氯胺酮导致下尿路症状的研究进展

氯胺酮导致下尿路症状是一种由于长期吸食氯胺酮导致的一种以尿频、尿急、夜尿增多伴有耻骨上疼痛的综合征。近几年临床工作者开始重视氯胺酮对于泌尿系统的损害,开展了一系列调查和研究,包括对发病机制、病理特点、治疗方案的研究。但该病的病因、命名和诊断仍不清楚,治疗多为对症治疗。本文检索了近年来发表的相关文献,以探究氯胺酮导致下尿路症状。     

Perceived risk of using novel psychoactive substances in school students: lower in users compared to non-users

Background: There has been an increase in the availability of novel psychoactive substances (NPS) over the last decade. The 2013 US Monitoring the Future study suggested that the perceived risk of NPS use in US students was greater than for classical recreational drugs. This survey was undertaken to determine the perceived risk of NPS in adolescents in UK education.

Methods: Questionnaire survey of 917 students (15–18 years) collected the details of whether: (i) they had heard of NPS; (ii) they had taken an NPS; and (iii) their perceived risk of NPS use.

Results: Five-hundred and fifty-four (57.9%) had heard of NPS and 75 (8.2%) had previously used an NPS. The mean?±?standard deviation perceived risk of using an NPS was 7.32?±?2.07 (95% CI 7.18–7.46), where 1 is “completely safe” and 10 is “not safe at all”; those who had previously used an NPS had a lower perceived risk [6.11?±?2.17 (95% CI 5.60–6.62)] compared to those who had not previously used an NPS [7.46?±?2.00 (95% CI 7.31–7.61) (p?<?0.0001)].

Discussion: Further work is needed to determine whether the lower perceived risk relates to having previously used NPS or whether those who perceive them as low risk are more likely to use NPS. It is important to determine whether this perceived risk is same across all NPS to inform the development of harm minimisation educational strategies.     

Two cases of severe intoxication associated with analytically confirmed use of the novel psychoactive substances 25B-NBOMe and 25C-NBOMe

Context. A new group of novel psychoactive substance, the N-methoxybenzyl (NBOMe) derivatives of substituted phenethylamine, has recently emerged on the drug market, among which 25I-NBOMe and 25B-NBOMe have previously been implicated in clinical intoxications and fatalities. We report two cases of acute intoxication associated with these substances. Case details. Two male patients (17 and 31 years of age) had ingested drugs labelled as ‘NBOMe’ or ‘Holland film’ and developed confusion, agitation, hypertension, tachycardia, hyperthermia, sweating and dilated pupils. Other features included convulsion, rhabdomyolysis and deranged liver function. The patients required benzodiazepines and other drugs for the control of symptoms. Urine samples from both patients were analysed using liquid-chromatography tandem mass spectrometry (LC-MS/MS) following glucuronidase digestion and solid-phase extraction. Identification was based upon comparison of the retention time and enhanced product ion scan with reference standards. In both urine samples, 25B-NBOMe was detected. Additionally, 25C-NBOMe was identified in one of the urine samples. Discussion. The NBOMe compounds are highly potent 5HT_2A receptor agonists and are also agonists at alpha-adrenergic receptors, which likely account for their serotonergic and sympathomimetic symptoms. The clinical testing of NBOMe drugs is not commonly available. Clinicians as well as laboratory staff play an important role in facilitating the detection of this group of potentially dangerous emerging drugs.     

Near death from a novel synthetic opioid labeled U-47700: emergence of a new opioid class

Background: In the last decade there has been a worldwide surge in the recreational abuse of novel psychoactive substances, particularly amphetamine derivatives and synthetic cannabinoids. Synthetic opioids such as AH-7921, MT-45, and U-47700, with structures distinct from those ever used therapeutically or described recreationally, have also recently emerged.

Case details: We report a patient who suffered respiratory failure and depressed level of consciousness after recreationally using a novel synthetic opioid labeled U-47700. A single dose of naloxone administered by paramedics completely reversed his opioid poisoning. Comprehensive laboratory analysis confirmed the presence of a novel synthetic opioid and excluded other drugs. The drug used appeared to have caused a false positive benzodiazepine result on the initial urine drugs of abuse panel.

Conclusion: The case we describe of toxicity from the synthetic opioid labeled U-47700 highlights the emerging trend of novel synthetic opioid abuse.     

Impact of urinary and climacteric symptoms on social and sexual life after surgical treatment of stress urinary incontinence in women: a long-term outcome

AIM: The aim of the present study was to evaluate the long-term results of surgical treatment of stress urinary incontinence (SUI) using both subjective and objective methods. BACKGROUND: Few studies have focused on the influence of biological and social changes in a woman's life on the long-term outcome of surgical treatment of stress urinary incontinence. METHODS: The study included 45 women with genuine SUI treated with either retropubic urethrocystopexy (n=30) or puboccocygeal repair (n=15). The assessment included interviews, questionnaires, urinary diary, pad test, continence test and urodynamic investigation. RESULTS: The results were evaluated at intervals of 3 months, 1 year and 5--7 years after the treatment. One year after the surgical treatment 71% of the women in the urethrocystopexy group and 80% in the pubococcygeal repair group were subjectively cured, while 5--7 years after surgery the corresponding values were 43% vs. 60%. However, according to pad test a 67% of the women in the urethrocystopexy group and 47% in the pubococcygeal repair group had ceased to leak urine 1 year after the operation whereas at the long-term follow-up the corresponding values were 64% vs. 71%. According to the questionnaire at the long-term follow-up only 35% of the women in the whole group had genuine SUI whereas 21% had urge-incontinence. Moreover, 37% experienced sweating, 23% flushing and 44% vaginal dryness. The number of women with adiposity had increased significantly (P < 0.001) at the long-term follow-up. Twenty-eight per cent of the women decreased their activities whereas the majority experienced no impediment. Seventy-nine per cent reported that they were sexually active and the majority reported satisfaction with their sexual lives. CONCLUSIONS: Accurate assessment of postoperative results of SUI demands rigorous recording of subjective and objective data taking into consideration psychological and social factors, otherwise there is a high risk of bias in the interpretation of the results of the treatment for SUI. This study indicates that, in order to give women with SUI adequate treatment the nursing care should comprehend the women's divergent experiences of urinary incontinence and its impact on social and sexual life.     

Substance use and associated emotional and behavioral problems in Nepalese adolescents

Background: Research has demonstrated that problem behavior has been associated with substance use, but knowledge is lacking on such associations in a low-income country like Nepal. Aims: This study aimed to find associations between emotional and behavioral problems and substance use among Nepalese adolescents. Method: A cross-sectional study was conducted at the end of 2011, with participants from three schools in the Province 4 of Nepal. We selected 408 adolescents aged 12 to 18 (mean 15.2 years, 54% boys) at one urban and two rural schools. The data were collected using the Youth Self-Report and Adolescents’ Substance Use Measurement. Results: Higher scores on withdrawn/depressed symptoms, thought problems, attention problems, delinquent or aggressive behavior or internalizing or externalizing problems were associated with the use of tobacco, alcohol or other substances. In the broadband scales, only internalizing problems predicted the use of intoxicants. Higher scores for attention problems predicted the use of tobacco, any intoxicants, and high-risk user. Conclusion: Our findings indicated that problem behavior among Nepalese adolescents was associated with substance use. Future studies should explore the association between problem behavior and substance use, including causal factors, so that risky behavior among Nepalese adolescents can be prevented.     

Acute toxicity following analytically confirmed use of the novel psychoactive substance (NPS) methiopropamine. A report from the Identification of Novel psychoActive substances (IONA) study

Objective: Use of the New Psychoactive Substance (NPS) methiopropamine was first reported in 2011, but there are limited data on its acute toxicity. We report 11 patients presenting with analytically confirmed methiopropamine use.

Methods: Adults presenting to 26 hospitals in the UK with severe acute toxicity after suspected NPS use were recruited from March 2015 to April 2018. Clinical features were recorded and biological samples analysed using tandem mass spectrometry.

Results: Methiopropamine was detected in 11 of 414 patients, with the last detection in August 2016. It was the only substance detected in one patient; other substances detected included other NPS in nine and conventional drugs of misuse in five. Common features included tachycardia (10/11), agitation (7/11), confusion (7/11), reduced level of consciousness (5/11), hallucinations (5/11) and a raised creatine kinase (7/11). The median length of hospital stay was 17?hours; ten were discharged without sequelae and one was transferred for in-patient psychiatric treatment.

Conclusions: Methiopropamine was only detected during 2015 and 2016; most patients had other drugs detected, particularly other NPS. Raised CK was common but it is not possible to determine the degree to which this and other features could be contributed to by co-use of other substances.     

Prevalence of use and acute toxicity associated with the use of NBOMe drugs

Abstract

Introduction. The 25X-NBOMe series are N-2-methoxybenzyl analogues of the respective 2C-X substituted phenethylamine and include 25B-N(BOMe)2, 25B-NBOMe, 25C-NBOMe, 25D-NBOMe, 25E-NBOMe, 25G-NBOMe, 25H-NBOMe, 25I-NBOMe, 25N-NBOMe and 25iP-NBOMe. There are reports of their use as novel psychoactive substances and associated acute toxicity from Europe, the United States and elsewhere over the last five years. This review will discuss the epidemiology of use and pattern of acute toxicity associated with use of these compounds. Methods. A PubMed search was performed using the search terms ‘NBOMe’, ‘25B-N(BOMe)2’, ‘25B-NBOMe’, ‘25C-NBOMe’, ‘25D-NBOMe’, ‘25E-NBOMe’, ‘25G-NBOMe’, ‘25H-NBOMe’, ‘25I-NBOMe’, ‘25N-NBOMe’ and ‘25iP-NBOMe’ covering the years 1966–2014. In addition, abstracts from the 2010–2014 congresses of the European Association of Poisons Centres and Clinical Toxicologists and the 2010–2013 North American Congress of Clinical Toxicology were reviewed using these search terms. Further information was obtained from the European Information System and Database on New Drugs co-ordinated by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). Prevalence of use. There are no national or international surveys collecting data on the prevalence of use of NBOMe drugs. The only information on prevalence of use is from two sub-population surveys of individuals who frequent nightclubs. Of 22,289 respondents of the 2013 Global Drugs Survey, 582 (2.6%) had previously used an NBOMe; the most commonly used NBOMe was 25I-NBOMe (442 respondents, 2.0% of whole cohort and 75.9% of those who had used an NBOMe). In a survey of 397 clubbers in London nightclubs in 2013, 11.8% had heard of the NBOMe drugs (compared with 96.0% for mephedrone), and 4.8% had ever used an NBOMe (compared with 76.6% for mephedrone). Acute toxicity. There were 29 published cases in the literature of acute toxicity associated with the use of an NBOMe: 25I-NBOMe – 23 cases; 25B-NBOMe – 3 cases; 25C-NBOMe – 3 cases. Commonly reported features include tachycardia (96.6%), hypertension (62.0%), agitation/aggression (48.2%), seizures (37.9%) and hyperthermia (27.6%). Five patients were reported to have developed acute kidney injury. There were an additional 25 reports of acute toxicity related to the use of 25I-NBOMe reported to the EMCDDA. The pattern of toxicity in these cases is similar to that seen in the published cases. NBOMe-related deaths. 25I-NBOMe has been detected in eight fatalities; in one of these, 25C-NBOMe was also detected. The role of the NBOMe drugs in these deaths has not been determined in all cases. Conclusions. Currently, there is evidence suggesting limited use of the NBOMe class of drugs as novel psychoactive substances compared with that of classical recreational drugs and other novel psychoactive substances such as mephedrone.     

Benign prostatic hyperplasia and urinary symptoms: Evaluation and treatment

Benign prostatic hyperplasia (BPH) is one of the most common conditions affecting middle-aged men. This condition can be microscopic, macroscopic, symptomatic, or asymptomatic. Up to 15% to 25% of men aged 50–65 years have lower urinary tract symptoms (LUTS) consisting of nocturia, urgency, frequency, a sensation of not completely emptying the bladder, stop-start urination, straining to urinate, a need to urinate soon after voiding, and weak urinary stream. These symptoms usually are associated with benign enlargement of the prostate gland that is of sufficient severity to interfere with a man’s quality of life. Although LUTS is often associated with BPH, LUTS can also be due to various unrelated syndromes such as heart failure, urinary tract infections, and diabetes. Most men will have benign hyperplasia of the prostate gland and this benign growth compresses the urethra resulting in LUTS. This article will discuss the evaluation, pharmacological management, minimally invasive treatment, and surgical therapy of this common condition affecting millions of American men.     

Characteristics of circadian change in urinary frequency, bladder capacity and residual urine volume in elderly men with lower urinary tract symptoms

Abstract In order to compare the daily voiding traits of elderly men with those of middle-aged men with lower urinary tract symptoms (LUTS), urinary frequency, bladder capacity at normal desire to void (CNDV), residual urine volume (RUV) and functional bladder capacity were evaluated at home during a 24 h period using a non-invasive method. The results showed that in both groups, urinary frequency was lowest from midnight to 06.00 h. The urinary frequency was the highest from 12.00 to 18.00 h. The CNDV in the elderly group was less than that of the middle-aged group for 1 day. In particular, bladder capacity from 24.00 to 06.00 h showed the greatest difference ( P < 0.05). The RUV in elderly men tended to accumulate more than those in middle-aged men. The findings suggest that the functional bladder capacity of elderly men was lower than that of middle-aged men in the home.     

A programme to audit the use of urinary catheters

• ? This paper describes the development of a tool to audit the use of urinary catheters on surgical wards; the overall objectives being a reduction in the inappropriate use of urinary catheters, and in the number of urinary tract infections.
• ? The literature is reviewed to determine the criteria necessary to audit urinary catheters effectively. The implementation of an audit of urinary catheters on one surgical ward over 6 weeks showed that 27 catheters were used. All catheters passed in the ward were of the appropriate size, balloon and lumen. Significant bacteriuria was found in 5/18 (28%) of catheters in situ for 3 days. All three catheters which remained in situ longer than 10 days had significant bacteriuria. The results were favourable; this was possibly due to the patient population and the individual reasons for catheterizations.
• ? The need for the results of audit tools such as this to be interpreted on a ward-to-ward basis, and not to compare wards with each other is highlighted. This audit tool could be used by other surgical wards.

     

The use of Mechanical Diagnosis and Therapy (MDT) in patients with lower urinary tract symptoms (LUTS): case series

Lower urinary tract symptoms (LUTS) are highly prevalent among men over the age of 40. Even though associations between lumbar spine conditions and LUTS have been documented in the literature, no studies have detailed a specific lumbar assessment and classification process, and the related treatment effects in patients with LUTS. In this case series, we present three male patients with LUTS as primary complaints, who were evaluated and treated with Mechanical Diagnosis and Therapy (MDT) for the lumbar spine. The duration of their symptoms was between 4 months and 7 years. Urogenital pathologies were ruled out for all patients. The Chronic Prostatitis Symptom Index was used as a functional outcome measure. All patients were classified as having lumbar derangements. Treatment of derangements with directional preference exercises resulted in the improvement of their LUTS, with clinically significant improvements (56.0%–77.4%) in functional outcome measures over an average of six sessions. Preliminary indications suggest that these LUTS cases may possibly have had a lumbar spine origin and “mechanical” nature. Therefore, they may be within the scope of MDT assessments and interventions. With careful monitoring of symptoms, MDT may serve as a screening tool and conservative treatment option.     

优质护理服务对老年病人导尿管相关尿路感染的影响

[目的]探讨优质护理服务对老年病人导尿管相关尿路感染的影响。[方法]观察组80例病人采用优质护理服务,对照组80例病人采用常规护理方法,观察两组导尿管相关尿路感染率、护理效果、不同时间段尿培养结果阳性率以及病人膀胱刺激症状消失率和消失时间。[结果]观察组导尿管相关尿路感染率明显低于对照组(P<0.05),护理总有效率明显高于对照组(P<0.05),在不同时间段尿培养阳性率明显低于对照组(P<0.05),膀胱刺激症状消失率明显低于对照组(P<0.05),消失时间明显少于对照组(P<0.05)。[结论]对留置尿管的老年病人采用优质护理服务能够有效降低不同时间段细菌感染阳性率、减少膀胱刺激症状的发生。     

Discrimination of bladder disorders in female lower urinary tract symptoms on ultrasonographic cystourethrography.

OBJECTIVE: To evaluate morphologic features of bladder disorders in female lower urinary tract symptoms using ultrasonographic cystourethrography and to elucidate the anatomic association of these morphologic characteristics. METHODS: Ultrasonographic cystourethrography was performed in 1049 women with lower urinary tract symptoms and 1 single urodynamic diagnosis, including 764 patients with genuine stress incontinence, 190 with detrusor instability, and 95 with a hypersensitive bladder. Thirty-six women with no lower urinary tract symptoms served as control subjects. Ultrasonographic assessment included measurement of the bladder neck position at rest and during stress and observation of the development of bladder neck funneling and cystocele during the Valsalva maneuver. RESULTS: Hypersensitive bladder and control groups had a significantly higher bladder neck position at rest and during stress, a lesser rotational angle of the bladder neck, a lower prevalence of bladder neck funneling and cystocele formation, and lesser mean bladder wall thickness than the other diagnostic groups. In the study groups, age, parity, and menopause may have effects on the cystourethrographic parameters except rotational angle and funneling of the bladder neck. With control of the confounding factors, bladder wall thickness at the trigone and dome was negatively correlated with the resting bladder neck angle (P = .006 and 0.019, respectively). Bladder wall thickness at the dome was positively associated with the rotational angle of the bladder neck (P = .022). Funneling of the bladder neck and development of cystocele during stress were positively associated with the resting and straining bladder neck angles as well as the rotational angle of the bladder neck. CONCLUSIONS: Ultrasonographic manifestation of a hypersensitive bladder is significantly different from that of genuine stress incontinence and detrusor instability.     

Trend analysis of anonymised pooled urine from portable street urinals in central London identifies variation in the use of novel psychoactive substances

Context. There is increasing interest in the analysis of waste water at sewage treatment plants to monitor recreational drug use. This technique is limited for novel psychoactive substances (NPS) due to limited knowledge on their human and bacterial metabolism and stability in waste water. Small studies have reported the detection of NPS using pooled anonymous urine samples, which eliminates some of these potential confounders. Objective. To determine patterns of recreational drug, including NPS, use by confirming their presence in analysis of pooled urine from portable street urinals across a wide geographical area in central London over a 6-month period. Materials and methods. Pooled anonymous urine samples were collected from 12 four-bay stand-alone portable urinals distributed once a month across central London for six consecutive months. Samples were analysed using high-performance liquid chromatography coupled to high-resolution accurate mass spectrometry (LC-HRAM-MS); acquired data were processed against target compound databases. Results. With regards to Classical Recreational Drugs, there was consistency of detection of cathine, cocaine, morphine, MDMA over the 6 months, with variability of detection of amphetamine, ketamine and cannabis. With regards to NPS, a total of 13 NPS were detected during the six months. Mephedrone and methylhexaneamine were detected consistently each month. Other commonly detected NPS included methiopropamine (5 months), pipradrol (4 months), cathinone (4 months), 5-(2-aminopropyl)benzofuran (3 months) and 4-methyethcathinone (3 months). Of note, methoxetamine and the synthetic cannabinoid receptor agonists were not detected in any samples. Discussion. Previous studies using the same method detected three and five NPS in a nightclub and pissoir setting, respectively, on a single night. The longer sampling time of 6 months has allowed detection of 13 NPS. Of note, mephedrone showed the least month-to-month variation in detection over the 6-month sampling period. With regards to classical recreational drugs, those detected were consistent with use-data from UK population surveys. The only exception is amphetamine which these surveys have shown a steady decline in use since 1996 but our study showed some variation in the frequency of its detection. However, the sampling period was too short and a longer study is needed to detect the trend in decreasing use. Conclusion. This study demonstrates that analysis of anonymous pooled urine samples from stand-alone urinals can be used to detect and monitor trends in the use of classical recreational drugs and NPS in a large city centre over time. This technique has the potential to be a novel key indicator alongside other existing indicators to provide a more robust picture of the use of recreational drugs including NPS.     

Three months of methoxetamine administration is associated with significant bladder and renal toxicity in mice

Context. Methoxetamine is a ketamine analogue that has recently emerged as a novel psychoactive substance. Chronic ketamine use is associated with significant bladder and renal toxicity. Methoxetamine has been marketed as “bladder friendly”, but there is no data to be able to substantiate this claim. Objective. To characterise the patterns of bladder and renal toxicity associated with 3 months of methoxetamine administration in an animal model. Materials and methods. Two-month-old Institute of Cancer Research mice were administered 30 mg/kg methoxetamine intraperitoneally (n = 5) or saline (n = 3 control) for 3 months. The animals were then sacrificed and histological examination, immuno-cytochemistry using polyclonal anti-CD4 antibodies and sirius-red staining for collagen were performed. Results. The kidneys of methoxetamine-treated animals showed inflammatory cell infiltration, tubular cell necrosis and glomerular damage (1.9 ± 0.3% shrunken glomeruli in control, 9.8 ± 0.8% in methoxetamine-treated mice (p < 0.0001); 2.9 ± 0.3% tubular cell degeneration in control, 20.4 ± 1.1% in methoxetamine-treated mice (p < 0.0001)). There was a greater density of mononuclear cells in the bladder lamina propria and submucosa in methoxetamine-treated mice (43.0 ± 2.1 per 250 × 250 μm) than controls (7.1 ± 1.2 per 250 × 250 μm), p < 0.001. CD4-positive staining was seen in the bladder submucosa and lamina propria of all methoxetamine-treated mice and muscle-layer of two methoxetamine-treated mice; these changes were not seen in the control mice. There was an increase in sirius-red collagen in the bladder sub-mucosa and muscle-layer in the methoxetamine-treated mice compared with control mice. Discussion. This study has shown that 3 months of daily 30 mg/kg intra-peritoneal methoxetamine results in significant bladder and renal toxicity in mice. Changes in the bladder included inflammatory changes with subsequent fibrosis and changes in the kidney were seen at both a tubular and glomerular level. These changes are similar to those seen in comparable animal models of chronic ketamine administration. Further work is required to determine the time course of the onset of these effects and whether the effects are reversible with methoxetamine cessation.