海洛因海绵状白质脑病胶质细胞凋亡及其Caspase-3蛋白的表达

目的 探讨海洛因海绵状白质脑病（HSLE）胶质细胞凋亡及其Caspase-3蛋白的表达.方法 4例HSLE脑尸检和1例正常对照脑尸检分别进行脱氧核糖核苷酸末端转移酶介导的原位缺口末端标记法（TUNEL）染色以及Caspase-3免疫组化染色.利用显微镜观察阳性细胞数的改变,分析小脑不同部位细胞凋亡数与Caspase-3蛋白表达阳性细胞之间的关系.结果 HSLE的小脑深层白质病变区存在TUNEL阳性细胞表达和Caspase-3蛋白表达,明显高于浅层白质和正常对照（P＜0.01）.结论 HSLE深层白质存在胶质细胞凋亡可能是HSLE的发病原因之一,Caspase-3蛋白表达与HSLE细胞凋亡的发生相关.     

异病酚静脉全麻下复合氯胺酮或曲马多行纳屈酮快速阿片脱毒的效果比较

Toreleasetheseverewithdrawalsymptomsoftheheroinad-dicts,weinjecttheNaloxineinthegeneralanesthesia.160volun-teersreceivedRODwereperformedunderthecombinedanesthesiawithpropofol,midazolamandketamine.1Subjectsandmethods1.1Subjects160volunteerswhoaccordingwiththediagnosticstandardoftheICD-10abouttheopiate-addiction,male:145,fe-male15.Age:(30±6),theeldestwas45yearsold.Themeanbodyweightwasabout(58±8)kg.Educationalbackground:pri-maryschool118cases,juniorhighschool:24casesandseniorhighschool/seco…     

海洛因及腺苷补偿对大鼠部分血浆生化指标影响的分析

目的研究海洛因依赖及腺苷补偿时大鼠肾功能生化指标的变化和意义。方法建立海洛因依赖及腺苷补偿组大鼠模型，50只Wistar大鼠随机分成对照组、3d给药组、9d给药组、腺苷对照组及同时给海洛因和腺苷9天组，检测血液生化指标尿素氮（BUN）、肌酐（CREA）及尿酸URIC）。结果与对照组相比，海洛因3天、9天给药组中URIC含量均明显升高（P〈0．01）。与海洛因给药9天组相比，同时给海洛因和腺苷组中URIC的血浆含量明显下降（P〈0．01）。结论海洛因对肾功能损害则较轻，在代偿范围内；同时给予腺苷能够维持血浆部分生化指标的相对稳定。     

海洛因成瘾者食管运动功能研究

目的海洛因成瘾者常伴腹痛、胸部不适、反酸、反食等症状,是否存在食管运动功能紊乱有待探讨。方法随机抽取海洛因或瘾者41例。按年龄及性别配对41例健康对照组,采用PCPolygrafHR高分辨多通道灌注测压系统对82例研究对象进行食管动力的研究。测量下食管括约肌长度(LESL)、压力(LESP)、松弛率(LESR)、近端收缩压(NSP)、远端收缩村(FSP)等指标,并分析不同的吸毒年限、吸嗜方式、吸嗜量对食管动力的影响。结果海洛因成瘾者LESP、LESR与正常组相比(P<0.05),且病理性蠕动多峰波或双峰波、同步收缩比例则显著高于正常对照组(P<0.05);吸嗜量越大对食管动力损伤越大;肌肉注射、静脉注射海洛因对食管运动功能的损害明显大于香烟、烫吸方式。结论海洛因成瘾者存在食管运动功能紊乱,因此,其中吸嗜量、吸嗜方式与食管动力学指标异常有关系,在戒断康复治疗过程中,必须对此引起足够的重视。     

海洛因对女性生殖系统损害的特征

目的通过生育年龄吸毒女性及自愿受检非吸毒正常女性,从下丘脑生殖轴、外周血女性相关激素水平及临床症状体征3个水平进行对比研究,以探讨长期使用海洛因对女性生殖系统的损害。方法填写调查表、对患者进行相关体检,抽血进行女性激素检测、阴道细胞涂片查雌激素影响程度或卵巢功能低下情况、妇科彩色B超测量子宫及其内膜和卵巢大小。结果吸毒组促性腺激素释放激素(GnRH)、雌二醇(E2)、孕酮(P)明显低于正常组,而卵泡刺激素(FSH)、黄体生成素(LH)相反明显高于正常组(P<0.01及<0.05);与正常组比,吸毒组阴道雌激素水平降低、而阴道pH值升高(P<0.05);皮下脂肪减少、子宫、子宫内膜、卵巢、乳房、脂肪、大阴唇等明显萎缩(P<0.05或P<0.01);另吸毒组多数显现月经紊乱、停经或闭经。结论长期使用海洛因可通过抑制生殖轴、抑制排卵及卵巢功能等途径,对女性生殖系统造成明显损害。长期吸毒可致卵巢功能减退甚至衰竭危险。     

Abnormal resting‐state functional connectivity of the nucleus accumbens in multi‐year abstinent heroin addicts

Functional neuroimaging studies suggest that abnormal brain functional connectivity may be the neural underpinning of addiction to illicit drugs and of relapse after successful cessation therapy. Aberrant brain networks have been demonstrated in addicted patients and in newly abstinent addicts. However, it is not known whether abnormal brain connectivity patterns persist after prolonged abstinence. In this cross‐sectional study, whole‐brain resting‐state functional magnetic resonance images (8 min) were collected from 30 heroin‐addicted individuals after a long period of abstinence (more than 3 years) and from 30 healthy controls. We first examined the group differences in the resting‐state functional connectivity of the nucleus accumbens (NAc), a brain region implicated in relapse‐related processes, including craving and reactivity to stress following acute and protracted withdrawal from heroin. We then examined the relation between the duration of abstinence and the altered NAc functional connectivity in the heroin group. We found that, compared with controls, heroin‐dependent participants exhibited significantly greater functional connectivity between the right ventromedial prefrontal cortex and the NAc and weaker functional connectivity between the NAc and the left putamen, left precuneus, and supplementary motor area. However, with longer abstinence time, the strength of NAc functional connectivity with the left putamen increased. These results indicate that dysfunction of the NAc functional network is still present in long‐term‐abstinent heroin‐dependent individuals. © 2015 Wiley Periodicals, Inc.     

Heroin diffusion in the mid-Hudson region of New York State

Aims Prompted by the history of heroin diffusion in the United States, press reports and building on previous research into retail heroin distribution, ethnographic research was undertaken identifying and describing retail distribution and diffusion of heroin in and into medium‐ and small‐sized towns in the mid‐Hudson region of New York State. Methods In conjunction with fieldwork, in‐depth tape‐recorded interviews were conducted with recent admissions (30 days) at 28 different drug treatment facilities located in the region. Interviews were also conducted with drug counselors, narcotic officers, drug treatment administrators and the county commissioners of mental hygiene. Findings Heroin‐dependent individuals who have access to cheaper heroin in urban areas, such as New York City, Newark, and Patterson, New Jersey, drive retail heroin distribution in the mid‐Hudson region. They travel to these cities, purchase heroin in quantity (costing $8–10 per bag), return to the region and sell premium‐priced heroin ($20‐$25 per bag) mostly to irregular users who do not have access to retail drug sellers in urban areas. Conclusion Price disparity contributes to a recurrent process whereby irregular users who are able to gain access to cheaper heroin in urban areas, return to the mid‐Hudson and sell premium‐priced heroin to other users who do not have access to cheaper heroin. This process contributes to the diffusion of heroin abuse.     

Policy progress for physician treatment of opiate addiction

Medical treatment of heroin addiction with methadone and other pharmacotherapies has important benefits for individuals and society. However, regulatory policies have separated this treatment from the medical care system, limiting access to care and contributing to the social stigma of even effective addiction pharmacotherapy. Increasing problems caused by heroin addiction have added urgency to the search for policies and programs that improve the access to and quality of opiate addiction treatment. Recent initiatives aiming to reintegrate methadone maintenance and other addiction pharmacotherapies into medical practice may promote both expanded treatment capacity and increased physician expertise in addiction medicine. These initiatives include changes in federal oversight of the opiate addiction treatment system, the approval of physician office-based methadone maintenance programs for stabilized patients, and federal legislation that could enable physicians to treat opiate addiction with new medications in regular medical practice. This work was assisted by a grant from the Robert Wood Johnson Foundation Substance Abuse Policy Research Program.     

Methadone medical maintenance in primary care

BACKGROUND: Methadone is effective treatment for opioid addiction, but regulations restrict its use. Methadone medical maintenance treats stabilized methadone patients in a medical setting, but only experimental programs have been studied. OBJECTIVE: To evaluate the implementation of the first methadone medical maintenance program established outside a research setting. DESIGN: One-year program evaluation. SETTING: A public hospital and a community opioid treatment program. PARTICIPANTS: Methadone patients with >1 year of clinical stability. Eleven generalist physicians and 4 hospital pharmacists. INTERVENTIONS: Regulatory exemptions were requested. Physicians and pharmacists were trained. Patients were transferred to the medical setting and permitted 1-month supplies of methadone. MEASUREMENTS: Patient eligibility and willingness to enroll, treatment retention, urine toxicology results, change in addiction severity and functional status, medical services provided, patient and physician satisfaction, and physician attitudes toward methadone maintenance. RESULTS: Regulatory exemptions were obtained after a 14-month process, and the program was cited in federal policy as acceptable for widespread implementation. Forty-nine of 684 patients (7.2%) met stability criteria, and 30 enrolled. Twenty-eight were retained for 1 year, and 2 transferred to other programs. Two patients had opioid-positive urine tests and were managed in the medical setting. Previously unmet medical needs were addressed, and the Addiction Severity Index (ASI) medical composite score improved over time (P=.02). Patient and physician satisfaction were high, and physician attitudes toward methadone maintenance treatment became more positive (P=.007). CONCLUSIONS: Methadone medical maintenance is complex to arrange but feasible outside a research setting, and can result in good clinical outcomes.