护理干预对氯胺酮相关性膀胱炎的影响分析

目的 探讨护理干预对滥用氯胺酮(K粉)所致相关性膀胱炎患者的治疗效果.方法 将我科收治的15例K粉相关性膀胱炎患者在药物治疗基础上实行积极有效的护理干预,并通过治疗前后抑郁与焦虑的心理评分分析患者的生活质量有无改善.结果 15例患者在药物治疗基础上实行积极有效的护理干预后症状均有所改善,患者抑郁与焦虑的心理评分也明显改善,差异有显著性(P<0.001).结论 K粉所致相关性膀胱炎患者经过有效的治疗和护理干预,能明显改善患者负性心理状况,缓解膀胱炎症状,随访6个月均无复吸现象.     

《脑》：研究发现氯胺酮所致脑结构损害

长沙中南大学湘雅二医院称。该院在国际上首次发现了慢性氯胺酮（俗称K粉）成瘾者的脑结构损害。此研究为揭示K粉成瘾病理机制提供了宝贵线索,将为K粉成瘾的治疗开辟新的途径。     

氯胺酮对抑郁大鼠模型抗抑郁作用研究

目的:探讨在抑郁大鼠模型中单次氯胺酮可产生快速持久地抗抑郁作用。方法:实验一:32只Wistar大鼠随机分为四组(n=8),药物干预前1 d大鼠强迫游泳15 min,药物干预当天,分别腹腔注射相同容积的生理盐水(S组)、5 mg/kg氯胺酮(K5组)、10 mg/kg氯胺酮(K10组)、15 mg/kg氯胺酮(K15组)。30 min后记录大鼠运动能力及不动时间。实验二:20只Wistar大鼠随机分为两组(n=10),所有大鼠均经历21天慢性不可预知应激试验。第22天大鼠分别腹腔注射相同容积生理盐水及10 mg/kg氯胺酮,于干预前、干预后1 h、2 h、6 h、1 d、4 d、7 d分别进行敞箱试验,并记录大鼠水平运动及垂直运动得分。结果:与S组相比,K5、K10及K15组大鼠运动能力无明显变化(P>0.05)且强迫游泳不动时间均显著减少(P<0.01);与干预前生理盐水组相比,生理盐水干预后1 h、2 h、6 h、1 d、4 d及7 d组大鼠敞箱试验水平运动及垂直运动均无明显差异(P>0.05);与干预前氯胺酮组相比,生理盐水干预后1 h、2 h、6 h、1 d、4 d及7 d组大鼠敞箱试验水平运动及垂直运动有明显差异(P<0.05)。结论:在抑郁症大鼠模型中氯胺酮可产生快速且持久的抗抑郁作用。     

恩施硒茶对小鼠低氧/复氧损伤的保护作用及氯胺酮对这种保护作用的调节

目的 :探讨恩施硒茶对小鼠低氧 /复氧 (H /R)损伤的保护作用及氯胺酮对这种保护作用的调节。方法 :将小鼠用硒茶和氯胺酮处理后 ,建立小鼠H /R模型 ,观察血液中的活性氧 (ROS)、超氧化物歧化酶 (SOD)、过氧化氢酶 (CAT )等的变化。结果 :硒茶组和氯胺酮组ROS均减少 ,且氯胺酮的作用明显强于硒茶 ;硒茶组SOD及CAT活性增强 (P <0 .0 1 ) ,氯胺酮组SOD活性明显减弱(P <0 .0 1 ) ,氯胺酮、硒茶联合组ROS、MDA明显减少 (P <0 .0 1 )。结论 :硒茶有很强的抗氧化作用 ,它能清除体内的ROS ,氯胺酮能清除ROS ,降低SOD的活力 ;二者联合能更有效地清除ROS。     

氯胺酮诱导细胞自噬的研究进展

氯胺酮是一种N-甲基-D-天冬氨酸受体(NMDAR)拮抗剂,常作为分离性麻醉剂广泛应用于临床和外科手术中,因其具有较强的致幻效应并使人产生欣快感而在众多娱乐场所中被消遣滥用。此外,氯胺酮还是一种起效迅速的抗抑郁药,对中枢神经系统兼有兴奋和抑制作用,但是长期使用氯胺酮会对中枢神经系统产生较强的神经毒性和精神依赖性。自噬是一个溶酶体依赖性降解蛋白质和细胞器以维持内环境稳态的过程。在氯胺酮诱导神经毒性的过程中,自噬具有双向调控的作用,可加重或减轻机体的神经毒性,但其具体的机制尚不清楚。该文主要从氯胺酮诱导细胞自噬的机制、氯胺酮诱导的自噬与神经毒性的关系以及药物对氯胺酮神经毒性的干预作用等方面进行综述,旨在为进一步研究氯胺酮诱导细胞自噬的机制以及自噬在氯胺酮神经毒性中的调控机制提供参考。     

微清蛋白中间神经元在氯胺酮抗抑郁中的作用

目的:观察微清蛋白(PV)中间神经元在氯胺酮抗抑郁中的作用。方法:32只Wistar雄性大鼠随机均分为4组(n=8),包括生理盐水组(S组)、氯胺酮组(K组)、夹竹桃麻素预处理+生理盐水组(AS组)、夹竹桃麻素预处理+氯胺酮组(AK组)。夹竹桃麻素预处理组将药物溶于大鼠饮水中,共喂养1周,于第8 d制备模型。大鼠强迫游泳15 min制备急性应激抑郁模型,24 h后给大鼠分别腹腔注射1 mL生理盐水或氯胺酮10 mg/kg,给药后0.5 h行敞箱实验记录大鼠水平运动及垂直运动得分,行强迫游泳6 min记录后5 min内不动时间。行为学测试结束后,取大鼠前额皮层,Western印迹检测PV中间神经元中PV及谷氨酸脱羧酶67(GAD67)的表达。结果:与S组相比,K组大鼠强迫游泳不动时间减少,PV及GAD67的表达下降(P0.05),AS组则无显著变化(P0.05);与K组相比,AK组大鼠强迫游泳不动时间增加,PV及GAD67的表达增加(P0.05)。生理盐水、氯胺酮、夹竹桃麻素均未显著影响大鼠自主活动(P0.05)。结论:氯胺酮通过下调大鼠前额皮层PV中间神经元功能发挥快速有效的抗抑郁作用。     

择时电针对氯胺酮滥用大鼠隔内侧核酪氨酸羟化酶、c-fos表达的影响

目的探讨择时电针治疗氯胺酮滥用成瘾的某些神经生物学机制。方法将56只清洁级SD大鼠随机分为7组,即正常组、生理盐水组、模型组、子时电针组、卯时电针组、午时电针组和酉时电针组,每组8只。每天1次经腹腔注射盐酸氯胺酮注射液100mg/kg,连续给药7d复制氯胺酮滥用成瘾模型,不同时辰电针组在造模成功后选取一侧"三阴交"和"足三里"穴给予电针(低频2Hz)治疗,每次30min,连续7d。采用免疫组织化学染色方法检测隔内侧核(medial septal nucleus,MS)酪氨酸羟化酶(tyrosine hydroxylase,TH)、c-fos的表达。结果与正常组和生理盐水组相比较,模型组MS TH、c-fos表达明显增强(P0.05)。与模型组相比较,午时、酉时电针组MS TH、c-fos表达明显减弱(P0.05),而子时、卯时电针组无明显变化(P0.05)。结论氯胺酮滥用成瘾可以增强TH、c-fos在MS的表达,午时、酉时电针具有逆转作用。     

谷氨酸及γ-氨基丁酸在氯胺酮致大鼠精神分裂样表现中的变化

目的:观察大鼠前额皮层谷氨酸(Glu)及γ-氨基丁酸(GABA)在氯胺酮致精神分裂样表现中的变化。方法:雄性Wistar大鼠32只随机分为生理盐水组(S组,n=16)和氯胺酮组(K组,n=16)。腹腔注射生理盐水或氯胺酮30 mg/kg(容积1 mL),一天一次,连续5天,最后一次给药后0.5 h及2 h分别通过敞箱实验观察大鼠自主活动,并记录刻板行为评分。行为学测试后,取大鼠前额皮层,检测Glu及GABA含量。结果:与S组比较,K组大鼠给药后0.5 h自主活动增强、刻板行为评分增高(P0.05),符合精神分裂症大鼠表现;给药后2 h行为学评分则无显著差异(P0.05);给药后0.5 h及2 h大鼠前额皮层Glu水平均增加、GABA水平均下降(P0.05)。与氯胺酮给药后0.5 h组相比,给药后2 h Glu水平下降(P0.05)、GABA水平则无显著差异(P0.05)。结论:氯胺酮致精神分裂样表现可能与大鼠前额皮层Glu增加及GABA减少有关。     

异丙酚和氯胺酮对大鼠离体缺血再灌注损伤心肌脂质过氧化的影响

目的：比较异丙酚和氯胺酮对大鼠离体缺血再灌注损伤心肌脂质过氧化的影响。方法：成年Wistar大鼠18只,雌雄不拘。体重240-300g,随机分为3组（T1=6）：心肌缺血再灌注损伤组（I／R组）,异丙酚组（P组）,氯胺酮组（K组）。采用Langendorff灌装置建立离体心脏缺血再灌注模型,将心脏连接至Langendorff逆灌装置,3组均以K-H液平衡灌注10min后,再分别以K．H液、含30μmol/L。异丙酚的K-H液、含10μmol-L-1氯胺酮的K-H液灌注10min,然后全心停灌25min,再分别以停灌前相同的灌注液恢复灌注30min。留取冠脉流出液测定总LDH活性;灌注末取左室心肌组织置于2．5％的戊二醛固定,观察心肌的超微结构;心尖部心肌组织留待检测8-异前列腺素和SOD活性。结果：与I／R组比较,P组8-异前列腺素含量降低,SOD活性升高,LDH活性降低（P〈0．05）;K组8-异前列腺素含量,SOD及LDH活性均无统计学意义（P〉0．05）;与P组比较,K组8-异前列腺素含量升高,SOD及LDH活性降低（P〈0．05）;P组心肌超微结构损伤较m组和K组也明显改善。结论：异丙酚可显著减轻心肌缺血再灌注损伤大鼠的脂质过氧化和心肌缺血再灌注损伤,而氯胺酮没有抗心肌缺血再灌注损伤心肌脂质过氧化的作用。     

氯胺酮对黑猩猩的麻醉保定

黑猩猩应用氯胺酮进行麻醉，可平稳地进入麻醉状态。黑猩猩于肌肉注射６．２—１１．９ｍｇ／ｋｇ氯胺酮后，３—７ｍｉｎ进入麻醉状态，可持续１５—２０ｍｉｎ，麻醉追加量为首次剂量的１／２。麻醉诱导快，黑猩猩无兴奋及挣扎现象，清醒快，无呕吐及躁动等现象，麻醉期，黑猩猩心率增快，呼吸次数变化不明显、睁眼、唾液分泌量多。氯胺酮应用于黑猩猩的麻醉，安全有效。     

Repeated ketamine administration alters N-methyl-d-aspartic acid receptor subunit gene expression: Implication of genetic vulnerability for ketamine abuse and ketamine psychosis in humans

For more than 40 years following its approval by the Food and Drug Administration (FDA) as an anesthetic, ketamine, a non-competitive N-methyl-d-aspartic acid (NMDA) receptor antagonist, has been used as a tool of psychiatric research. As a psychedelic drug, ketamine induces psychotic symptoms, cognitive impairment, and mood elevation, which resemble some symptoms of schizophrenia. Recreational use of ketamine has been increasing in recent years. However, little is known of the underlying molecular mechanisms responsible for ketamine-associated psychosis. Recent animal studies have shown that repeated ketamine administration significantly increases NMDA receptor subunit gene expression, in particular subunit 1 (NR1 or GluN1) levels. This results in neurodegeneration, supporting a potential mechanism where up-regulation of NMDA receptors could produce cognitive deficits in chronic ketamine abuse patients. In other studies, NMDA receptor gene variants are associated with addictive behavior. Here, we focus on the roles of NMDA receptor gene subunits in ketamine abuse and ketamine psychosis and propose that full sequencing of NMDA receptor genes may help explain individual vulnerability to ketamine abuse and ketamine-associated psychosis.     

Recreational myocardial infarction legacy of the 1990s

Cocaine is a common drug of abuse with a potential lethal cardiac toxicity. Although cocaine abuse has reached epidemic proportions, the number of cardiovascular complications observed clinically remains low. Over 30% of men and 20% of women between the ages of 26 and 34 have used cocaine at least once. Moreover, more than 30 million Americans have used cocaine at some time, and more than five million are regular abusers. Chest pain is one of the most common reasons for cocaine users to seek medical attention. Over 64,000 patients are evaluated annually for cocaine-related chest pain, of whom more than 57% are admitted to hospital for possible myocardial ischaemia, at an annual cost of more than $83 million.     

Drug abuse,psychiatric disorders,and AIDS. Dual and triple diagnosis.

Substance abuse and psychiatric disorders commonly occur together. This form of dual diagnosis is notable because it complicates assessment and makes treatment more difficult for both psychiatric and drug abuse problems. Drugs can cause psychiatric disorders and can also be used as an attempt to "cure" them by self-medication. The spread of the human immunodeficiency virus (HIV) among drug users has added a third potential clinical problem, that of the acquired immunodeficiency syndrome, to the difficulties already presented by drug abuse and psychiatric disorders. Patients with this triple diagnosis pose challenges to primary care physicians as well as addiction medicine specialists or psychiatrists. Assessment should include a drug abuse history, preferably corroborated by others, evaluation of the mental state, and examination focusing on signs of drug abuse and HIV infection. Treatment should include the management of HIV disease, abstinence from drug abuse, and access to psychiatric care. New systems of health care service, including interdisciplinary case management, may be needed to manage patients with a triple diagnosis.     

Risk for AIDS in multiethnic neighborhoods in San Francisco,California. The population-based AMEN Study.

To examine the actual and potential spread of human immunodeficiency virus (HIV) from an acquired immunodeficiency syndrome (AIDS) epicenter to surrounding neighborhoods, we studied the prevalence of the viral infection and AIDS risk behaviors from 1988 to 1989 in a representative sample of unmarried whites, African Americans, and Hispanics living in San Francisco. We surveyed 1,770 single men and women aged 20 to 44 years (a 64% response rate) in a random household sample drawn from 3 neighborhoods of varying geographic and cultural proximity to the Castro District where the San Francisco epidemic began. Of 1,369 with blood tests, 69 (5%) had HIV antibodies; all but 5 of these reported either homosexual activity (32% HIV-positive; 95% confidence interval [CI] = 23%, 41%), injection drug use (5% HIV-positive; CI = 1%, 14%), or both (59% HIV-positive; CI 42%, 74%). Homosexual activity was more common among white men than among African-American or Hispanic men, but the proportion of those infected was similar in the 3 races. Both the prevalence of homosexually active men and the proportion infected were much lower in the 2 more outlying neighborhoods. Risk behaviors in the past year for acquiring HIV heterosexually--sex with an HIV-infected person or homosexually active man or injection drug user, unprotected sexual intercourse with more than 4 partners, and (as a proxy) having a sexually transmitted disease--were assessed in 1,573 neighborhood residents who were themselves neither homosexually active men nor injection drug users. The prevalence of reporting at least 1 of these risk behaviors was 12% overall, and race-gender estimates ranged from 5% among Hispanic women to 21% among white women. We conclude that in San Francisco, infection with HIV is rare among people who are neither homosexually active nor injection drug users, but the potential for the use spread of infection is substantial, as 12% of this group reported important risk behaviors for acquiring the virus heterosexually.     

Patterns of childhood trauma and psychological distress among injecting heroin users in China

Background

Childhood trauma has been reported as a possible cause of future substance abuse in some countries. This study reports the prevalence of childhood trauma and examines its association with psychological distress among injecting drug users from mainland China.

Methodology

The study was conducted in three government-operated drug rehabilitation facilities in Shanghai, China in 2007. The Early Trauma Inventory Self Report-Short Form (ETISR-SF) was used to evaluate 4 types (general, emotional, physical and sexual) and severity of childhood trauma, and the Symptom Checklist-90-Revised (SCL-90-R) to evaluate psychological distress.

Principal Findings

Among 341 injecting drug users who completed the study, about 80% reported one or more types of childhood trauma, specifically 53% general trauma, 56% physical abuse, 36% emotional abuse and 26% sexual abuse. Compared to female injecting drug users, males reported significantly higher scores of general trauma and physical abuse, but lower sexual abuse scores. Hierarchical linear regression analyses showed that greater physical and emotional abuse in childhood predict greater current psychopathological distress among these injecting drug users in China.

Conclusions

The results reveal a high prevalence of childhood trauma among injecting drug users in China, and it is comparable to other similar studies in Western countries. It is important to consider the role of childhood trauma in the prevention and treatment of substance abuse.     

Violinists,demandingness, and the impairment argument against abortion

The ‘impairment argument’ against abortion developed by Perry Hendricks aims to derive the wrongness of abortion from the wrongness of causing foetal alcohol syndrome (FAS). Hendricks endorses an ‘impairment principle’, which states that, if it is wrong to inflict an impairment of a certain degree on an organism, then, ceteris paribus, it is also wrong to inflict a more severe impairment on that organism. Causing FAS is wrong in virtue of the impairment it inflicts. But abortion inflicts an even more severe impairment (death), and so, ceteris paribus, is also wrong. Notably, Hendricks thinks that this argument does not require the claim that the foetus is a person. Here, I respond to Hendricks by arguing that the ceteris paribus clause of the impairment principle is not met in ordinary cases of pregnancy. Carrying an unwanted pregnancy to term is much more burdensome than is refraining from excessive drinking for nine months. This provides a pro tanto justification for obtaining an abortion that does not apply to causing FAS. If the foetus is not a person, it seems fairly clear to me that this justification is strong enough to render abortion permissible. Hendricks is therefore incorrect in claiming that the impairment argument can go without claims concerning foetal personhood. If the foetus is a person, then whether burdensomeness justifies abortion depends on certain questions relating to Thomson’s famous violinist argument. I will not attempt to answer those. But anyone who is otherwise sympathetic to Thomson’s argument should not be moved by the impairment argument.     

Use of marijuana in pharmacy students (2000-2005)

In 2000-2005, a survey on the consumption of legal and illegal drugs of abuse was conducted in 1571 students of Faculty of Pharmacy in Hradec Králové, Charles University in Prague. The availability of cannabis and the prevalence rates of its use in university students were investigated. A standardized anonymous questionnaire was employed for the survey. The average age of respondents was 20 years. The number of females was higher (82.8 %) than that of males. Marijuana was the most available and the most commonly used illegal drug of abuse in the group of pharmacy students. Its offer and the life-time prevalence increased over the 5 year period of the survey from 55.8 % to 72.9 % and from 30.3 % to 48.4 %, respectively. There was a predominance of the male users over the female ones, mainly in a category of high frequency of marijuana consumption ("used more than five times"). Almost three quarters of marijuana consumers admitted more than one experience with marijuana. Our data provide worrying statistics and support the need of continuous education also in university students to advise them on the risks of drug misuse.     

Chronic ketamine administration modulates midbrain dopamine system in mice

Ketamine is an anesthetic and a popular abusive drug. As an anesthetic, effects of ketamine on glutamate and GABA transmission have been well documented but little is known about its long-term effects on the dopamine system. In the present study, the effects of ketamine on dopamine were studied in vitro and in vivo. In pheochromocytoma (PC 12) cells and NGF differentiated-PC 12 cells, ketamine decreased the cell viability while increasing dopamine (DA) concentrations in a dose-related manner. However, ketamine did not affect the expression of genes involved in DA synthesis. In the long-term (3 months) ketamine treated mice, significant increases of DA contents were found in the midbrain. Increased DA concentrations were further supported by up-regulation of tyrosine hydroxylase (TH), the rate limiting enzyme in catecholamine synthesis. Activation of midbrain dopaminergic neurons could be related to ketamine modulated cortical-subcortical glutamate connections. Using western blotting, significant increases in BDNF protein levels were found in the midbrain, suggesting that perhaps BDNF pathways in the cortical-subcortical connections might contribute to the long-term ketamine induced TH upregulation. These data suggest that long-term ketamine abuse caused a delayed and persistent upregulation of subcortical DA systems, which may contribute to the altered mental status in ketamine abusers.     

Emergency measures to control the spread of diseases caused by the human immunodeficiency virus

Since the middle of 1996 the growth of HIV-infected persons and AIDS morbidity are registered in Russia. In 1997 4,300 new cases of HIV infection were registered, which exceeded 1.6 times the total number of cases for the period of 1987-1996. The highest morbidity rate was observed in the cities of the European part of Russia: Kaliningrad (west), Krasnodar and Rostov-on-Don (south), Nizhny Novgorod and Moscow (center). AIDS patients and HIV-infected persons were registered in 73 out of 89 regions of the country. 90% of HIV-infected persons were drug users in 1997. In 1992-1997 the number of drug addicts increased 3.5 fold and young women in 1987-1997, 6.5 fold. 71 HIV-infected children were registered were born from HIV-infected mothers at present time. The article deals with the main provisions of the federal laws aimed at the prevention of the spread of HIV infection in Russia and characterizes scientific research on AIDS. Evidence is presented that the early detection of HIV-infected persons, as well as rendering timely medical and social assistance to such persons, makes it possible to increase their mean survival time and check the spread of human immunodeficiency virus.     

Impact of Exposure to Intimate Partner Violence on CD4+ and CD8+ T Cell Decay in HIV Infected Women: Longitudinal Study

Intimate partner violence (IPV) is a risk factor for HIV acquisition in many settings, but little is known about its impact on cellular immunity especially in HIV infected women, and if any impact differs according to the form of IPV. We tested hypotheses that exposure to IPV, non-partner rape, hunger, pregnancy, depression and substance abuse predicted change in CD4+ and CD8+ T-cell count in a dataset of 103 HIV infected young women aged 15-26 enrolled in a cluster randomised controlled trial. Multiple regression models were fitted to measure rate of change in CD4 and CD8 and including terms for age, person years of CD4+/CD8+ T-cell observation, HIV positivity at baseline, and stratum. Exposure variables included drug use, emotional, physical or sexual IPV exposure, non-partner rape, pregnancy and food insecurity. Mean CD4+ T cell count at baseline (or first HIV+ test) was 567.6 (range 1121-114). Participants were followed for an average of 1.3 years. The magnitude of change in CD4 T-cells was significantly associated with having ever experienced emotional abuse from a current partner at baseline or first HIV+ test (Coeff -132.9 95% CI -196.4, -69.4 p<0.0001) and drug use (Coeff -129.9 95% CI -238.7, -21.2 p=0.02). It was not associated with other measures. The change in CD8 T-cells was associated with having ever experienced emotional abuse at baseline or prior to the first HIV+ test (Coeff -178.4 95%CI -330.2, -26.5 p=0.02). In young ART-naive HIV positive women gender-based violence exposure in the form of emotional abuse is associated with a faster rate of decline in markers of cellular immunity. This highlights the importance of attending to emotional abuse when studying the physiological impact of IPV experience and the mechanisms of its impact on women’s health.