Efficacy of the alcohol use disorders identification test as a screening tool for hazardous alcohol intake and related disorders in primary care: a validity study.

OBJECTIVE: To determine the properties of the alcohol use disorders identification test in screening primary care attenders for alcohol problems. DESIGN: A validity study among consecutive primary care attenders aged 18-65 years. Every third subject completed the alcohol use disorders identification test (a 10 item self report questionnaire on alcohol intake and related problems) and was interviewed by an investigator with the composite international diagnostic interview alcohol use module (a standardised interview for the independent assessment of alcohol intake and related disorders). SETTING: 10 primary care clinics in Verona, north eastern Italy. PATIENTS: 500 subjects were approached and 482 (96.4%) completed evaluation. RESULTS: When the alcohol use disorders identification test was used to detect subjects with alcohol problems the area under the receiver operating characteristic curve was 0.95. The cut off score of 5 was associated with a sensitivity of 0.84, a specificity of 0.90, and a positive predictive value of 0.60. The screening ability of the total score derived from summing the responses to the five items minimising the probability of misclassification between subjects with and without alcohol problems provided an area under the receiver operating characteristic curve of 0.93. A score of 5 or more on the five items was associated with a sensitivity of 0.79, a specificity of 0.95, and a positive predictive value of 0.73. CONCLUSIONS: The alcohol use disorders identification test performs well in detecting subjects with formal alcohol disorders and those with hazardous alcohol intake. Using five of the 10 items on the questionnaire gives reasonable accuracy, and these are recommended as questions of choice to screen patients for alcohol problems.     

Influence of acute alcohol intake and alcohol withdrawal on circulating levels of IL-6, IL-8, IL-10 and IL-12

Cytokine balance alterations are responsible for some of the systemic and hepatic manifestations of alcoholism. The present study was aimed to evaluate the influence of both acute alcohol abstinence (in alcoholics) and acute alcohol intake (in healthy subjects) on serum IL-6, IL-8, IL-10, and IL-12 levels. Serum cytokine concentrations were determined on admission and after a median of 6 days of ethanol abstinence in 29 patients with alcohol withdrawal syndrome. The same determinations were made in five healthy volunteers at baseline and after 36 h of a single 60 g-dose alcohol intake. Increased serum levels of IL-6, IL-10 and, to a lesser extent IL-8, declined in the few days after alcohol abstinence in patients with alcohol withdrawal syndrome. Serum IL-8 values increased after alcohol intake in healthy subjects. Rapid variation of serum cytokine levels along with alcohol intake or abstinence should be taken into account in cytokine studies in alcohol abusers.     

Effects of alcohol on the fetus: impact and prevention.

In the spectrum of adverse effects on the fetus or infant associated with maternal drinking during pregnancy the most dramatic is the fetal alcohol syndrome, a pattern of malformation that has been associated with maternal alcohol abuse. Other undesirable outcomes of pregnancy linked to alcohol exposure in utero include growth deficiency, major and minor anomalies, decrements in mental and motor performance, and fetal and perinatal wastage. Alcohol, like other teratogens, does not uniformly affect all those exposed to it. Rather, there seems to be a continuum of effects of alcohol on the fetus with increasingly severe outcomes generally associated with higher intakes of alcohol by the mother. The cost of fetal damage associated with alcohol exposure is very high. A program to decrease the incidence of fetal alcohol effects is therefore imperative. The cornerstone of such a program must be not only education of the public but also careful training of all professionals who provide health care for pregnant women.     

酒精性肺疾病的临床研究及进展

酒精对全身器官均有损害,随着研究的深入,酒精性肺疾病逐渐被人们重视。基于酒精的挥发性和肺脏的丰富血供,酒精可以通过支气管循环从纤毛上皮进入到气道,汽化的酒精还可以沉积回气道随呼气再次被释放,这种重复循环使局部气道上皮细胞持续暴露于高浓度酒精下。酒精在肺脏的代谢分为氧化和非氧化代谢两种途径,氧化代谢产物乙醛可引起氧化应激,并产生大量的ROS和自由离子。酒精可影响肾素-血管紧张素系统,提高血管紧张素II水平,并引起内皮细胞应激。酒精还可降低肺脏内还原型谷胱甘肽含量,损害机体先天性和获得性免疫功能。本文将阑述酒精在肺脏的代谢途径及代谢产物对肺脏的损害,其引起重要的应激反应对肺脏均造成损害,是发生肺炎、慢性阻塞性肺疾病、急性呼吸窘迫征等肺疾病的重要因素之一。作者通过酒精对肺脏的作用机制,总结最新的治疗措施。     

Disturbance of human immunohomeostasis by environmental pollution and alcohol consumption

Environmental pollution and consumption of alcohol evoke various immunomodulations promoting the progress of different pathologies. The purpose of this study was to evaluate the influence of alcohol consumption intensity on the immune system functions of humans living in ecologically different regions, i.e. in a district polluted with industrial siftings (Trakai, n = 270) and in a relatively clean district (Sirvintos, n = 250). In the Trakai cohort 96% and in Sirvintos group 89% of persons consumed alcohol. With regard to alcohol consumption habits the immunohaematological indices were investigated in the following four groups: abstinents, light alcohol users, moderate alcohol users and alcohol abusers. We determined the compensatory mechanisms of immune system functions of moderate alcohol users and alcohol abusers in comparison with abstinents in the relatively clean Sirvintos district. In the Trakai district polluted with industrial siftings such compensatory reactions where not found. Thus, damage to the immune system functions is not only an endogenous risk factor for many diseases, but also an indicator of organism injury. This investigation stated, that immunity disturbance in humans depends on alcohol consumption intensity and place of residence.     

Effects of Alcohol Compounds on the Growth and Lipid Accumulation of Oleaginous Yeast Trichosporon fermentans

The inhibitors present in dilute acid-treated lignocellulosic hydrolysates would show great effect on the growth and product formation of microorganisms. To understand their inhibitory law and mechanism on oleaginous microorganism could help improving the efficiency of lignocellulose hydrolysis, detoxification, and lipid fermentation. The effects of four representative alcohol compounds present in lignocellulosic hydrolysates, including furfuryl alcohol, vanillyl alcohol, catechol, hydroquinone on the cell growth and lipid accumulation of Trichosporon fermentans were systematically investigated in this work. The toxicity of selected alcohol compounds was well related to their log P value except furfuryl alcohol, whose log P value was the minimum but with the highest toxicity to T. fermentans. The inhibition of all the alcohol compounds on the growth of T. fermentans was more serious than on the lipid synthesis. Also, the growth of T. fermentans was more sensitive to the variation of inoculum size, temperature, and initial pH than lipid synthesis in the presence of alcohol compounds. Initial pH had more profound influence on the lipid fermentation than inoculum size and cultural temperature did. Careful control of fermentation conditions could be helpful for improving lipid yield of T. fermentans in lignocellulosic hydrolysates. Among the four alcohol compounds tested, most alcohol compounds showed inhibition on both sugar consumption and malic enzyme activity of T. fermentans. However, vanillyl alcohol had little influence on the malic enzyme activity. Similarly, all alcohol compounds except vanillyl alcohol exerted damage on the cell membrane of T. fermentans.     

Comparative study of the effect of ferrocyanide and EDTA on the production of ethyl alcohol from molasses by Saccharomyces cerevisiae

The effects of potassium ferrocyanide and EDTA on ethyl alcohol production from molasses by Saccharomyces cerevisiae were investigated on simulated batch pilotplant-scale conditions for alcoholic fermentation of molasses. Ethyl alcohol production was more sensitive to ferrocyanide than to EDTA. When ferrocyanide was introduced into the cultures at the time of inoculation, there was stimulation of ethyl alcohol production, with 261 ppm ferrocyanide producing the maximum effect, which was 3.0% more than in control cultures. When added during the propagation of the yeast, ferrocyanide depressed ethyl alcohol production by 4.0% maximum whereas EDTA stimulated ethyl alcohol production by 2.0%. Addition of ferrocyanide during the fermentation stage produced no significant effect on alcohol production, whereas over a wide range of EDTA concentration there was a steady increase in alcohol yield.     

Anaerobic Degradability of Alcohol Ethoxylates and Related Non-Ionic Surfactants

The anaerobic degradability of alcohol ethoxylates with various degrees of branching and several related substances was studied. Different inocula were employed in order to increase the probability of obtaining capable bacteria, and the degradation assays were fed with several small doses of the test substances in order to avoid inhibition by too high initial concentrations. Mineralization was quantified by monitoring the biogas production and inorganic carbon concentration in the liquid phase. Almost complete mineralization was achieved in the assays with linear alcohol ethoxylate, poly(ethylene glycol), dodecanol, 2-ethyl-hexanoic acid and 3-methyl-valeric acid. No significant degradation was detected in the assays with highly branched alcohol ethoxylate, 2-butyl-branched alcohol ethoxylate, alcohol alkoxylate, poly(propylene glycol) and iso-tridecanol. A 2-ethyl-branched alcohol ethoxylate was transformed to (2-ethyl-hexyloxy)-acetate, which was not further degraded. Apparently already the first step of anaerobic degradation of alcohol ethoxylates, the ethoxylate chain shortening, is sterically hindered by the alkyl branching. Alkyl branching in alcohol ethoxylates and the inclusion of propylene oxide units in alcohol alkoxylates seem to have a clearly more detrimental effect on anaerobic degradability than on aerobic degradability.     

Severity of alcohol dependence in patients with alcoholic liver disease.

To determine the severity of dependence on alcohol in patients with alcoholic liver disease the severity of alcohol dependence questionnaire was administered to 193 patients with various types of alcoholic liver disease established histologically, in whom a detailed history of lifetime alcohol consumption was also obtained. Only 34 patients (18%) were classified as being severely dependent compared with 56% of patients without overt liver disease who were attending a neighbouring alcohol treatment unit. There was a significant correlation between the severity of dependence and mean daily alcohol consumption (r = 0.45 and 0.39 for men and women, respectively) but not duration of drinking. Dependence scores tended to be lower in patients with cirrhosis than in those with precirrhotic liver disease, but this difference reached significance only in women. These findings confirm that patients who develop chronic alcoholic liver disease are usually only mildly dependent on alcohol and support the hypothesis that patients who escape florid symptoms of alcohol dependence are at greater risk of developing liver damage because they are able to sustain a continual consumption of alcohol over many years.     

Cometabolic degradation of chloroallyl alcohols in batch and continuous cultures

The biodegradation of chloroallyl alcohols by pure and mixed bacterial cultures was investigated. Only 2-chloroallyl alcohol and cis- and trans-3-chloroallyl alcohol served as growth substrate for pure cultures. The other chloroallyl alcohols could be cometabolically degraded during growth on 2-chloroallyl alcohol. Cometabolic degradation of trichloroallyl alcohol, which was the most recalcitrant congener, by a Pseudomonas strain isolated on 2-chloroallyl alcohol resulted in 60% dechlorination. Efficient degradation of a mixture of chloroallyl alcohols in continuous culture could only be achieved in the presence of a satellite population. The mixed culture degraded 99% of the total chloroallyl alcohols added with 71% chloride release. The culture contained strains with a new catabolic potential. The results indicate the importance of mixed cultures and genetic adaptation for efficient chloroallyl alcohol removal.     

Benzyl alcohol inhibits <Emphasis Type="Italic">N</Emphasis>-methyl-<Emphasis Type="SmallCaps">d</Emphasis>-aspartate receptor-mediated neurotoxicity and calcium accumulation in cultured rat cortical neurons

The purpose of this study is to examine whether benzyl alcohol affects N-methyl-D-aspartate (NMDA) receptor in cortical cells. Benzyl alcohol (0.5–2 mM) inhibited NMDA-induced cytotoxicity. The protective effect of benzyl alcohol on NMDA-induced toxicity disappeared by washing cells with buffer to remove benzyl alcohol. Benzyl alcohol reduced NMDA receptor-mediated calcium accumulation, indicating that benzyl alcohol inhibits NMDA receptor activity.     

Responses of the Steroid Circadian System to Alcohol in Humans: Importance of the Time and Duration of Intake

Reports provide conflicting data about the effects of alcohol consumption on the hormonal system. Any study of these effects must control for a number of variables, including sex, alcohol status (alcoholic addiction vs. non-addiction), medical status (malnutrition, liver disease), and conditions of alcohol exposure, including an acute or continuous pattern of intake. The latter appears to be an especially critical factor in interpreting these effects. The authors therefore conducted a trial with a circadian design in which alcohol was administered repeatedly and regularly over a 26 h period for a total dose of 256 g. Because this protocol involves continuous alcohol administration, it is similar to administration among alcoholics and thus sheds new light on alcohol's effect on hormone secretion. Using healthy volunteers rather than alcoholics, however, prevents any confounding due to liver disorders and nutritional deficiencies, and thus makes it possible to focus on the direct role of alcohol in hormonal modifications. In these conditions, the continuous administration of alcohol did not affect cortisol secretion, but serum testosterone levels were significantly higher at all time points during the alcohol session than at the corresponding time points during the control session. These data are not consistent with previously reported findings for the relation between alcohol and both cortisol and testosterone, because in the current experiment the action of ethanol on steroid secretion should involve the circadian clock more than the hormonal system itself.     

Kinetic and mechanistic studies of methylated liver alcohol dehydrogenase.

Reductive methylation of lysine residues activates liver alcohol dehydrogenase in the oxidation of primary alcohols, but decreases the activity of the enzyme towards secondary alcohols. The modification also desensitizes the dehydrogenase to substrate inhibition at high alcohol concentrations. Steady-state kinetic studies of methylated liver alcohol dehydrogenase over a wide range of alcohol concentrations suggest that alcohol oxidation proceeds via a random addition of coenzyme and substrate with a pathway for the formation of the productive enzyme-NADH-alcohol complex. To facilitate the analyses of the effects of methylation on liver alcohol dehydrogenase and factors affecting them, new operational kinetic parameters to describe the results at high substrate concentration were introduced. The changes in the dehydrogenase activity on alkylation were found to be associated with changes in the maximum velocities that are affected by the hydrophobicity of alkyl groups introduced at lysine residues. The desensitization of alkylated liver alcohol dehydrogenase to substrate inhibition is identified with a decrease in inhibitory Michaelis constants for alcohols and this is favoured by the steric effects of substituents at the lysine residues.     

The effect of alcohol on zinc absorption

Two methods of intestinal perfusion are described and used to study the effecs of alcohol on zinc absorption in the rat small intestine. The first method used perfusion of the lumen of the rat small intestinein situ without interruption of the vascular supply. During perfusion with a zinc-containing medium (with and without alcohol), alcohol was found to have no effect on net zinc uptake from the lumen of the intestine. However, there were significantly higher serum zinc concentrations recorded in the rats perfused wih the zinc and alcohol, 28.8 μmol/L, when compared with a group perfused without alcohol, 19.1 μmol/L (P < 0.01). The second method used simultaneous perfusion of the lumen of the rat small intestine, with constant-rate perfusion of the vascular bed with an artificial blood supply. In this experiment with a zinc-containing medium, with and without alcohol, there was no difference noted in zinc absorption from the lumen of the intestine, or release into the artificial blood supply. Therefore, in conclusion, alcohol does not appear to directly influence zinc absorption by the mucosal cells of the small intestine.     

International Commission for Protection against Environmental Mutagens and Carcinogens. ICPEMC Working Paper No. 15/7. Reproductive consequences of alcohol abuse: males and females compared and contrasted

The adverse effects of ethyl alcohol on the hypothalamic pituitary gonadal axes of men and women are discussed with particular attention being given to effects of alcohol upon reproduction. Data obtained from acute and chronic alcohol exposure studies are presented. The putative pathophysiologic mechanisms responsible for disturbed reproductive performances in alcohol abusing individuals are discussed where sufficient data are available.     

The level of free radical oxidation products in heart and blood plasma in diabetes mellitus combined with chronic alcohol intoxication

The level of glycemia, contents of free radical oxidation products (thiobarbituric acid reactive substances, oxidatively modified proteins) have been investigated in blood plasma and heart of rats with diabetes mellitus subjected to chronic alcohol intoxication. Preexisting diabetes mellitus had no influence on the effect of chronic alcohol consumption on the blood plasma levels of oxidatively modified proteins, thiobarbituric acid reactive substances and glucose. However, the contents of thiobarbituric acid reactive substances and products of oxidative modification of proteins were significantly higher in hearts of diabetic rats with chronic alcohol intoxication than in diabetic rats without alcohol intoxication or in rats subjected to chronic alcohol treatment. The alcohol-induced hyperactivation of free radical processes found in the heart may have additional damaging effect.     

Alcohol and nicotine consumption exacerbates choroidal neovascularization by modulating the regulation of complement system

The objective of the present study was to investigate the effect of alcohol and nicotine consumption on the pathogenesis of choroidal neovascularization (CNV) in rats after laser-photocoagulation. Confocal microscopic analysis demonstrated an increase in CNV complex size in rats fed with alcohol (2.3-fold), nicotine (1.9-fold), and the combination of alcohol and nicotine (2.7-fold) compared with the control groups. Immunohistochemical analysis revealed that alcohol and nicotine consumption increased MAC deposition and VEGF expression in laser spots. Expression of CD59 by RT-PCR and Western blot was drastically reduced in the animals that were fed with alcohol, nicotine and alcohol and nicotine compared to those fed with water alone and this was associated with exacerbation of CNV.     

Low digit ratio 2D:4D in alcohol dependent patients

The ratio of the lengths of the second and fourth finger (2D∶4D) has been described as reflecting the degree of prenatal androgen exposure in humans. 2D∶4D is smaller for males than females and is associated with traits such as left-handedness, physical aggression, attention-deficit-hyperactivity disorder and a genetic polymorphism of the androgen receptor. All of these traits are known to be correlated to the vulnerability for alcohol dependency. We therefore hypothesized low 2D∶4D in patients with alcohol dependency. In the present study on 131 patients suffering from alcohol dependency and 185 healthy volunteers, we found that alcohol dependent patients had smaller 2D∶4D ratios compared to controls with preserved sexual dimorphism but with reduced right-left differences. The detection of alcohol dependency based on 2D∶4D ratios was most accurate using the right hand of males (ROC-analysis: AUC 0.725, sensitivity 0.667, specificity 0.723). These findings provide novel insights into the role of prenatal androgen exposure in the development of alcohol dependency and for the use of 2D∶4D as a possible trait marker in identifying patients with alcohol dependency.     

Responses of the steroid circadian system to alcohol in humans: Importance of the time and duration of intake

Reports provide conflicting data about the effects of alcohol consumption on the hormonal system. Any study of these effects must control for a number of variables, including sex, alcohol status (alcoholic addiction vs. non-addiction), medical status (malnutrition, liver disease), and conditions of alcohol exposure, including an acute or continuous pattern of intake. The latter appears to be an especially critical factor in interpreting these effects. The authors therefore conducted a trial with a circadian design in which alcohol was administered repeatedly and regularly over a 26 h period for a total dose of 256 g. Because this protocol involves continuous alcohol administration, it is similar to administration among alcoholics and thus sheds new light on alcohol's effect on hormone secretion. Using healthy volunteers rather than alcoholics, however, prevents any confounding due to liver disorders and nutritional deficiencies, and thus makes it possible to focus on the direct role of alcohol in hormonal modifications. In these conditions, the continuous administration of alcohol did not affect cortisol secretion, but serum testosterone levels were significantly higher at all time points during the alcohol session than at the corresponding time points during the control session. These data are not consistent with previously reported findings for the relation between alcohol and both cortisol and testosterone, because in the current experiment the action of ethanol on steroid secretion should involve the circadian clock more than the hormonal system itself.