海洛因成瘾和海洛因成瘾者的治疗

近年来在国际毒潮的影响下，我国的毒品问题越来越严重，吸毒人数连年呈直线上升趋势，其中主要的是海洛因吸毒者。因此了解海洛因成瘾的原因和海洛因成瘾者的戒毒治疗对预防吸毒，挽救吸毒者、控制吸毒问题的发展是十分重要的。海洛因，学名二乙酰吗啡，是由吗啡乙酰化而...     

油橄榄叶提取物联合美沙酮对海洛因成瘾大鼠肾功能及活性物质的影响

目的观察油橄榄叶提取物(olive leaf extract,OLE)联合美沙酮对海洛因依赖大鼠肾功能及活性物质的影响。方法将40只健康大鼠随机分成正常组、模型组、OLE+美沙酮处理组、美沙酮处理组。按递增法采用皮下注射海洛因建立海洛因依赖大鼠模型,造模后药物处理30 d,自动生化分析仪分析血浆尿酸(UA)、尿素氮(UN)、肌酐(Cr)含量,比色法检测肾脏组织一氧化氮(NO)含量、一氧化氮合酶(NOS)活性,免疫组织化学法检测肾脏组织中环氧化酶-2(COX-2)的表达情况。结果与正常组相比,模型组海洛因依赖大鼠血浆UA、UN、Cr含量明显增高,肾脏组织中NO含量和NOS活性明显降低,COX-2的表达则显著升高;与模型组相比,OLE+美沙酮处理组和美沙酮处理组大鼠血浆UA、UN、Cr含量明显降低,肾脏组织中NO含量和NOS活性升高,COX-2表达明显减少。OLE联合美沙酮对海洛因依赖大鼠肾脏的治疗效果比美沙酮处理组更明显。结论 OLE联合美沙酮对海洛因依赖大鼠肾功能损害有明显的治疗作用,机制可能与其降低血尿酸、减少尿酸盐在肾小管沉积、升高肾组织NO含量和NOS活性、抑制COX-2的表达有关。     

海洛因成瘾者抑制控制加工异常的电生理证据

抑制控制功能的异常或障碍是成瘾的核心特征．本研究的主要目的是考察海洛因成瘾者反应抑制加工的时间进程,进而为长期海洛因成瘾者的抑制控制功能障碍提供神经生理学证据．本研究比较了14名海洛因成瘾者（海洛因使用年限（13．54±5．71）年,戒断持续时间（4．67±6．44）月）和14名年龄和教育水平匹配的健康成人在视觉等概率Go／Nogo任务中的ERP成分（N2和P3）．结果显示,海洛因成瘾组的Go—N2波幅明显大于对照组,由此导致海洛因成瘾组的N2差异波幅值（Nogo波幅减去Go波幅）显著小于对照组．而两组被试的P3成分无显著差异．此外,无论是N2和P3在头皮的分布还是潜伏期都未发现显著差异．该结果表明,海洛因成瘾者的前中央区皮层在抑制控制过程的200～300ms期间出现异常,且对靶刺激过度加工．这种早期加工的异常很可能反应了海洛因成瘾者在冲突监控阶段存在障碍．     

282例海洛因依赖者复吸原因调查分析

目的探讨海洛因依赖者复吸原因,并分析社会因素、心理因素和戒毒后稽延症状对复吸的影响。方法采用在北京大学中国药物依赖研究所编制的16项复吸原因问卷,调查282例海洛因依赖者吸毒、脱毒后复吸情况以及影响复吸的三方面因素。结果出现稽延性戒断症状（81．9％）、失眠（75．5％）是产生复吸的主要身体因素;消除心情烦恼（39．0％）、打发无聊时间（34．4％）以及再享受最后一次（32．6％）是产生复吸的主要心理因素;毒友影响（43．3％）、旧的吸毒环境又引发毒瘾（33．7％）是产生复吸的主要社会因素。讨论吸毒者的心理康复是预防复吸最重要工作的之一;加强对戒毒后回归社会人员的管理,建立家庭社区综合康复机制,是预防复吸的重要手段;加大在广大青少年人群中禁毒的宣传力度。     

治疗蛇伤625例临床分析

总结分析研究我院１９８４年８月至１９９４年１１月１０年间共治疗毒蛇咬伤６２５例,按病情分型：轻型５７４例,中型１８例,重型３０例,危型３例,其中蛇伤危重症２３例。经采用现代医学结合中医治疗方法进行治疗,有６１５例治愈,１０例好转,治愈率为９８．４％,好转率为１．６％,治愈好转率１００％,蛇伤危重症抢救成功率１００％。     

325例腹腔镜附件手术的临床分析

目的:评价腹腔镜在附件疾病治疗中的价值及安全性。方法:回顾性分析325例附件良性疾病腹腔镜手术治疗情况。随机选取妇科附件良性肿瘤、异位妊娠、输卵管粘连及伞端不通、卵巢破裂、巧克力囊肿,卵巢冠囊肿等病例;采用腹腔镜手术治疗。术式根据病情不同,采取卵巢(冠)囊肿剥除术、附件切除术、输卵管切除术及造口术。结果:腹腔镜手术占同期手术42．54%,手术成功率100%,发生并发症5例(1．54%)。结论:腹腔镜微创手术,副作用少,适应证掌握得当,妇科大部分附件手术可在腹腔镜下完成。     

清栓酶治疗脑梗死1971例疗效分析

１９８２年６月至１９９８年６月,我们用东北白眉蝮蛇毒制剂清栓酶治疗脑梗死共１９７１例,取得良好疗效,现报告如下。１临床资料１．１一般资料本组１９７１例脑梗死病人。男性１４２７例,女性５４４例,年龄２３～８９岁,其中４１岁以上者１８３４例,占总数９３％...     

恶性滋养细胞肿瘤治疗、预后的评价-附169例临床分析

目的:对恶性滋养细胞肿瘤按2000年国际妇产科联盟(FIGO)预后评分标准评分并选择治疗方案的疗效进行评价.方法:恶性滋养细胞肿瘤患者169例,治疗前按2000年FIGO预后评分标准进行分期及评分,以此选择治疗方案.结果:169例患者中,绒毛膜癌49例,30例为高危,19例为低危;侵蚀性葡萄胎120例,8例为高危,112例为低危.治疗原则:低危患者以单药化疗为主,高危患者采用多药联合化疗.本组患者的1年、3年、5年生存率分别为98.8％、97.6％及96.9％.无一例因毒副反应或并发症而死亡.结论:治疗前应用2000年FIGO顸后评分系统选择恶性滋养细胞肿瘤治疗方案取得较好的临床效果,新分期系统对指导临床治疗有重大意义.     

BPM红外光治疗宫颈炎149例疗效分析

应用BPM红外光治疗宫颈炎,对149例患者在手术中及手术后的反应进行观察,并对其疗效进行客观评价,说明红外光治疗仪是目前治疗宫颈炎疾病新型科学的光学仪器。     

Reduced dosing and liability in methadone maintenance treatment by targeting oestrogen signal for morphine addiction

Methadone maintenance treatment (MMT) is the major tapering therapy for morphine addictive patients. There have gender differences reported in response to MMT. This study discovered that the estrogen‐response element single nucleotide polymorphism (ERE‐SNP; rs16974799, C/T) of cytochrome 2B6 gene (cyp2b6; methadone catabolic enzyme) responded differently to MMT dosing. Oestradiol was associated with high MMT dosing, high enantiomer (R‐ or S‐) of 2‐ethylidene‐1,5‐dimethyl‐3,3‐dipheny‐pyrrolidine (EDDP; methadone metabolite) to methadone ratio and increased drug‐seeking behaviour, implicating oestradiol‐CYP‐EDDP/methadone axis decreasing MMT efficacy. In mouse model, oestrogen mitigates methadone antinociceptive response, facilitates methadone catabolism and up‐regulates methadone‐associated metabolizing enzymes. Oestrogen also ablates chronic methadone administration‐induced rewarding response. Mechanism dissection revealed the CC genotype of CYP2B6‐ERE‐SNP exerts higher ERE sequence alignment score, higher estrogenic response as compared to TT genotype. At last, preclinical study via targeting estrogen signal that tamoxifen (TMX; selective estrogen receptor modulator, SERM) could facilitate the tolerance phase rewarding response of methadone. Strikingly, TMX also reduces tapering/abstinence phases methadone liability in mice. In conclusion, this study demonstrates altering methadone metabolism through targeting estrogen signals might be able to free morphine addictive patients from the addiction of opioid replacement therapy. Therefore, the add‐on therapy clinical trial introducing SERM in MMT regimen is suggested.     

Method for determination of methadone in exhaled breath collected from subjects undergoing methadone maintenance treatment

At present drugs of abuse testing using exhaled breath as specimen is only possible for alcohol. However, we recently discovered that using modern liquid chromatography–mass spectrometry technique amphetamine and methamphetamine is detectable in exhaled breath following intake in drug addicts. We therefore undertook to develop a method for determination of methadone in exhaled breath from patients undergoing methadone maintenance treatment. Exhaled breath was collected from 13 patients after intake of the daily methadone dose. The compounds were trapped by filtering the air through a C18 modified silica surface. After elution of any trapped methadone the extract was analysed by a combined liquid chromatography–tandem mass spectrometry method. Recovery of trapped methadone from the filter surface was 96%, no significant matrix effect was observed, and the quantification using methadone-d3 as an internal standard was accurate (<10% bias) and precise (coefficient of variation 1.6–2.0%). Methadone was indisputably identified by means of the mass spectrometry technique in exhaled breath samples from all 13 patients. Identification was based on monitoring two product ions in selected reaction monitoring mode with correct relative ratio (±20%) and correct retention time. Excretion rates ranged from 0.39 to 78 ng/min. No methadone was detected in 10 control subjects. This finding confirms that breath testing is a new possibility for drugs of abuse testing. Collection of exhaled breath specimen is likely to be more convenient and safe as compared to other matrices presently in use.     

The effect of methadone addiction on cyclic nucleotide levels in regions of rat brain

Studies of tissue culture cells and tissue slices have implicated the nucleotides, cyclic AMP and cyclic GMP, in the mechanism of action of opiates. However, there are little in vivo data to corroborate this hypothesis. We addicted rats to the synthetic opiate, methadone, by providing the drug in their drinking water (dosage 2.1 mg./kg./day). The two cyclic nucleotides were measured in four brain areas which contain a high concentration of opiate receptors: amygdala, neostriatum, periventricular grey, and thalamus. Data were obtained after acute exposure of the drug (1 day), tolerance (35 days), withdrawal (35 days on drug then 1 day off drug), and readjustment (35 days on drug then 21 days off drug). Cyclic GMP levels were low (0.03 pmol./mg. tissue) in the four regions and did not differ significantly during the experiment. Cyclic AMP levels were higher (1-3 pmol./mg.) and fluctuated consistently in the four regions. After acute methadone treatment, there was a reduction in cyclic AMP, which continued at lower levels after tolerance. One day of withdrawal led to increased cAMP, which rose to near control levels. After readjustment, the levels were reduced. These data indicate an involvement of cyclic AMP in the addiction and withdrawal processes in the intact animal.     

我院抗菌药物实行分级管理后使用情况分析

目的:分析抗菌药物分级管理干预措施的实施及效果。方法:选择2011年5月至2013年5月间我院全院出院患者6622例的病案资料。其中实施分级管理制度之前的患者3238例,实施分级管理制度之后的患者3384例,分析分级管理前后医院抗菌药物使用情况。结果:实施分级管理制度后抗菌药物使用率,人均使用频次及人均抗菌药物费用均明显降低,与实施分级管理制度前比较差异具有统计学意义(P0.05)。实施分级管理制度后一线抗菌药物使用率显著提高,二线、三线抗菌药物使用率降低,与实施分级管理制度前比较差异具有统计学意义(P0.05)。实施分级管理后三联用药比例显著降低(P0.05),送检标本及检出阳性率较实施分级管理前无统计学意义(P0.05)。结论:实施抗菌药物分级管理可以有效的限制抗菌药物滥用情况,对于临床抗菌药物合理应用有积极意义。     

Rapid determination of methadone and its major metabolite in biological fluids by gas–liquid chromatography with thermionic detection for maintenance treatment of opiate addicts

A rapid gas–liquid chromatographic assay is developed for the quantification of methadone (Mtd) and its major metabolite, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP), in biological fluids of opiate addicts. After alkaline extraction from samples with lidocaine hydrochloride as internal standard, Mtd and EDDP are separated on SP-2250 column at 220°C and detected with a thermionic detector. The chromatographic time is about 6 min. The relative standard deviations (R.S.D.) of Mtd and EDDP standards are between 1.5 and 5.5%. Most drugs of abuse (morphine, codeine, narcotine, cocaine, benzoylecgonine, cocaethylene, dextropropoxyphene etc) are shown not to interfere with this technique. The method has been applied to study the levels of Mtd and EDDP metabolite in serum, saliva and urine of patients under maintenance treatment for opiate dependence. EDDP levels were found higher than those of Mtd in urine samples from four treated patients, but lower in serum and undetectable in saliva. However, Mtd concentrations were higher in saliva than in serum.     

The effect of obesity management on body image in patients seeking treatment at medical centers

Objective: Body image dissatisfaction is common in treatment‐seeking patients with obesity. We aimed to investigate the effects of obesity management on body image in patients with obesity attending Italian medical centers for weight loss programs. Research Methods and Procedures: A total of 473 obese patients seeking treatment in 13 Italian medical centers (80% females; age, 45.9 ± standard deviation 11.0 years; BMI, 36.8 ± 5.7 kg/m²) were evaluated at baseline and after a 6‐month weight loss treatment. Body uneasiness, psychiatric distress, and binge eating were tested by Body Uneasiness Test (BUT, Part A), Symptom CheckList‐90 (SCL‐90), and Binge Eating Scale (BES), respectively. Results: At 6‐month follow‐up, the percentage weight loss was significantly higher in men (9.0 ± 6.3%) than in women (6.8 ± 7.3%; p = 0.010). Both men and women had a significant improvement in BUT Global Severity Index and in all of the BUT subscales with the exception of the Compulsive Self‐Monitoring subscale. Linear regression analysis selected baseline psychological and behavioral measures (global score of BUT and SCL‐90) and improved psychiatric distress and binge eating as independent predictors of changes in basal body dissatisfaction in females, whereas in males, changes were associated only with baseline BUT‐Global Severity Index score, binge eating, and its treatment‐associated improvement. Pre‐treatment BMI and BMI changes did not enter the regression. Discussion: Obesity treatment, even with a modest degree of weight loss, is associated with a significant improvement of body image, in both females and males. This effect depends mainly on psychological factors, not on the amount of weight loss.     

Use of large particles support for fast analysis of methadone and its primary metabolite in human plasma by liquid chromatography-mass spectrometry

A bioanalytical method was developed for the quantitation of methadone (MTD) and its primary metabolite, (EDDP) in plasma. The extraction step was performed within a capillary column packed with large particles (35x0.3 mm I.D.; d(p) 30 micrometer) at high flow-rate conditions (450 microliter/min). The separation was performed on a microbore analytical column (55x2 mm I.D.; d(p) 3 micrometer) coupled to a mass spectrometer (MS). This procedure was based on a column-switching unit. Analytes of interest were retained on the precolumn by hydrophobic interactions and backflushed from the precolumn to the analytical column. The detection was carried out with a MS single quadrupole equipped with an electrospray interface. The total analysis time was 6 min. The limits of quantification were evaluated at 10 and 25 ng/ml for MTD and EDDP, respectively. At this level, good accuracies were obtained for both analytes with repeatability values less than 18%.     

海洛因成瘾模型建立及中脑腹侧被盖区Bax的表达

目的探索海洛因对中脑腹侧被盖区细胞Bax表达的影响。方法肌肉注射海洛因,建立成瘾大鼠模型,用免疫组化方法检测中脑腹侧被盖区细胞Bax的表达。结果连续给大鼠注射海洛因7d后,大鼠出现明显的戒断症状;中脑腹侧被盖区细胞Bax表达阳性细胞比对照组明显增多,与对照组相比差异有显著性（P〈0.01）。结论海洛因具有诱导Bax基因表达、损伤脑组织细胞的作用。     

The effect of treatment delay on time-to-recovery in the presence of unobserved heterogeneity

We study the effect of delaying treatment in the presence of (unobserved) heterogeneity. In a homogeneous population and assuming a proportional treatment effect, a treatment delay period will result in notably lower cumulative recovery percentages. We show in theoretical scenarios using frailty models that if the population is heterogeneous, the effect of a delay period is much smaller. This can be explained by the selection process that is induced by the frailty. Patient groups that start treatment later have already undergone more selection. The marginal hazard ratio for the treatment will act differently in such a more homogeneous patient group. We further discuss modeling approaches for estimating the effect of treatment delay in the presence of heterogeneity, and compare their performance in a simulation study. The conventional Cox model that fails to account for heterogeneity overestimates the effect of treatment delay. Including interaction terms between treatment and starting time of treatment or between treatment and follow up time gave no improvement. Estimating a frailty term can improve the estimation, but is sensitive to misspecification of the frailty distribution. Therefore, multiple frailty distributions should be used and the results should be compared using the Akaike Information Criterion. Non-parametric estimation of the cumulative recovery percentages can be considered if the dataset contains sufficient long term follow up for each of the delay strategies. The methods are demonstrated on a motivating application evaluating the effect of delaying the start of treatment with assisted reproductive techniques on time-to-pregnancy in couples with unexplained subfertility.     

The effect of heat treatment and meristem-tip culture on June Yellows in strawberry

Because there is some evidence that June Yellows (JY) of strawberry may be caused by a pathogenic agent, combinations of heat treatment and meristem-tip culture that are known to eliminate some viruses from tissues were used in attempts to cure affected Cambridge Favourite strawberry plants from JY. None of 397 propagants derived from JY-affected plants subjected to various combinations of these treatments were freed from JY. Indeed, all propagants showed more obvious JY symptoms than the parent plants from which they were derived, suggesting that such treatments may be useful for detecting incipient JY in symptomless strawberry stocks.