Anabolic Steroid Abuse and Dependence in Clinical Practice

Abstract

The nonmedical use of anabolic-androgenic steroids (AAS) appeals to athletes across several sports, particularly those whose activity makes muscle size and strength advantageous, and in individuals (usually men) with body dysmorphic disorder. Patterns of nonmedical use, including supratherapeutic doses of illicitly obtained drugs, increase the risk for adverse psychiatric and other medical consequences. Although AAS users may be more likely to consult physicians for nonpsychiatric medical consequences than changes in their mental status, it is argued that the motivation for persistent use despite adverse consequences is sustained in large part by psychological variables. Therefore, all physicians who treat nonmedical AAS users will benefit from an understanding of these psychological variables, including the potential for AAS to cause dependence. This article aims to aid such understanding, and guidelines are suggested for assessment and treatment of nonmedical AAS users.     

运动员尿中类固醇激素水平的研究

目的:对1217名运动员尿中8种类固醇激素的含量进行测定及统计分析,以考察我国运动员内源性类固醇激素水平.方法:对尿样进行预提取、水解、萃取、衍生化等前处理,采用GC/MS方法分离检测,测定内源性类固醇激素含量.结果:我国男运动员尿中类固醇水平一般高于女性,但都普遍低于国外统计数据,尤其是睾酮和5β雄烷二醇的水平低于国外数据4～7倍.某些类固醇含量的比值(如An/Etio、T/ET、5α-diol/5β-diol)较为恒定,且受性别因素影响较小.     

Acute exercise: response of HDL-C, LDL-C lipoproteins and HDL-C subfractions levels in selected sport disciplines

BACKGROUND: High HDL levels has been shown to be associated with high endurance capacity. The acute effects of maximal endurance exercise (of short duration) (15 min) on low density lipoproteins-cholesterol (LDL-C), high density lipoproteins - cholesterol (HDL-C) and HDL subfractions HDL2 and HDL3 were examined, in order to determine whether the magnitude of response can be affected by maximal intensity of exercise (incremental stress test). METHODS: Male athletes (n=78) of national level, from four sport disciplines, volunteered to participate in this cross-sectional study; basketball (n=10), swimming (n=9), long distance (LD) running (n=23) and wrestling (n=35); also a group of non athletes as controls (n=19). Participants trained at least 2 hrs/day for more than 3 years; they were healthy, non-smokers and fasted 12 hrs before blood sampling. The ergometric test was a test for the estimation of maximal oxygen uptake on a treadmill ergometer based on a stepwise stress protocol. RESULTS: Immediately after a maximal effort all groups (controls included) showed significant HDL-C increases (p<0.001) from rest values, while LD running showed the highest values. HDL2 levels increased in LD running (p<0.001), basketball and wrestling, while HDL3 ones in all groups and controls (p<0.001). The HDL2 of all athletes showed the highest correlation (R=0.37**, p<0.01) with VO2max, even higher than HDL itself. CONCLUSIONS: Acute maximal endurance exercise (100 percent VO2max) may induce acute modifications and intermolecular redistribution of HDL-C and subfractions. It is possible that the increased flux of lipids to HDL-C molecule may result from the regulatory action of lipoprotein lipase (LPL).     

Prophylactic Use of NSAIDs by Athletes: A Risk/Benefit Assessment

Abstract

Athletes often seek artificial means to gain advantage and prolong participation when competing. This often involves taking naturally occurring or chemically synthesized compounds. The World Anti-Doping Agency does not prohibit the use of nonsteroidal anti-inflammatory drugs (NSAIDs) because these agents are not performance enhancing, and their analgesic and anti-inflammatory effects are at best performance enabling. Consequently, athletes have relatively unrestricted access to NSAIDs, which are readily available as over-the-counter drugs. However, concern has been raised on athletes' prophylactic use of these agents. Data from many sporting fields have consistently demonstrated that many individuals self-administer NSAIDs prior to athletic participation to prevent pain and inflammation before it occurs. However, scientific evidence for this approach is currently lacking, and athletes should be aware of the potential risks in using NSAIDs as a prophylactic agent. These agents are not benign, and can produce significant side effects, including gastrointestinal and cardiovascular conditions, as well as musculoskeletal and renal side effects. The latter side effects appear paradoxical to the rationale for prophylactic use of NSAIDs. This article discusses current observations regarding athlete use of NSAIDs, and the possible benefits and potential risks of their use.     

月经失调运动员下丘脑─垂体─卵巢的内分泌变化

为了探讨运动性闭经及月经失调的发病机制，选择了５３名女运动员作为研究对象。采用放免法（ＲＩＡ）测定闭经组、长月经周期组和对照组血浆基础β—内啡肽（β－ＥＰ）、促性腺激素释放激素（ＧｎＲＨ）、黄体生成素（ＬＨ）、卵泡刺激素（ＦＳＨ）的浓度。结果表明闭经组和长周期组的ＧｎＲＨ值显著低于对照组（Ｐ＜０．０５）。对闭经组进行垂体兴奋试验表明，其垂体未发生器质性病变。用ＲＩＡ法测定长月经周期组、短月经周期组和对照组唾液基础雌二醇（Ｅ_２）、孕酮（Ｐ）浓度。结果表明，长、短周期组Ｅ_２和Ｐ浓度均低于对照组（Ｐ＜０．０５）。     

Raised Anxiety Levels Among Outpatients Preparing to Undergo a Medical Imaging Procedure: Prevalence and Correlates

PurposeTo examine the percentage of patients with raised state anxiety levels before undergoing a medical imaging procedure; their attribution of procedural-related anxiety or worry; and sociodemographic, health, and procedural characteristics associated with raised state anxiety levels.Materials and MethodsThis prospective cross-sectional study was undertaken in the outpatient medical imaging department at a major public hospital in Australia, with institutional board approval. Adult outpatients undergoing a medical imaging procedure (CT, x-ray, MRI, ultrasound, angiography, or fluoroscopy) completed a preprocedural survey. Anxiety was measured by the short-form state scale of the six-item State-Trait Anxiety Inventory (STAI: Y-6). The number and percentage of participants who reported raised anxiety levels (defined as a STAI: Y-6 score ≥ 33.16) and their attribution of procedural-related anxiety or worry were calculated. Characteristics associated with raised anxiety were examined using multiple logistic regression analysis.ResultsOf the 548 (86%) patients who consented to participate, 488 (77%) completed all STAI: Y-6 items. Half of the participants (n = 240; 49%) experienced raised anxiety, and of these, 48% (n = 114) reported feeling most anxious or worried about the possible results. Female gender, imaging modality, medical condition, first time having the procedure, and lower patient-perceived health status were statistically significantly associated with raised anxiety levels.ConclusionRaised anxiety is common before medical imaging procedures and is mostly attributed to the possible results. Providing increased psychological preparation, particularly to patients with circulatory conditions or neoplasms or those that do not know their medical condition, may help reduce preprocedural anxiety among these subgroups.     

冷环境和缺氧对大鼠阿黑皮素原衍生肽的影响

目的 研究低温和低压缺氧复合因素对大鼠脑垂体和血浆阿黑皮素原衍生肽含量的影响。方法采用56只健康成熟的雄性Wistar大鼠,分别在10度和20度条件下模拟上升至3km和5km高度,设25度室温地面对照组,观察大鼠脑垂体和血浆阿黑皮素原衍生肽含量的变化。结果 20度环境中,5km组血浆β-EP和ACTH含量显著高于地面对照组和3km组（P＜0．01）,脑垂体β-EP的含量显著降低（P＜0．01）,10度环境中随高度升高,血浆β-EP含量显著降低（P＜0．01）,脑垂体β－EP的含量显著升高（P＜0．0）,5km组血浆ACＴＨ较地面对照组显著降低（Ｐ＜０．０１）,２０度地面对照及各高度组血浆随着缺氧程度加深,血浆β－ＥＰ和ＡＣＴＨ升高,１０度条件下血浆β-EP降低,低压缺氧条件下,随着环境温度降低,血浆ACTH含量下降,将对体温调节产生重要影响。     

ACSM Symposium: Former Athletes in Later Life

Wrist pain in an active patient is a physician's cue to look for specific clues in the history, physical exam, and diagnostic tests. Without prompt diagnosis and accurate treatment, the chronic pain can impair sports participation and performance. And in certain instances, a misdiagnosed condition, such as a carpal dislocation or distal radial physeal fracture, can lead to deformity or disability from lack of adequate treatment.     

Menstrual Irregularity in Athletes: The Unanswered Question

Rose Frisch, PhD, has a simple explanation: It is related to their lean-fat ratio. But she doesn't claim to have all the answers.     

Alcoholism in Athletes: New Directions for Treatment

Is the view of the beer-drinking jock contributing to alcoholism among athletes? Many professional sports organizations are taking steps to identify athletes with a drinking problem and help them get help and recover fully. In addition, many teams are taking preventive steps such as providing information about the dangers of alcohol.     

食管癌病人手术前后血浆内皮素变化的临床意义

目的　检测食管癌病人血浆中内皮素 (ET 1 )含量的变化,探讨内皮素与食管癌发生和转移的关系。方法　采用放射免疫法检测 20名正常人及 40例食管癌伴或不伴锁骨上淋巴结转移的病人手术前后血浆中内皮素含量变化。结果　40例食管癌病人血浆中ET 1含量明显高于正常人,且随着肿瘤分化程度的降低而升高,有锁骨上淋巴结转移者高于无转移者 (P<0. 01 );术后 1, 2d的ET 1水平高于术前,而术后 3, 10d则低于术前水平。结论　内皮素参与食管癌生长、转移过程,同时对肿瘤的分期及治疗有指导作用。     

肝炎病毒感染者血中SOD GSH-PX LPO含量测定的意义

对５０９例门诊查体者进行了ＡＬＴ及ＨＡＶ、ＨＢＶ、ＨＣＶ、ＨＤＶ、ＨＥＶ标志物的检测；并对检测出的肝炎病毒感染者、肝炎患者以及肝炎病毒标志物阴性者（对照组）的血液进行了ＳＯＤ、ＧＳＨ－ＰＸ、ＬＰＯ测定。结果显示：肝炎病毒感染者、肝炎患者血中ＳＯＤ、ＧＳＨ－ＰＸ的含量，均显著低于对照组（Ｐ＜００５）；ＬＰＯ的含量高于对照组（Ｐ＜００５，Ｐ＜００１），当多种肝炎病毒混合感染时血ＳＯＤ、ＧＳＨ－ＰＸ下降、ＬＰＯ增高更明显，其中以ＨＢＶ、ＨＣＶ、ＨＥＶ三重叠感染及复合型肝炎（ＨＢＶ、ＨＣＶ、ＨＤＶ）时更为显著（Ｐ＜００５），提示：肝炎病毒感染者及肝炎患者血ＳＯＤ、ＧＳＨ－ＰＸ均有不同程度降低，ＬＰＯ却有不同程度增高，并与肝损伤有一定的相关性。     

Anabolic steroid use in adolescents: identification of those at risk and strategies for prevention

Success in sports is often defined by winning, which drives athletes to use performance-enhancing drugs (PEDs) to gain an advantage over opponents. Over the past 20 years, use of PEDs by Olympic and professional athletes has led to public discussion regarding potential negative health effects and ethical implications of their use. Unfortunately, PEDs are not isolated to professional athletes, as PED use in adolescents has increased dramatically. Many professional organizations, including the American Academy of Orthopaedic Surgeons (AAOS), have taken a stance against PED use in sports. The AAOS believes neither anabolic steroids nor their precursors should be used to enhance performance or appearance, and that these substances should be banned in all sports programs. Pediatricians and orthopedists are often the first physicians to see these young athletes. It is critical for these physicians to recognize the significance of the problem, have the knowledge to inform adolescents, dissuade them from future use, and provide viable alternatives for meeting performance goals.