Role of selenium depletion in the etiopathogenesis of depression in patients with alcoholism [corrected

Chronic heavy alcohol consumption adversely affects both macronutrients and micronutrients. Alcohol use affects selenium status. Considerable evidence suggests that selenium status may modify mental function. The author suggests that the effects of alcohol intake on mood, behavior, and cognition may be partly mediated by biological changes related to selenium deficiency.It has been observed that there is a trend towards the normalization of selenium levels in patients with alcoholism after a relatively short period of abstinence from alcohol. It has also been observed that when depression develops in persons with alcoholism, they are likely to improve fairly rapidly after a relatively short period of abstinence from alcohol without therapy aimed at the depressive symptoms. The author suggests that improvement in depressed patients after a period of abstinence from alcohol might be in part related to the normalization of selenium status.Treatment and prevention of comorbid alcoholism and mood disorders require more attention by research workers, practicing physicians, and the general public. Future studies of the etiology and pathogenesis of mood disorders in patients with alcoholism are merited.     

Comparison of ventilatory efficiency in alcohol and opiate abusers

The aim of this study was to evaluate the respiratory efficiency in alcohol and opiate abusers. There were 220 persons under examination: 144 alcohol abusers (group I), 36 opiate abusers (group II) and 40 healthy persons (control group). Both groups of dependent persons were treated in the Detoxication Unit of the Department of Clinical Toxicology CMUJ. During hospitalization the functional state of respiratory system was monitored. Ventilation efficiency was determined on the basis of the results from a "flow-volume" loop, spirometry and the measurements of the respiratory tract resistance in a computerised system Lungtest-MES company (Poland). In the examination performed directly after admission to the Clinic the normal respiratory efficiency was noted in 36.1% in ethanol abusers and 54.9% in opiate abusers. 63.9% of alcohol abusers (group I) and 45.1% of opiate abusers (group II) suffered from the bronchial obturation. In the examination performed after hospitalisation and 9 days of total abstinence in 33.3% of the alcohol dependent patients and in 38.5% of the opiate dependent patients respiratory obturation was observed. The values of respiratory tract resistance in both groups of dependent patients in examination on admission and after treatment were increased compared to controls. The changes of ventilatory parameters can be explained mainly by withdrawal syndrom revealing that it is connected with initial (9 days lasting) period of controlled and total abstinence.     

云南省戒毒人群对药物滥用预防、治疗服务的评价及期望

目的:了解戒毒人员对药物滥用预防、治疗服务的评价以及戒毒者的需求,以提高今后药物滥用治疗和预防项目的有效性.方法:采用自拟调查问卷,以集中匿名自填调查问卷的方式对云南省10个地州市级强制戒毒所的2400名戒毒者进行了调查.结果:76.2%的戒毒人员在其吸毒前从未接受过预防吸毒的宣传教育,53.6%以上接受过预防吸毒宣传教育的戒毒人员认为,所接受的宣传教育没有帮助或帮助很少;戒毒者对目前强制戒毒机构的多数软、硬件服务基本满意,需要改善的是治疗的有效性和戒毒所的饮食;戒毒人员最迫切的需求是了解预防复吸的技能、帮助改变生活环境和帮助找工作等.结论:目前我国药物滥用预防活动的覆盖面不够,其有效性、针对性均尚待提高.     

Analysis of carbohydrate deficient transferrin serum levels during abstinence

An alcohol-associated change in the serum transferrin glycoform pattern, carbohydrate-deficient transferrin (CDT), is used as a biomarker of chronic moderate to heavy alcohol consumption. Furthermore, CDT is employed as a marker of abstinence. Here, we analyzed CDT in patients with chronic excessive alcohol abuse at the beginning and during abstinence. Twenty-nine alcohol dependent patients were recruited from an in-patient abstention program. Reported drinking levels were at least 100 g/d (range up to 450 g/d; mean: 248.9±94.7 g/d) within the last month before study entry. Blood samples were drawn at the beginning and during the abstention program and the relative concentration (%CDT) of CDT was determined using ion exchange followed by immunodetermination of CDT. At study entry, 25/29 patients had a %CDT level above the established cutoff. Although CDT levels declined during abstinence in most patients, in ten patients with %CDT levels just above the cutoff at the start of the program, the CDT values remained elevated 6 weeks after cessation of drinking. Our data indicate that %CDT levels below the cutoff cannot even rule out long lasting excessive alcohol abuse. Further, measurement of %CDT should be interpreted with special care when used as a marker of alcohol abstinence.     

The assessment of serum soluble transferrin receptor in alcoholics

The consumption of large amounts of alcohol disturbs body iron metabolism and leads to increase of body iron stores and may cause various hematologic changes. Both, iron overload and iron depletion could have effect on the metabolic, transit and storage pools. These pools and its indicators were evaluated previously in abusers, but there is no information concerning the serum soluble transferrin receptor (sTfR) as a new marker of transit compartment. Therefore, the aim of this study was to assess the sTfR and compare it to the other indicators of transit pool in alcoholics. sTfR was measured immunoturbidimetrically. The markers of alcohol abuse, metabolic, transport and storage pools and the other hematologic assays were determined by routine laboratory methods. The tested group consisted of 148 alcoholics. The abusers were not affected by anemia. Every second patient had increased iron storage pool. Serum iron level only tended to increase. The mean serum sTfR did not show any significant difference and the mean transferrin–ferritin index (sTfR/log ferritin ratio) was significantly decreased compared with the controls. None of the transit pool markers presented significant differences between subgroups classified according to liver enzyme activities. We suggest that the iron excess in alcoholics did not limit the cellular iron uptake by transferrin receptor-mediated endocytosis which was confirmed by the unchanged level of serum soluble transferrin receptor. Additionally, the serum sTfR in alcohol abusers is independent of the weekly alcohol intake, age of the patients, duration of dependence, time of abstinence, time of last drinking and the liver function tests.     

Effectiveness of abstinence-based incentives: interaction with intake stimulant test results

Intake urinalysis test result (drug positive vs. negative) has been previously identified as a strong predictor of drug abuse treatment outcome, but there is little information about how this prognostic factor may interact with the type of treatment delivered. The authors used data from a multisite study of abstinence incentives for stimulant abusers enrolled in outpatient counseling treatment (N. M. Petry, J. M. Peirce, et al., 2005) to examine this question. The first study urine was used to stratify participants into stimulant negative (n = 306) versus positive (n = 108) subgroups. Abstinence incentives significantly improved retention in those testing negative but not in those testing positive. Findings suggest that stimulant abusers presenting to treatment with a stimulant-negative urine benefit from abstinence incentives, but alternative treatment approaches are needed for those who test stimulant positive at intake.     

Sugar-dependent rats show enhanced responding for sugar after abstinence: evidence of a sugar deprivation effect

Studies have shown that intermittent sugar availability (12 h/day) produces signs of dependence in rats, including escalation of intake, mu-opioid and dopamine receptor changes, behavioral and neurochemical indices of withdrawal, and cross-sensitization with amphetamine. "Deprivation-effect" paradigms, whereby abstinence from a substance results in enhanced intake, are often used to measure "craving" for drugs of abuse, such as alcohol. The present study used operant conditioning to investigate consumption of sugar after abstinence in rats selected for glucose avidity. The experimental group was trained on a fixed ratio (FR-1) schedule for 25% glucose for 30 min/day for 28 days and also had glucose access in the home cages for an additional 11.5 h daily. The control group had only the 30-min/day access to glucose in the operant chambers. Then, both groups were deprived of glucose for 2 weeks. After this period of abstinence, animals were put back in the operant chambers. The experimental group responded significantly more than ever before, and significantly more than the control group. In conclusion, daily 12-h access to sugar, in the paradigm used, can result in an altered neural state that lasts throughout 2 weeks of abstinence, leading to enhanced intake. Together with previous results, this deprivation effect supports the theory that animals may become dependent on sugar under selected dietary circumstances.     

Alcohol abuse prevention in African-American communities.

Because of the devastating morbidity, mortality, and social dislocations associated with alcohol abuse in many African-American communities, the prevention of alcohol abuse represents a critical component of the public health agenda for African Americans. This article reviews African-American cultural issues pertinent to alcohol use and abuse and the information available regarding the excess medical and social complications experienced by African Americans secondary to alcohol abuse. Some recommendations are made for a specific research agenda for the prevention of alcohol abuse with relevance to African Americans.     

Subtypes of codeine cough syrup abusers

This paper highlights the abuse potential of the codeine containing cough syrups, which may take two forms. One, experimental abuse in school or college students which later persists in a dependent pattern. Two, pre-existing opioid abusers, as a substitute which starts after the school or college years. The short term treatment outcome is better in the former group in that they are able to maintain abstinence for a relatively longer period.     

老年病人的术后认知功能障碍

术后认知功能障碍（POCD）定义为术后通过反复多次神经心理测试,患者的基本认知功能出现不同程度的损害。而早期术后认知功能及精神障碍更多见于老年患者。虽然POCD多见于心脏手术术后，但非心脏手术后发生POCD亦不少见，老年患者（年龄大于65岁）行心脏手术或非心脏手术，术后1周POCD的发生率分别为50%及26%。POCD的高危因素包括：高龄、术前认知受损以及酗酒等。POCD影响生活质量，加重社会负担并干扰药物治疗效果，延长患者住院周期。有必要深入的研究POCD的病因和神经功能保护的策略。     

Clinical pathology of alcohol.

There is good though not conclusive evidence that a small to modest average daily intake of alcohol--that is, 20-30 g/day is associated with increased longevity due mainly to a reduction in death from cardiovascular disease. Larger average daily alcohol intakes--especially those in excess of 60 g/day for men and 40 g/day for women--are associated with gradually increasing morbidity and mortality rates from a variety of diseases. Alcohol may be unrecognised as the cause of somatic disease, which can occur without overt psychosocial evidence of alcohol abuse, unless the index of suspicion is high and a thorough drink history obtained. Laboratory tests for the detection and/or confirmation of alcohol abuse are useful but subject to serious limitations being neither as sensitive nor specific as sometimes believed. The value of random blood and/or breath alcohol measurements, in outpatients, as an aid to diagnosis of alcohol-induced organic disease is probably not sufficiently appreciated and, though relatively insensitive, is highly specific.     

Incidence of postoperative hypothermia and its risk factors in adults undergoing orthopedic surgery under brachial plexus block: A retrospective cohort study

Postoperative hypothermia increases patient mortality and morbidity. However, the incidence of, and risk factors for, postoperative hypothermia in patients undergoing surgery under brachial plexus block (BPB) as the primary method of anesthesia remain unclear. This study aimed to determine the incidence of, and risk factors for, postoperative hypothermia in patients undergoing surgery under BPB. We retrospectively analyzed 660 patients aged ≥ 19 years who underwent orthopedic surgery under BPB in our hospital between October 2014 and October 2019. Postoperative hypothermia was defined as a tympanic membrane temperature < 36 °C when the patient arrived in the post-anesthesia care unit. Multivariate logistic regression analysis was performed to identify the independent risk factors for postoperative hypothermia. Postoperative hypothermia was observed in 40.6% (268/660) of patients. Independent risk factors for postoperative hypothermia were lower baseline core temperature before anesthesia (odds ratio [OR] 0.355; 95% confidence interval [CI] 0.185-0.682), alcohol abuse (OR 2.658; 95% CI 1.105-6.398), arthroscopic shoulder surgery (OR 2.007; 95% CI 1.428-2.820), use of fentanyl (OR 1.486; 95% CI 1.059-2.087), combined use of midazolam and dexmedetomidine (OR 1.816; 95% CI 1.268-2.599), a larger volume of intravenous fluid (OR 1.001; 95% CI 1.000-1.002), and longer duration of surgery (OR 1.010; 95% CI 1.004-1.017). Postoperative hypothermia is common in adult patients undergoing orthopedic surgery under BPB. The risk factors identified in this study should be considered to avoid postoperative hypothermia in these patients.     

Analgesic-associated nephropathy

Summary Although the question of whether or not analgesic abuse leads to a certain type of nephropathy has been investigated since 1953, no conclusive answer has been forthcoming. Epidemiologic investigations on the correlation between analgesic abuse and renal function as well as experimental animal studies have given contradictory results concerning the possibility of analgesic-associated kidney damage. However, studies on the correlation between analgesic abuse and papillary necrosis have demonstrated that this lesion coincides in 69% of the cases with an analgesic history. Follow-up studies of patients with analgesic nephropathy have shown that renal function deteriorates in 60% of the patients with continued abuse and that it stabilizes in 80% of the patients after cessation of abuse. Studies on the legislative restriction of phenacetin/acetaminophen, carried out mostly in Scandinavian countries since 1965, show a 50%–90% decline in signs of analgesic nephropathy (papillary necrosis) following a reduction in the sale of these drugs. The prevalence of analgesic abuse may be underestimated, since up to 80% of the abusers tend to deny their analgesic intake. Obviously, only a small percentage of analgesic abusers (approximately 1%) finally develop nephropathy. Even though the results of epidemiologic and experimental studies are contradictory, the results of investigations on papillary necrosis and on legislative prevention as well as of patient follow-ups tend to indicate a correlation between analgesic abuse and a well-defined type of nephropathy.Abbreviations AAN analgesic-associated nephropathy - AA analgesic abuse - PN renal papillary necrosis     

Hybrid Mice as Genetic Models of High Alcohol Consumption

We showed that F1 hybrid genotypes may provide a broader variety of ethanol drinking phenotypes than the inbred progenitor strains used to create the hybrids (Blednov et al. in Alcohol Clin Exp Res 29:1949–1958, 2005). To extend this work, we characterized alcohol consumption as well as intake of other tastants (saccharin, quinine and sodium chloride) in five inbred strains of mice (FVB, SJL, B6, BUB, NZB) and in their reciprocal F1 hybrids with B6 (FVBxB6; B6xFVB; NZBxB6; B6xNZB; BUBxB6; B6xBUB; SJLxB6; B6xSJL). We also compared ethanol intake in these mice for several concentrations before and after two periods of abstinence. F1 hybrid mice derived from the crosses of B6 and FVB and also B6 and SJL drank higher levels of ethanol than their progenitor strains, demonstrating overdominance for two-bottle choice drinking test. The B6 and NZB hybrid showed additivity in two-bottle choice drinking, whereas the hybrid of B6 and BUB demonstrated full or complete dominance. Genealogical origin, as well as non-alcohol taste preferences (sodium chloride), predicted ethanol consumption. Mice derived from the crosses of B6 and FVB showed high sustained alcohol preference and the B6 and NZB hybrids showed reduced alcohol preference after periods of abstinence. These new genetic models offer some advantages over inbred strains because they provide high, sustained, alcohol intake, and should allow mapping of loci important for the genetic architecture of these traits.     

Voluntary alcohol consumption and plasma beta-endorphin levels in alcohol-preferring rats chronically treated with naltrexone

It is well known that alcohol consumption leads to an increase in the levels of beta-endorphin (an endogenous opioid), which can contribute to the reinforcing effect of alcohol. Our previous studies have shown that repeated treatment with naltrexone, a nonselective opioid antagonist, results in increased plasma beta-endorphin levels. Ample studies in animals and humans have shown that naltrexone diminishes ethanol consumption. The aim of the present study in alcohol-preferring rats (Warsaw High Preferring; WHP) was to investigate the effect of 10 days of naltrexone treatment (2 mg/kg i.p.) on voluntary alcohol intake and on changes in plasma beta-endorphin levels while alcohol was available and 10 days after imposed abstinence. It was observed that voluntary alcohol intake induces an increase in plasma beta-endorphin levels in WHP rats. After a 10-day period of alcohol withdrawal, the levels of this peptide were significantly reduced compared with the levels in rats with free access to ethanol and in control alcohol-naïve rats. In chronic naltrexone-treated rats with free access to alcohol, an increase in the levels of this peptide was also observed; however, voluntary alcohol intake was diminished. A similar increase in plasma beta-endorphin levels was observed in naltrexone-treated rats that did not have access to ethanol. As the endogenous opioid system has an important role in the development of a craving for alcohol, it is likely that chronic naltrexone treatment may have a beneficial effect leading to a compensatory increase in the beta-endorphin concentration and ameliorating its deficiency during ethanol withdrawal. Restoring the alcohol-induced deficiency of beta-endorphin may be an important factor in the prevention of craving and maintenance of abstinence. This finding supports the proposition that the endogenous opioid system plays an important role in developing a craving for alcohol.     

Hepatic vagotomy increases consumption of a novel-tasting diet presented immediately after surgery

To further characterize the possible effect of hepatic vagotomy on food intake, rats adapted to a medium-fat diet (MF diet) were offered a novel-tasting diet immediately after hepatic branch vagotomy (HBX rats) or sham vagotomy (SHAM rats) and food intake as well as diet selection (novel-tasting vs. familiar diet) was measured. When a novel-tasting sweet medium-fat diet (SMF diet) was offered immediately after surgery, HBX rats ate transiently more (days 1-4 after surgery) and selected more (days 5 and 6 after surgery) of the SMF diet than SHAM rats. Similar results were obtained when a novel-tasting bitter diet (AMF diet) was offered instead of the SMF diet. In contrast, when rats adapted to the AMF diet prior to surgery were given normal MF diet as novel-tasting diet immediately after surgery, HBX and SHAM rats' postoperative food intake and diet selection did not differ. When rats were given only MF or SMF diet before and after surgery, HBX and SHAM rats' food intake during the initial postoperative period also did not differ. The results indicate that hepatic branch vagotomy and sham vagotomy have different aversive effects which lead to transient differences in postoperative food intake when diets with a novel and strong taste are presented during the initial postoperative period. Therefore, information conveyed by the hepatic branch of the vagus can apparently lead to a conditioned feeding response. This is evidence for a more subtle role of the liver in the control of food intake than previously thought.     

Surgery for endometriosis-associated infertility: a pragmatic approach

Laparoscopic treatment for endometriosis-associated infertility is gaining widespread popularity supported mostly by uncontrolled studies, but the purported benefit of surgery may be overvalued. We have therefore analysed the best available evidence with the aim of defining an approximate estimate of the effect size of conservative surgery for infertile women with endometriosis in various clinical conditions. The overall increase in post-operative likelihood of conception over background pregnancy rate may be estimated to be between 10 and 25%. The effect of surgery for peritoneal lesions is limited, and an estimate of benefit should be decreased by the fact that preoperative identification of the subjects actually with the condition is unfeasible. The benefit of excision of ovarian endometriomas is difficult to define due to multiple confounding factors and methodological drawbacks in the considered studies. Excision of rectovaginal endometriosis is of doubtful value and associated with worrying morbidity. The role of surgery before, after or as an alternative to IVF needs clarification. In conclusion, the absolute benefit increase of surgery for endometriosis-associated infertility appears smaller than previously believed. Complete and detailed information on risks and benefits of treatment alternatives must be offered to infertile patients to allow unbiased choices between possible options.     

Rhabdomyolysis: report of eleven cases.

This article reports the results of a retrospective study of 11 patients with rhabdomyolysis-induced acute renal failure. All patients had multiple risk factors for rhabdomyolysis, the most common of which were alcoholism, illicit drug abuse, compression, and trauma. Patients with combined alcohol/illicit drug abuse had more severe electrolyte imbalances than patients without alcohol/illicit drug abuse. Myoglobinuria was detected in only half the patients despite rhabdomyolysis and urine "hematest" positivity. The serum creatine phosphokinase level was elevated in all of the patients, which is a good marker for rhabdomyolysis. Rhabdomyolysis is a relatively common disorder in municipal hospitals. Routine serum creatine phosphokinase levels should be checked on patients at risk, especially alcoholics, illicit drug abusers, and older patients.     

Clusters of alcohol use disorders diagnostic criteria and predictors of alcohol use after liver transplantation for alcoholic liver disease

BACKGROUND: Establishing the correct alcohol use disorder diagnosis is clinically relevant because several reports of post-transplant alcohol use suggest that a pre-transplant diagnosis of alcohol dependence (rather than abuse) predicts relapse to alcohol use. Numerous combinations of specific symptoms are possible to achieve diagnostic significance. OBJECTIVE: The authors hypothesized that there would be distinct clusters of liver transplant recipients who showed specific combinations of alcohol-related symptoms and that these clusters would be predictive of alcohol-abuse outcome after transplant. METHOD: A group of 120 ALD liver transplant recipients received the Structured Clinical Interview for DSM-IV (SCID) module for alcohol abuse/dependence, and a cluster analysis was performed. RESULTS: Within the clusters of those with alcohol dependence, cluster assignment did not predict those more likely to drink. However, those assigned to the alcohol abuse cluster were significantly less likely to drink than those with alcohol dependence. CONCLUSION: Results therefore suggest that the prognosis regarding continued abstinence posttransplant is much more positive for individuals with a diagnosis of abuse than for those who meet criteria for alcohol dependence.     

Peripheral markers, future perspectives]

Four of the recently described peripheral markers of alcohol abuse have been reviewed. The acetaldehyde adducts allow to detect an alcohol abuse lasting for several weeks, even after a recent alcohol withdrawal. Inversely, 5-hydroxytryptophol (5-HTOL) reflects the alcohol consumption of the last 24 hours. Its detection is possible after the blood alcohol concentration has disappeared. Its measurement is run in urine samples, thus without invasive sampling. The hyaluronic acid and the activity of beta-hexosaminidase are markers of hepatobiliary alcohol induced disorders more than direct markers of alcohol intake. Acetaldehyde adducts could be used as markers of long term alcohol abuse, CDT as a marker of the recent alcohol abuse, and 5-HTOL the detection of alcohol abuse of the past day.