二醋吗啡依赖患者血细胞胎盘型谷胱甘肽S-转移酶mRNA的表达

定量RT-PCR检测33例二醋吗啡依赖患者和19例正常对照血细胞中的胎盘型谷胱甘肽S-转移酶（GST-π）表达水平,同时用银染法检测患者T细胞的核仁机化区（NOR)面积比（Ag-NOR）. 结果表明二醋吗啡依赖患者血细胞中GST-π表达水平明显高于正常对照,但与性别,吸毒时间和吸毒方式无关.     

Changes in the states of opioid receptors coupled to G proteins in the erythrocytes of diamorphine addicts 1

用功能大分子复合体表观靶体积幅射失活法,比较二醋吗啡（海洛因）成瘾者,非吸毒志愿者及成功戒毒３个月以上者,其红细胞阿片受体与Ｇ蛋白耦联状态的异同．结果表明,对照组,成瘾组和康复组的阿片μ－受体复合体的大小（表观分子量）依次为：（３４７±２）ｕ（ｎ＝１１）;（２２８±５）ｕ（ｎ＝１６）和（２７９±１１）ｕ（ｎ＝９）．成瘾组明显低于对照组（Ｐ＜０．０１）;值得注意的是康复组虽然明显低于对照组（Ｐ＜０．０１）,但明显高于成瘾组（Ｐ＜０．０１）．上述３组的阿片δ－受体复合体的大小（表观分子量）则分别为：（３０８±４）ｕ（ｎ＝１１）,（２２４±４）ｕ（ｎ＝１６）和（２９９±７）ｕ（ｎ＝９）．成瘾组明显低于对照组（Ｐ＜０．０１）;同样值得注意的是康复组明显高于成瘾组（Ｐ＜０．０１）,而且非常接近对照组（Ｐ＞０．０５）．结果提示：（１）二醋吗啡成瘾时红细胞阿片μ－和δ－受体均可能与Ｇ蛋白发生解耦联现象;（２）这种现象在红细胞是可逆转的．     

二醋吗啡成瘾者红细胞阿片受体与G蛋白耦联状态的改变

用功能大分子复合体表观靶体积幅射失活法,比较二醋吗啡(海洛因)成瘾者,非吸毒志愿者及成功戒毒3个月以上者,其红细胞阿片受体与G蛋白耦联状态的异同. 结果表明,对照组,成瘾组和康复组的阿片μ-受体复合体的大小(表观分子量)依次为： (347±2) u(n=11); (228±5) u(n=16)和(279±11) u(n=9). 成瘾组明显低于对照组(P<0.01); 值得注意的是康复组虽然明显低于对照组(P<0.01),但明显高于成瘾组(P<0.01). 上述3组的阿片δ-受体复合体的大小(表观分子量)则分别为：(308±4) u(n=11), (224±4) u(n=16)和(299±7) u(n=9). 成瘾组明显低于对照组(P<0.01); 同样值得注意的是康复组明显高于成瘾组(P<0.01), 而且非常接近对照组(P>0.05). 结果提示：(1) 二醋吗啡成瘾时红细胞阿片μ-和δ-受体均可能与G蛋白发生解耦联现象; (2) 这种现象在红细胞是可逆转的.     

乙酰吗啡成瘾者外周血单个核细胞中单核细胞趋化蛋白-1 mRNA表达的抑制(英文)

目的:探究乙酰吗啡(海洛因)成瘾者单核细胞趋化蛋白-1(MCP-1)基因表达状况是否与正常人有区别.方法:以β-actin为内标准物,用逆转录聚合酶链式反应(RT-PCR)分别检测乙酰吗啡成瘾者和正常志愿者外周血单个核细胞中MCP-1 mRNA表达状况,并对RT-PCR产物进行测序,以证实其特异性.结果:外周血单个核细胞中MCP-1 mRNA表达的相对水平,正常志愿者对照组为0.47±0.12(n=15);乙酰吗啡成瘾组为0.21±0.09(n=21),两组间差异显著(P<0.05).结论:乙酰吗啡成瘾者外周血单个核细胞中MCP-1 mRNA的表达显著被抑制;这可能是乙酰吗啡成瘾者群体中包括AIDS等严重感染性疾病发病率显著增高的机制之一.     

Improving patients' postoperative sleep: a randomized control study comparing subcutaneous with intravenous patient-controlled analgesia

One hundred female patients undergoing major reconstructive plastic or gynaecological surgery were randomized to either receive subcutaneous patient-controlled analgesia (PCA) (bolus dose 2.5 mg diamorphine in 1 ml with a 20-minute lockout) or intravenous PCA (bolus dose 0.5 mg diamorphine in 1 ml with a 5-minute lockout). Data were collected by questionnaire and interview to evaluate the intervention on pain scores, quality of sleep on the first postoperative night, postoperative nausea and vomiting (PONV) and overall patient acceptability. The subcutaneous PCA group experienced less 'worse pain' (P < 0.01) and less sleep disturbance due to pain (P < 0.001). Subcutaneous PCA would appear to offer patients a safe and effective means of analgesia and may offer significant advantages over the intravenous route of administration.     

Intrathecal inflammatory masses: is the yearly opioid dose increase an early indicator?

Objectives: The objective of this study is to investigate the association between intrathecal drug, flow rate, drug concentration, and drug dose with the formation of intrathecal inflammatory masses. Methods: A retrospective longitudinal study of 56 consecutive patients receiving long‐term intrathecal analgesic administration was undertaken through screening of medical records. Data regarding drug flow rate, dose per day, and concentration of drugs administered were recorded for morphine, diamorphine, bupivicaine, clonidine and baclofen and averages computed. Results: The average follow‐up time post‐implant was 91 ± 55 months (range: 9–209). Four of the 56 patients were diagnosed with intrathecal granuloma indicating a rate of 7%, the equivalent to 0.009 events per patient year. Twenty‐one of the patients had received morphine either alone or combined; 22 had received diamorphine either alone or mixed; and 13 crossed over from morphine to diamorphine or the inverse. None of the patients with granuloma crossed over before diagnosis. A significant correlation was found between opioid dose (r= 0.275, p < 0.05), yearly increase of the opioid dose (r= 0.433, p < 0.05), and granuloma formation. Clonidine appeared to have a protective effect for the non‐granuloma patients. No association was found with flow rate (r= 0.056) or opioid concentration (r= 0.214). Conclusion: This is the first detailed study showing an association of diamorphine with granulomas. This study supports the previous finding of intrathecal opioid dose being a risk factor for intrathecal granulomas and clonidine being protective. In addition we have found that the yearly increase in opioid dose is a risk factor for granulomas and could serve as an indicator for closer surveillance.