Association between Nonmedical Marijuana and Pain Reliever Uses among Individuals Aged 50+

Marijuana and pain reliever use for medical and nonmedical purposes has been increasing among older adults. Using the 2012–2013 U.S. National Survey on Alcohol and Related Conditions (NESARC-III), this study examined: (1) the association between past-year nonmedical marijuana and pain reliever use among adults aged 50+ years (N = 14,715); and (2) sociodemographic, health, and pain-related correlates of nonmedical marijuana and/or pain reliever use. The findings show that 3.87% and 3.12%, respectively, used marijuana and pain relievers nonmedically and 14.40% of marijuana users, compared to 2.67% of nonusers, used pain relievers nonmedically. Controlling for sociodemographics, health status, pain interference, and mental and other substance use disorders, marijuana use anduse disorder were significantly associated with nonmedical pain reliever use and opioid use disorder, respectively. Compared to marijuana users (with or without nonmedical use of pain relievers), nonmedical pain reliever users (without marijuana) are older, married, and women. Users of both substances nonmedically are a small group (0.56% of the 50+ age group), but they are at greatest risk of lifetime opioid, alcohol, and nicotine use disorders. Pain interference is a significant correlate of nonmedical pain reliever use. Healthcare providers should assess for the nonmedical use of these medicines/drugs and help older adults receive effective pain treatment.     

Visualizing the Complex Brain Dynamics of Chronic Pain

Chronic pain is now recognized as a disease state that involves changes in brain function. This concept is reinforced by data that document structural and morphological remapping of brain circuitry under conditions of chronic pain. Evidence for aberrant neurophysiology in the brain further confirms neuroplasticity at cellular and molecular levels. Proper detection of pain-induced changes using emerging non-invasive and cost-effective technologies, such as analytical electroencephalography methods, could yield objective diagnostic measures and may guide therapeutic interventions targeting the brain for effective management of chronic pain.     

Chronic Tobacco-Smoking on Psychopathological Symptoms,Impulsivity and Cognitive Deficits in HIV-Infected Individuals

HIV-infected individuals (HIV+) has 2–3 times the rate of tobacco smoking than the general population, and whether smoking may lead to greater psychiatric symptoms or cognitive deficits remains unclear. We evaluated the independent and combined effects of being HIV+ and chronic tobacco-smoking on impulsivity, psychopathological symptoms and cognition. 104 participants [27 seronegative (SN)-non-Smokers, 26 SN-Smokers, 29 HIV+ non-Smokers, 22 HIV+ Smokers] were assessed for psychopathology symptoms (Symptom Checklist-90, SCL-90), depressive symptoms (Center for Epidemiologic Studies-Depression Scale, CES-D), impulsivity (Barratt Impulsiveness Scale, BIS), decision-making (The Iowa Gambling Task, IGT, and Wisconsin Card Sorting Test, WCST), and cognition (seven neurocognitive domains). Both HIV+ and Smoker groups had higher SCL-90 and CES-D scores, with highest scores in HIV+ Smokers. On BIS, both HIV+ and Smokers had higher Total Impulsiveness scores, with higher behavioral impulsivity in Smokers, highest in HIV+ Smokers. Furthermore, across the four groups, HIV+ Smokers lost most money and made fewest advantageous choices on the IGT, and had highest percent errors on WCST. Lastly, HIV+ had lower z-scores on all cognitive domains, with the lowest scores in HIV+ Smokers. These findings suggest that HIV-infection and chronic tobacco smoking may lead to additive deleterious effects on impulsivity, psychopathological (especially depressive) symptoms and cognitive dysfunction. Although greater impulsivity may be premorbid in HIV+ and Smokers, the lack of benefits of nicotine in chronic Smokers on attention and psychopathology, especially those with HIV-infection, may be due to the negative effects of chronic smoking on dopaminergic and cardio-neurovascular systems. Tobacco smoking may contribute to psychopathology and neurocognitive disorders in HIV+ individuals.     

Pain Interference in Individuals in Driver Intervention Programs for Driving Under the Influence Offenders

Pain-related problems among individuals in court-mandated Driver Intervention Programs (DIPs) for “driving under the influence” (DUI) offenders have not been well studied. This project examines 3,189 individuals from a DIP in Dayton, Ohio. Over 11% of participants reported significant pain-related interference in the past 4 weeks. Pain was significantly more likely in those with depression, more childhood conduct problems, and recent use of multiple illicit drugs. Many individuals seen in court-mandated DIP programs for DUI offenders also report difficulties with pain. DIP programming should address pain in relation to substance use and mental health issues.     

Effect of Modafinil on Learning and Task-Related Brain Activity in Methamphetamine-Dependent and Healthy Individuals

Methamphetamine (MA)-dependent individuals exhibit deficits in cognition and prefrontal cortical function. Therefore, medications that improve cognition in these subjects may improve the success of therapy for their addiction, especially when cognitive behavioral therapies are used. Modafinil has been shown to improve cognitive performance in neuropsychiatric patients and healthy volunteers. We therefore conducted a randomized, double-blind, placebo-controlled, cross-over study, using functional magnetic resonance imaging, to examine the effects of modafinil on learning and neural activity related to cognitive function in abstinent, MA-dependent, and healthy control participants. Modafinil (200 mg) and placebo were administered orally (one single dose each), in counterbalanced fashion, 2 h before each of two testing sessions. Under placebo conditions, MA-dependent participants showed worse learning performance than control participants. Modafinil boosted learning in MA-dependent participants, bringing them to the same performance level as control subjects; the control group did not show changes in performance with modafinil. After controlling for performance differences, MA-dependent participants showed a greater effect of modafinil on brain activation in bilateral insula/ventrolateral prefrontal cortex and anterior cingulate cortices than control participants. The findings suggest that modafinil improves learning in MA-dependent participants, possibly by enhancing neural function in regions important for learning and cognitive control. These results suggest that modafinil may be a suitable pharmacological adjunct for enhancing the efficiency of cognitive-based therapies for MA dependence.     

神经妥乐平与恩在适抗脑缺血与镇痛作用比较

目的 观察神经妥乐平和恩在适对动物脑缺血和腹腔注射醋酸所致疼痛扭体反应的改善作用。方法 建立大鼠大脑中动脉阻断再灌注模型，其中4组分别按10和20 U· kg^-1的剂量给予神经妥乐平和恩在适，模型组和假手术组不给予任何药物，将各组大鼠的神经症状、脑梗死面积和脑水肿改善情况作为评价药物的指标；将小鼠腹腔注射醋酸致疼痛扭体反应，从小鼠对化学刺激所引起的扭体反应次数来评价药物的镇痛作用。结果 神经妥乐平（10和20 U·kg^-1）可改善神经症状、缩小梗死面积并减轻脑水肿；恩在适20 U·kg^-1剂量组脑含水量和梗死面积减少，10 U·kg^-1剂量组梗死面积无缩小。无论大小剂量组均无改善神经症状作用。神经妥乐平20 U·kg^-1和40 U·kg^-1剂量组均能抑制腹腔注射醋酸后引起的扭体反应，与模型组比较差异有显著性。恩在适在同样剂量下无镇痛作用。 结论 神经妥乐平有改善脑缺血 再灌注的作用，而较高剂量的恩在适才有抗脑缺血的作用。神经妥乐平能抑制由醋酸引起的疼痛反应，恩在适在同样剂量下无镇痛作用。     

度洛西汀改善膝骨性关节炎疼痛症状有效性和安全性的Meta分析

目的:系统评价度洛西汀改善膝骨性关节炎(KOA)疼痛症状的有效性和安全性,为临床治疗KOA提供循证参考。方法:计算机检索PubMed、Embase、Medline、Cochrane Library、中国知网、维普网和万方数据库中发表的度洛西汀(试验组)对比安慰剂(对照组)改善KOA疼痛症状的随机对照试验(RCT),检索时限为建库起至2019年9月。对符合纳入标准的文献进行资料提取,并采用Cochrane系统评价员手册5.1.0进行质量评价后,采用Stata 14.0软件对膝关节的西安大略麦马斯特大学骨关节炎指数可视化量表(WOMAC)总分、WOMAC疼痛评分、WOMAC僵硬程度评分、WOMAC功能评分、简明疼痛评估量表(BPI-S)评分以及口干、嗜睡、恶心等不良反应发生率进行Meta分析。结果:共纳入6项RCT,合计2 059例患者。Meta分析结果显示,试验组患者WOMAC总分[MD=-0.34,95%CI(-0.48,-0.20),P<0.05]、WOMAC疼痛评分[MD=-0.41,95%CI(-0.54,-0.29),P<0.05]、WOMAC僵硬程度评分[MD=-...     

护理干预对颅脑损伤性精神症状的影响效果

目的观察护理干预对颅脑损伤性精神症状的影响效果。方法选取2013年6月至2015年7月在我院接受颅脑损伤性精神症状治疗的患者58例为研究对象,将其分为观察组和对照组,观察组患者给予护理干预,对照组患者给予常规护理。结果观察组患者护理5d和10d后精神症状明显优于对照组,差异具有统计学意义(P<0.05)。结论运用护理干预对颅脑损伤性精神症状患者实施护理服务,改善了患者护理后的精神症状,促进了患者的更好康复,值得予以临床推广。     

Pharmacological Treatment of Insomnia Symptoms in Individuals with Substance Use Disorders in Spain: A Quasi-Experimental Study

Introduction: Pharmacological treatment of insomnia in patients with addictions has been hardly investigated and there are few researches about it in an inpatient detoxification. The aim of this study was to describe the outcomes of the pharmacological treatment of insomnia in SUD patients admitted to a detoxification unit in Spain, with a focus on the primary substance of abuse and co-occurring mental disorders. Methods: A quasi-experimental study was conducted in 481 addicted in patients, who were admitted for substances detoxification in Vall d´Hebron University Hospital, Barcelona, Spain, from 2010 to 2015. The patients underwent systematic evaluation of axes I and II psychiatric disorders (SCID-I, SCID-II, and CAADID). Insomnia was evaluated using a night time sleep log. Substance-dependent patients, who had insomnia during hospital detoxification, received a psychotropic medication with hypnotic effect, keeping the regular clinical practice without randomization. Results: At discharge, insomnia was considered to have been alleviated in 63.8% (n = 204) of patients while 36.2% (n = 116) of patients remained with insomnia disturbances. Comparing hypnotic treatments it was observed that mirtazapine and clotiapine were the treatment that corrected the insomnia more frequently. Discussion: Since insomnia is not corrected in all patients, it should be further investigated in medications with hypnotic purpose. Based on the results of this work, randomized clinical trials might be proposed.     

NF-kB、TNF-α在淹溺大鼠脑组织中的表达及其与脑损伤的相关性

目的:探讨淡水淹溺后大鼠脑组织中细胞因子NF-kB、TNF-α的表达及其与淹溺应激引起脑损伤之间的关系.方法:Wistar大鼠70只,其中正常对照(Ⅰ组)、溺水致死(Ⅱ组)、溺水后存活(Ⅲ组)3 h、6 h、12 h、24 h、40 h各10只,剥取脑组织固定、切片,HE染色后光镜下观察形态学改变;SABC免疫组化法检测各组大鼠脑组织中NF-kB、TNF-α的表达.结果:Ⅰ组脑组织结构清晰,无水肿、出血、坏死病灶;Ⅱ组脑实质疏松,小血管周隙增宽,部分神经细胞体积增大变性;Ⅲ组随溺水后存活时间的推移,脑损伤程度逐渐加重,其中24 h脑水肿最重,40 h个别脑实质小灶性液化性坏死.Ⅱ组脑指数明显高于Ⅰ组(P<0.05),并高于Ⅲ组,与3 h,6h、12 h差异有统计学意义(P<0.05).与Ⅰ组相比,Ⅲ组6 h时NF-KB表达显著增加(P<0.05);12 h时TNF-α表达显著增加(P<0.05).结论:淡水淹溺后存活大鼠发生脑损伤时NF-kB和TNF-α高表达,提示NF-kB、TNF-α与淹溺应激所致脑损伤有关.     

Relationship Between Brain Glutamate Levels and Clinical Outcome in Individuals at Ultra High Risk of Psychosis

Alterations in brain glutamate levels may be associated with psychosis risk, but the relationship to clinical outcome in at-risk individuals is unknown. Glutamate concentration was measured in the left thalamus and anterior cingulate cortex (ACC) using 3-Tesla proton magnetic resonance spectroscopy in 75 participants at ultra high risk (UHR) of psychosis and 56 healthy controls. The severity of attenuated positive symptoms and overall functioning were assessed. Measures were repeated in 51 UHR and 33 Control subjects after a mean of 18 months. UHR subjects were allocated to either remission (no longer meeting UHR criteria) or non-remission (meeting UHR or psychosis criteria) status on follow-up assessment. Thalamic glutamate levels at presentation were lower in the UHR non-remission (N=29) compared with the remission group (N=22) (t(49)=3.03; P=0.004), and were associated with an increase in the severity of total positive symptoms over time (r=−0.33; df=47; P=0.02), most notably abnormal thought content (r=−0.442; df=47; P=0.003). In the UHR group, ACC glutamate levels were lower at follow-up compared with baseline (F(80)=4.28; P=0.04). These findings suggest that measures of brain glutamate function may be useful as predictors of clinical outcome in individuals at high risk of psychosis.     

Associations between dieting and smoking-related behaviors in young women

Many young women report smoking due to weight concerns, but little is known about the relationship between weight concerns and current smoking behavior. The present study examined smoking topography and the acute sensory and physiological responses to smoking in dieting and non-dieting young women. In addition, the effect of presentation of food cues on these responses was examined. Self-reported female current dieters (n=15) and non-dieters (n=15) attended two laboratory sessions (food cues present/food cues absent). Physiological and subjective responses were recorded pre- and post-cigarette at each session. Smoking topography was assessed by video analysis. Dieters scored higher than non-dieters on measures of weight control smoking, dietary restraint, and disinhibition. At both sessions, they smoked less of the cigarette, had shorter inhalation durations, longer inter-puff intervals, experienced smaller physiological effects and gave lower ratings of the sensory aspects of smoking than non-dieters. The presence of food cues did not alter smoking topography or sensory/physiological responses but the dieters reported a greater desire to smoke in the presence of food cues. These data suggest that sensory factors may be less important influences on smoking for weight control smokers than non-weight control smokers and that further investigation of the role of food cues in maintaining smoking behavior in weight control smokers is warranted.     

Associations between ethnicity and obstetric intervention in New Zealand

AIMS: To determine whether the lower rates of obstetric interventions in Maori and Pacific Island women from the New Zealand Ministry of Health obstetric procedures report in 1999 existed also in National Women's Hospital (NWH), Auckland data and if so whether they persisted after controlling for parity and obstetric risk. METHODS: The study population included 43,367 singleton, cephalic deliveries, not preceded by caesarean section at NWH from 1992-1999. Ethnicity was Maori, Pacific Island, or other. Obstetric interventions were explored at two time points: (1) at the initiation of the delivery process: induction of labour, prelabour caesarean section, or spontaneous onset of labour; and (2) at the point of delivery: either caesarean section, operative vaginal delivery, or spontaneous vaginal birth. Independent associations were found by fitting polytomous logistic regression models. RESULTS: 10% of the study population were Maori, 19% Pacific Islanders, and 71% other. Unadjusted analyses showed lower rates of all obstetric interventions for Maori and Pacific Island women. Adjusted analyses showed that rates of induction of labour, prelabour caesarean, and operative vaginal delivery were lower for Maori and Pacific women than for all other ethnicities grouped together. However, caesarean delivery rates overall were not different for Maori or Pacific Island women. CONCLUSIONS: The adjusted analysis did not confirm the association seen in the New Zealand Ministry data between ethnicity and caesarean section. However, induction, prelabour caesarean section, and operative vaginal delivery were less common in Maori and Pacific Island women.     

Gender and Iron Genes May Modify Associations Between Brain Iron and Memory in Healthy Aging

Brain iron increases with age and is abnormally elevated early in the disease process in several neurodegenerative disorders that impact memory including Alzheimer''s disease (AD). Higher brain iron levels are associated with male gender and presence of highly prevalent allelic variants in genes encoding for iron metabolism proteins (hemochromatosis H63D (HFE H63D) and transferrin C2 (TfC2)). In this study, we examined whether in healthy older individuals memory performance is associated with increased brain iron, and whether gender and gene variant carrier (IRON+) vs noncarrier (IRON−) status (for HFE H63D/TfC2) modify the associations. Tissue iron deposited in ferritin molecules can be measured in vivo with magnetic resonance imaging utilizing the field-dependent relaxation rate increase (FDRI) method. FDRI was assessed in hippocampus, basal ganglia, and white matter, and IRON+ vs IRON− status was determined in a cohort of 63 healthy older individuals. Three cognitive domains were assessed: verbal memory (delayed recall), working memory/attention, and processing speed. Independent of gene status, worse verbal-memory performance was associated with higher hippocampal iron in men (r=−0.50, p=0.003) but not in women. Independent of gender, worse verbal working memory performance was associated with higher basal ganglia iron in IRON− group (r=−0.49, p=0.005) but not in the IRON+ group. Between-group interactions (p=0.006) were noted for both of these associations. No significant associations with white matter or processing speed were observed. The results suggest that in specific subgroups of healthy older individuals, higher accumulations of iron in vulnerable gray matter regions may adversely impact memory functions and could represent a risk factor for accelerated cognitive decline. Combining genetic and MRI biomarkers may provide opportunities to design primary prevention clinical trials that target high-risk groups.     

Associations between laboratory parameters and outcome of paraquat poisoning

Paraquat, a non-selective herbicide, is a known fatal substance in humans, and intentional ingestion of paraquat is increasing among Korean suicides. In 1999, 147 subjects admitted to the Institute of Pesticide Poisoning, Soonchunhyang Chunan Hospital, Korea ingested paraquat. Initial routine laboratory tests were conducted and the outcome of paraquat poisoning was categorized as survivor and fatality. Mean amount (S.D.) of ingestion was 54.5 (104.9) ml, and the overall fatality rate was 44.2%. Abnormal liver function (GOT and GPT), renal dysfunction (BUN and creatinine), metabolic acidosis (pH and PaCO(2)), and abnormal urine analysis (RBC, WBC, and protein) had significant odds ratios (ORs) for paraquat fatality (P<0.05). In multiple logistic regression, subjects with liver or renal dysfunction or metabolic acidosis had significant risks of the fatality. Our results determined that initial routine laboratory parameters could be used to predict the outcome of paraquat poisoning and recommended that evaluation of acid-base status and renal and liver function should be conducted and evaluated before intensive therapy.     

Depressive Symptoms,Substance Use,and HIV-Related High-Risk Behaviors Among Opioid-Dependent Individuals: Results From the Clinical Trials Network

The sample included 343 opioid-dependent adults enrolled in two national multisite studies of the National Drug Abuse Treatment Clinical Trials Network (CTN001-002). Opioid-dependent individuals were recruited from 12 sites across the United States from January 2001 to July 2002. We examined associations between depressive symptoms, co-occurring substance use (i.e., the use of substances other than opioids), and HIV-related sexual and injection risk behaviors. Data were collected using the Addiction Severity Index and the HIV Risk Behavior Scale, and analyzed using linear regression. Depressive symptoms were associated with an increased level of injection risk behaviors but were not associated with risky sexual behaviors. The co-occurring use of amphetamines also increased the likelihood of risky sexual behaviors. The study limitations and clinical implications are noted. The study was funded by the U.S. National Institute on Drug Abuse.     

Associations between initial opioid exposure and the likelihood for long-term use

Objectives

This study examined the association between initial opioid exposure and subsequent long-term use in 2 national Veterans Administration (VA) cohorts from 2011 and 2016, a period during which opioid prescribing declined.

基质金属蛋白酶-3/9在重型颅脑损伤患者脑脊液中的表达及与预后关系的研究

目的探讨基质金属蛋白酶-3/9在重型颅脑损伤患者脑脊液中的表达及其与预后的关系。方法选取我院神经外科收治重型颅脑损伤患者30例为实验组,随机选取我科30例诊断为单纯性脑积水患者为对照组。实验组患者入院后行腰椎穿刺,分别取伤后3、5、7 d脑脊液各5 m L;对照组30例入院后行腰椎穿刺,取脑脊液5 m L。脑脊液在4℃下以3000 rmp离心10 min,取上清液冻存于-70℃待检。MMP-3和MMP-9采用ELISA法测定。结果相比于对照组,实验组患者脑脊液中MMP-9与MMP-3均有升高,并具有统计学意义(P<0.05)。MMP-9与患者预后GOS评分呈负相关。结论 MMP-3与MMP-9在重型颅脑损伤的病理生理过程中起着重要的作用,伤后3 d的MMP-9浓度可作为重型颅脑损伤患者预后判断指标。