Evolution of the NBOMes: 25C- and 25B- Sold as 25I-NBOMe

Introduction

The NBOMes (N-benzyl-oxy-methyl derivatives of known 2C phenylethylamines) are a new and growing class of potent synthetic stimulants. Case reports provide the bulk of available safety and clinical data for clinicians. We report two cases of NBOMe intoxication with 25C-NBOMe (the first lab-confirmed US case) and 25B-NBOMe, respectively, both confirmed via triple quadrapole mass spectrometry.

Case Reports

Case 1: A 16-year-old girl had a generalized seizure after reported use of 25I-NBOMe. She presented with altered mental status, lower extremity rigidity, and elevated CPK (6042 U/L). Despite treatment with benzodiazepines, her lower extremity rigidity persisted and CPK peaked at 47,906 U/L. She was discharged on hospital day 8. Serum and urine specimens confirmed presence of 25C-NBOMe. Case 2: A 15-year-old boy developed bizarre behavior after reported use of 25I-NBOMe. In the ED, he had two generalized seizures and persistent muscle rigidity. CPK peaked at 429 U/L. Seizures were managed with benzodiazepines, and he was discharged within 24 h. Serum specimens revealed 25B-NBOMe.

Discussion

NBOMes are amphetamine derivatives and highly potent 5-HT_2A receptor agonists. Clinical manifestations are a product of enhanced central sympathetic and serotonergic tone. We report two cases of NBOMe intoxication in patients who believed they used 25I-NBOME, while lab confirmation proved otherwise. Whether unique clinical manifestations are specific to the NBOMe variant, dose, route of administration, or other factors is unknown. Laboratory confirmation may play a role in identifying unexpected NBOMe variants, while contributing to the epidemiologic data on these novel substances.     

药物治疗应激性胃溃疡的研究进展

应激性胃溃疡是由于应激引起的以胃黏膜糜烂、表浅溃疡以及胃黏膜出血为特征的应激胃黏膜病变。其发病原因与生活息息相关,发病人数日益增多。近年来相应的药物基础研究主要围绕着抑制应激所造成的氧化损伤、抗炎症因子的表达、调节胃酸等,并取得大量的研究成果,对于治疗应激性胃溃疡的药物选择逐渐多样化,植物提取物对应激性胃溃疡的作用得到越来越多的关注。文中就目前对应激性胃溃疡的药物治疗研究情况作一综述。     

Mapping U.S. long-haul truck drivers’ multiplex networks and risk topography in inner-city neighborhoods

This article illustrates how urban inner-city trucking milieux may influence STI/BBI/HIV acquisition and transmission risks for U.S. long-haul truckers, as well as their social and risk relationships. Using mixed methods, we collected ethnoepidemiological and biological data from long-haul truck drivers and their risk contacts in inner-city trucking milieux in Atlanta, Georgia, United States. Key findings indicate that within the risk-endemic environment of distressed inner-city areas, diverse trucking risk milieux can amplify STI/BBI/HIV risk for multiplex networks of truckers. Inner-city neighborhood location, short geographic distance among risk contacts, and trucker concurrency can potentially exacerbate transmission via bridging higher-risk individuals with lower-risk populations at disparate geographic and epidemiological locations.     

中西医结合治疗肺结核的临床疗效研究

目的:评价常规化疗方案联合中成药“抗痨合剂”及中医适宜技术治疗肺结核的临床疗效。方法:采用前瞻性研究的方法,连续纳入2017年1月至2019年12月浙江中医药大学附属丽水中医院结核科诊治的300例初治肺结核患者,采用随机数字表法将患者均等分成3组,即常规西药抗结核治疗组(A组)、常规西药抗结核治疗联合中成药抗痨合剂组(B组)、常规西药抗结核治疗联合中成药抗痨合剂及中医适宜技术组(C组)。剔除24例因诊断变更、中断治疗、发生药物不良反应患者后最终纳入276例患者,其中A组97例、B组93例、C组86例。观察并比较三组患者疗程末的中医症状改善情况、肺部病灶吸收情况、T淋巴细胞亚群变化及治疗转归情况。结果:治疗6个月后,B组和C组中医证状改善有效率[92.5%(86/93)和94.2%(81/86)]、肺部病灶吸收有效率[92.5%(86/93)和94.2%(81/86)]、CD3⁺T淋巴细胞百分比[(65.76±5.42)%和(67.06±5.95)%]、CD4⁺T淋巴细胞百分比[(44.97±5.35)%和(46.51±5.26)%]、治疗成功率[94.6%(88/93)和97.7%(84/86)]均明显优于A组[分别为82.5%(80/97)、76.3%(74/97)、(63.80±4.57)%、(42.72±4.82)%、80.4%(78/97)],差异均有统计学意义(χ²=2.000,P=0.046;χ²=2.999,P=0.003;χ²=2.427,P=0.015;χ²=2.886,P=0.004;t=2.699,P=0.008;t=4.186,P=0.005;t=3.048,P=0.003;t=6.428,P<0.001;χ²=2.069,P=0.039;χ²=2.192,P=0.028)。而B组和C组治疗后外周血CD8⁺T淋巴细胞百分比[(27.12±2.32)%和(26.35±3.17)%]均明显低于A组[(29.12±2.21)%],差异有统计学意义(t=5.051,P<0.001;t=9.231,P<0.001)。结论:中西药联合抗结核治疗可明显减轻肺结核患者的临床症状,促进肺部病灶吸收,提高肺结核患者免疫力,有效提高临床疗效,但中医适宜技术的应用效果未得到证实。     

老年人肝内胆汁郁积16例临床分析

总结16例老年人肝内胆汁郁积患者的临床资料,并与26例中青年患者进行比较.结果表明,药物和病毒性肝炎是引起老年人肝内胆汁郁积的常见原因,尤以药物所致者显著增多.老年患者中男性占绝大多数.两年龄组胆汁郁积型肝炎患者的临床表现、病程经过和预后等并无明显差别,但由于老年患者常伴随多种疾病,特别是胆囊结石,使病情趋于复杂,极易误诊为胆石引起的肝外阻塞性黄疸.因此,对老年黄疸患者应尽早超声探查肝胆系统.以确立肝内胆汁郁积的诊断.     

海南省吸毒人群HIV感染状况调查

目的摸清海南省吸毒人群艾滋病病毒（HIV）感染的相关行为的信息，为针对这组人群开展艾滋病干预措施提供依据。方法采用筛查的方法，在规定的时间内，对全省强制戒毒所的4243名戒毒人员进行HIV检测和问卷调查。结果在4243名戒毒者中，检出35名HIV抗体阳性者，平均检出率为0．82％。35名阳性者分布在东方（6．45％）、乐东（4．29％）、儋州（3．03％）、三亚（2．30％）等6个市县；有注射毒品行为者占50．3％～82．9％。感染的主要原因是通过共用针具静脉注射毒品引起，共用针具率14．2％～24．9％。结论海南省吸毒人员HIV总体上虽处于低流行水平，但是在东方、乐东、儋州、三亚等市县存在着局部流行现象，与艾滋病相关的危险行为依然存在，必须引起相关部门的关注。     

疏水性低共熔溶剂对水中5种非甾体抗炎药物的萃取研究

目的 建立一种以疏水性低共熔溶剂为萃取溶剂的分散液液微萃取方法,以提取水中的酮洛芬、布洛芬、洛索洛酚钠、萘普生、双氯酚酸钠五种非甾体抗炎药物。方法 以五种非甾体抗炎类药物的萃取率为指标,考察了疏水性低共熔溶剂种类和体积、氢受体/氢供体比例、分散剂的种类和体积及氯化钠的浓度对萃取效率的影响,确定了最佳萃取条件。结果 通过条件筛选,得到的最佳萃取条件为以DES（甲基三辛基氯化铵/癸酸比例=1：5）为萃取溶剂,以乙腈为分散剂,DES的体积为300μL,乙腈的体积为650μL,氯化钠的浓度为13.5%。结论 在最佳条件下,酮洛芬、布洛酚、洛索洛芬钠、萘普生、双氯酚酸钠的萃取率为89.7%,80.3%,77.1%,92.6%和91.4%。     

关于中药命名规范化现状与发展的思考

通过文献研究对中药饮片和中成药命名规范存在的问题和原因进行回顾与分析,提出植物的不同基原、各地处方规范和国家标准不统一等是中药命名不规范的主要原因。尽管国家已出台的相关法规和指导原则推动了中药命名规范化的进程,但缺乏通用的中成药编码系统与标准,因此建议政府相关部门制定统一标准来实现中药命名规范化,为中药的合理使用和国际化,以及全球草药的统一监管奠定基础。