. Moreover, transfection with the miR-152 mimic also inhibited apoptosis induced by hypoxia. Furthermore, expression of the pro-apoptotic gene Bax was downregulated while the anti-apoptotic gene Bcl2 was upregulated after miR-152 mimic transfection. Taken together, these results indicate that miR-152 induced by hypoxia suppresses cell apoptosis and acts as a protective factor during hypoxia by repressing PTEN.

Physiologic and biochemical effects of electroacupuncture combined with intramuscular administration of dexmedetomidine to provide analgesia in goats.

OBJECTIVE: To investigate physiologic and biochemical effects of electroacupuncture and dexmedetomidine administration to goats. ANIMALS: 30 healthy adult goats. PROCEDURES: Goats were allotted to 5 groups (6 goats/group) and received electroacupuncture, dexmedetomidine (5 or 20 µg/kg, IM), electroacupuncture plus dexmedetomidine (5 µg/kg, IM), or saline (0.9% NaCl) solution (IM [control treatment]). Pain threshold, cardiorespiratory effects, rectal temperature, and hematologic and biochemical variables were assessed. RESULTS: Dexmedetomidine (20 µg/kg) increased pain threshold and decreased heart rate, respiratory rate, and rectal temperature. Pain threshold of goats receiving electroacupuncture plus dexmedetomidine (5 µg/kg) was higher than that of goats receiving electroacupuncture or of goats receiving dexmedetomidine at 5 µg/kg at 30 minutes, but did not differ from that of goats receiving dexmedetomidine at 20 µg/kg. Compared with goats administered dexmedetomidine at 20 µg/kg, goats receiving electroacupuncture plus dexmedetomidine at 5 µg/kg had a higher heart rate from 30 to 60 minutes and a higher respiratory rate from 5 to 60 minutes. Electroacupuncture plus dexmedetomidine (5 µg/kg) did not affect rectal temperature. Serum glucose concentrations of goats receiving electroacupuncture plus dexmedetomidine (5 µg/kg) were higher than for goats receiving dexmedetomidine at 5 µg/kg at 30 minutes but not for goats receiving dexmedetomidine at 20 µg/kg. Creatinine and BUN concentrations, alanine or aspartate aminotransferase activities, and hematologic variables of treated goats did not change. CONCLUSIONS AND CLINICAL RELEVANCE: Electroacupuncture in combination with a low dose of dexmedetomidine (5 µg/kg, IM) administered to goats provided antinociception.

Excess mortality for operated geriatric hip fracture in Hong Kong.

INTRODUCTION: Geriatric hip fracture places an increasing burden to health care systems around the world. We studied the latest epidemiology trend of geriatric hip fracture in Hong Kong, as well as the excess mortality for patients who had undergone surgery for hip fracture. METHODS: This descriptive epidemiology study was conducted in the public hospitals in Hong Kong. All patients who underwent surgery for geriatric hip fracture in public hospitals from January 2000 to December 2011 were studied. They were retrieved from the Clinical Management System of the Hospital Authority of Hong Kong. Relevant data were collected using the Clinical Data Analysis and Reporting System of the Hospital Authority. The actual and projected population size, and the age- and sex-specific mortality rates were obtained from the Census and Statistics Department of Hong Kong. The 30-day, 1-year and 5-year mortality, and excess mortality following surgery for geriatric hip fracture were calculated. RESULTS: There was a steady increase in the incidence of geriatric hip fracture in Hong Kong. The annual risk of geriatric hip fracture was decreasing in both sexes. Female patients aged 65 to 69 years had the lowest 1-year and 5-year mortality of 6.91% and 23.80%, respectively. Advancing age and male sex were associated with an increase in mortality and a higher excess mortality rate following surgery. CONCLUSION: The incidence of geriatric hip fracture is expected to increase in the future. The exact reason for a higher excess mortality rate in male patients remains unclear and should be the direction for future studies.

Successful Treatment of Giant Basal Cell Carcinoma with Topical Imiquimod 5% Cream with Long Term Follow-up.

The use of the topical Imiquimod 5% cream offers a noninvasive, nonsurgical, and an effective option for the treatment of primary small (<2 cm) superficial basal cell carcinoma (sBCC). However, reports about successful treatment of giant (>5 cm) BCC with topical Imiquimod 5% cream are rare. We present our experience in the treatment of two giant tumors (6 × 8 cm(2), 5.2 × 4.2 cm(2)) of BCC on the face with Imiquimod 5% cream, 2 to 3 days/week for 12 weeks. Both the tumors were cured with clinical and pathological evidence, one with 6-year follow-up and the other with 3.5-year follow-up.

Prevalence and psychosocial correlates of depressive symptoms in urban Chinese women during midlife.

OBJECTIVE: Depression is common in women with much research focusing on hormonal changes and menopausal symptoms but with little exploration of psychosocial problems in midlife. This study investigates the prevalence of clinically relevant depressive symptoms in midlife Chinese women and its association with psychosocial factors. METHODS: A cross-sectional, community-based household survey of women aged 45 to 64 years of age was conducted in Hong Kong from September 2010 to March 2011. The structured questionnaire included demographic data, educational status, marital status and household income, as well as perceived current stressful events and significant life events in the past 12 months. Information on clinically relevant depressive symptoms was measured by the validated chinese Patient Health Questionnaire (PHQ-9). RESULTS: A total of 402 participants were recruited in the study period. Of the 393 women who completed the questionnaire, the prevalence of clinically relevant depressive symptoms (PHQ-9 score≧10) was 11.0%. In multiple regression analysis, being single/divorced/separated/widowed, having an educational level of primary school level or below, having multiple chronic diseases, loss of hobby or loss of close social support in the past 12 months in midlife were associated with clinically relevant depressive symptoms. CONCLUSIONS: Correlates of clinically relevant depressive symptoms in midlife Chinese women can be used to identify those at increased risk and potentiate further studies to explore early psychosocial and community interventions.

Revealing the beneficial effect of protease supplementation to high gravity beer fermentations using "-omics" techniques.

BACKGROUND: Addition of sugar syrups to the basic wort is a popular technique to achieve higher gravity in beer fermentations, but it results in dilution of the free amino nitrogen (FAN) content in the medium. The multicomponent protease enzyme Flavourzyme has beneficial effect on the brewer's yeast fermentation performance during high gravity fermentations as it increases the initial FAN value and results in higher FAN uptake, higher specific growth rate, higher ethanol yield and improved flavour profile. RESULTS: In the present study, transcriptome and metabolome analysis were used to elucidate the effect on the addition of the multicomponent protease enzyme Flavourzyme and its influence on the metabolism of the brewer's yeast strain Weihenstephan 34/70. The study underlines the importance of sufficient nitrogen availability during the course of beer fermentation. The applied metabolome and transcriptome analysis allowed mapping the effect of the wort sugar composition on the nitrogen uptake. CONCLUSION: Both the transcriptome and the metabolome analysis revealed that there is a significantly higher impact of protease addition for maltose syrup supplemented fermentations, while addition of glucose syrup to increase the gravity in the wort resulted in increased glucose repression that lead to inhibition of amino acid uptake and hereby inhibited the effect of the protease addition.

An outbreak of diarrhoeic shellfish poisoning in Antwerp, Belgium.

In Antwerp, Belgium, 403 cases of diarrhoeic shellfish poisoning were reported after consumption of blue mussels. Symptoms included diarrhoea, vomiting, abdominal pain, and nausea. The analysis of faecal specimens from patients allowed diagnosis exclusions for bacteria and viruses. Mouse-assays revealed the presence of biotoxins specific of dinoflagellates, which were identified and quantified by LC-MS. The mussels were imported from Denmark, and were part of a batch presenting high concentrations of okadaic acid above the regulatory limits.

Are the Twelve Steps more acceptable to drug users than to drinkers? A comparison of experiences of and attitudes to Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) among 200 substance misusers attending inpatient detoxification.

The present study is a cross-sectional interview-based investigation comparing experiences of and attitudes towards Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) in a sample of 200 patients attending inpatient substance misuse detoxification services. Two hundred consecutive admissions were recruited; 100 each from one drug and one alcohol in-patient treatment service in which attendance at AA/NA was a voluntary adjunct to a generic treatment programme. Although there were no differences in the history of AA/NA attendance, the drug users (who were on average younger) reported significantly more positive attitudes towards AA/NA, more willingness to attend during their in-patient treatment and greater intention to attend following completion of their detoxification. In particular, despite no differences in spiritual/religious orientation, the drug users reported more positive views of the Twelve Steps. As AA/NA remain popular and accessible forms of substance misuse support, it is critical that we develop a clearer understanding of their impact and of the scope for their integration with generic forms of substance misuse treatment.

Peer-initiated overdose resuscitation: fellow drug users could be mobilised to implement resuscitation.

Research interviews about overdose experiences were conducted with 115 patients attending a methadone maintenance clinic in south London, UK. While almost half (49.6%) reported having experienced overdose personally (on an average of four occasions each), almost all (97.4%) reported that they had witnessed overdoses (on an average of six occasions each). This represents a total of 706 overdoses witnessed, of which 106 had resulted in fatalities. The vast majority of patients (86/97) reported that they had taken actions when they had witnessed overdoses with those acting taking an average of nearly threee different actions on the last occasion on which they had seen someone overdosing. Most respondents reported that they would be willing to act, even if they did not know the overdose victim personally and that they had not been deterred from acting by the previous response from the emergency services. Fear of punishment was not a strong deterrent from acting certainly not for this sample, with many participants also expressing an interest in expanding their repertoire of overdose interventions, for example through training in resuscitation techniques and by keeping naloxone at home for use in overdose emergency.