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21.
Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation 总被引:17,自引:2,他引:15
The effects of drug dependence on social systems has helped shape the generally held view that drug dependence is primarily a social problem, not a health problem. In turn, medical approaches to prevention and treatment are lacking. We examined evidence that drug (including alcohol) dependence is a chronic medical illness. A literature review compared the diagnoses, heritability, etiology (genetic and environmental factors), pathophysiology, and response to treatments (adherence and relapse) of drug dependence vs type 2 diabetes mellitus, hypertension, and asthma. Genetic heritability, personal choice, and environmental factors are comparably involved in the etiology and course of all of these disorders. Drug dependence produces significant and lasting changes in brain chemistry and function. Effective medications are available for treating nicotine, alcohol, and opiate dependence but not stimulant or marijuana dependence. Medication adherence and relapse rates are similar across these illnesses. Drug dependence generally has been treated as if it were an acute illness. Review results suggest that long-term care strategies of medication management and continued monitoring produce lasting benefits. Drug dependence should be insured, treated, and evaluated like other chronic illnesses. JAMA. 2000;284:1689-1695. 相似文献
22.
Diana Martinez Allegra Broft Richard W Foltin Mark Slifstein Dah-Ren Hwang Yiyun Huang Audrey Perez W Gordon Frankle Thomas Cooper Herbert D Kleber Marian W Fischman Marc Laruelle W Gordon Frankel 《Neuropsychopharmacology》2004,29(6):1190-1202
Striatal dopamine D2 receptors have been implicated in the neurobiology of cocaine addiction. Previous imaging studies showed reduced striatal D2 receptor availability in chronic cocaine abusers, and animal studies suggested that low D2 receptor availability promotes cocaine self-administration. Here, D2 receptor availability was assessed with positron emission tomography (PET) and [11C]raclopride in the limbic, associative, and sensori-motor subdivisions of the striatum in 17 recently detoxified chronic cocaine-dependent (CCD) subjects and 17 matched healthy control (HC) subjects. In addition, the relationship between regional D2 receptor availability and behavioral measures obtained in cocaine self-administration sessions was investigated in CCD subjects. [11C]Raclopride binding potential was significantly reduced by 15.2% in the limbic striatum, 15.0% in the associative striatum, and 17.1% in the sensori-motor striatum in CCD subjects compared to HC subjects. In CCD subjects, no relationship was detected between D2 availability in striatal regions and either the positive effects of smoked cocaine or the choice of cocaine over an alternative reinforcer (money) following a priming dose of cocaine (a laboratory model of relapse). Thus, this study confirms previous reports of a modest decrease in D2 receptor availability in CCD subjects, and establishes that this decrease is generalized throughout the striatum. However, this study failed to demonstrate a relationship between D2 receptor availability and cocaine-induced cocaine-taking behavior. Additional research is warranted to unravel potential neurobiological traits that might confer vulnerability to relapse in detoxified CCD subjects. 相似文献
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Juliana Moscardini Chavasco Bárbara Helena Muniz Prado E Feliphe Claudio Daniel Cerdeira Fabrício Damasceno Leandro Luiz Felipe Leomil Coelho Jéferson Junior da Silva Jorge Kleber Chavasco Amanda Latercia Tranches Dias 《Revista do Instituto de Medicina Tropical de S?o Paulo》2014,56(1):13-20
The antimicrobial activity of plant hidroethanolic extracts on bacteria
Gram positive, Gram negative, yeasts, Mycobacterium tuberculosis H37
and Mycobacterium bovis was evaluated by using the technique of Agar
diffusion and microdilution in broth. Among the extracts evaluated by Agar diffusion,
the extract of Bidens pilosa leaf presented the most expressive
average of haloes of growth inhibition to the microorganisms, followed by the extract
of B. pilosa flower, of Eugenia pyriformis'' leaf
and seed, of Plinia cauliflora leaf which statistically presented
the same average of haloes inhibitory formation on bacteria Gram positive, Gram
negative and yeasts. The extracts of Heliconia rostrata did not
present activity. Mycobacterium tuberculosis H37 and
Mycobacterium bovis (BCG) appeared resistant to all the extracts.
The susceptibility profile of Candida albicans and
Saccharomyces cerevisiae fungi were compared to one another and
to the Gram positive Bacillus subtilis, Enterococcus
faecalis and the Gram negative Salmonella typhimurium
bacteria (p > 0.05). The evaluation of cytotoxicity was carried
out on C6-36 larvae cells of the Aedes albopictus mosquito. The
extracts of stem and flower of Heliconia rostrata, leaf and stem of
Plinia cauliflora, seed of Anonna crassiflora
and stem, flower and root of B. pilosa did not present toxicity in
the analyzed concentrations. The highest rates of selectivity appeared in the
extracts of stem of A. crassiflora and flower of B.
pilosa to Staphylococcus aureus, presenting potential
for future studies about a new drug development. 相似文献
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Periportal edema (PPE) of the liver in multislice computed tomography (MS-CT) scans that develops immediately (primary PPE [pPPE]) or later (secondary PPE [sPPE]) is not uncommon in severe trauma patients. Although PPE may serve as a marker for blunt abdominal trauma (22–31 % of cases), distinct causes and clinical implications of PPE are unclear. We analyzed the incidence of pPPE and sPPE in 68 MS-CT scans in severe trauma patients (2007–2009). Exclusion criteria were severely burned patients and patients with preexistent liver diseases predisposing to PPE. We divided PPE+ patients into two subpopulations—either initial/primary PPE (pPPE+) or later/secondary PPE (sPPE+). Further patient data were collected and statistically analyzed. PPE+ was found in 27.9 % (n?=?19). Females predominated (p?=?0.01), and PPE+ patients presented with a significantly better pH at admission (p?=?0.008). The total amount of volume resuscitation (1,983?±?1,155 ml; p?=?0.02) and crystalloids (1,117?±?796 ml; p?=?0.006) administered before MS-CT scans was significantly higher in PPE+, whereas the amount of administered colloids (797?±?640 ml) showed no significant difference in both groups. PPE+ was not associated with further patient data, i.e., trauma mechanism, injury severity, prognosis-relevant factors, adverse clinical events, or mortality. pPPE+ in MS-CT may serve as a surrogate parameter for intravenous volume load and/or venous congestion, and sPPE+ may also indicate venous congestion and right heart failure after severe trauma. In severe trauma patients with pPPE+/sPPE+ in MS-CT scans, causes of PPE relating to intravenous fluid overload and/or venous congestion should be excluded or treated. 相似文献
28.
Marco Aurélio Petroni Montezuma Felipe Paiva Fonseca Bernar Monteiro Benites Ciro Dantas Soares Gleyson Kleber do Amaral-Silva Oslei Paes de Almeida Fernando Augusto Soares Rosana Lima Pagano Eduardo Rodrigues Fregnani 《Pathology, research and practice》2018,214(6):907-913
Ameloblastoma is a locally aggressive neoplasm with a poorly understood pathogenesis. Therefore, the aim of this study is to investigate whether COX-2 expression is associated with ameloblastoma microvascular density (MVD) and with tumor aggressiveness. Sixty-three cases of primary ameloblastomas arranged in tissue microarray were submitted to immunohistochemistry against cyclooxigenase-2 (COX-2) and CD34. Clinicopathological parameters regarding sex, age, tumour size, tumour duration, tumour location, treatment, recurrences, radiographic features, vestibular/lingual and basal cortical disruption and follow-up data were obtained from patients’ medical records and correlated with the proteins expression. The results on BRAF-V600E expression were obtained from our previous study and correlated with COX-2 and CD34 expressions. Log-rank univariate analysis and multivariate Cox regression model were done to investigate the prognostic potential of the molecular markers. Twenty-eight cases (44.4%) exhibited cytoplasmic positivity for COX-2, predominantly in the columnar peripheral cells, with a mean MVD of 2.2 vessels/mm2. COX-2 was significantly associated with recurrences (p?<?0.001) and BRAF-V600E expression (p?<?0.001), whereas lower MVD was associated with the use of conservative therapy (p?=?0.004). Using univariate and multivariate analyses, COX-2 was significantly associated with a lower 5-year disease-free survival (DFS) rate (p?<?0.001 and p?=?0.012, respectively), but not with a higher MVD (p?=?0.68). In conclusion, COX-2 expression in ameloblastomas is not associated with MVD, but it is significantly associated with recurrences and with a lower DFS. 相似文献
29.
Calegari VC Alves M Picardi PK Inoue RY Franchini KG Saad MJ Velloso LA 《Endocrinology》2005,146(2):579-588
Angiotensin II inhibits insulin-induced activation of phosphatidylinositol 3-kinase through a mechanism, at least in part, dependent on serine phosphorylation of the insulin receptor and insulin receptor substrates (IRS)-1/2. Recent evidence shows that suppressor of cytokine signaling-3 (SOCS-3) is induced by insulin and angiotensin II and participates in the negative control of further stimulation of each of these signaling systems independently. In the present study, we evaluated the interaction of angiotensin II-induced SOCS-3 with the insulin signaling pathway in the heart of living rats. A single iv dose of angiotensin II promotes a significant increase of SOCS-3 in heart, an effect that lasts up to 180 min. Once induced, SOCS-3 interacts with the insulin receptor, JAK-2, IRS-1, and IRS-2. The inhibition of SOCS-3 expression by a phosphorthioate-modified antisense oligonucleotide partially restores angiotensin II-induced inhibition of insulin-induced insulin receptor, IRS-1 and IRS-2 tyrosine phosphorylation, and IRS-1 and IRS-2 association with p85-phosphatidylinositol 3-kinase and [Ser473] phosphorylation of Akt. Moreover, the inhibition of SOCS-3 expression partially reverses angiotensin II-induced inhibition of insulin-stimulated glucose transporter-4 translocation to the cell membrane. These results are reproduced in isolated cardiomyocytes. Thus, SOCS-3 participates, as a late event, in the negative cross-talk between angiotensin II and insulin, producing an inhibitory effect on insulin-induced glucose transporter-4 translocation. 相似文献
30.