Cirugía bariátrica y trastorno por abuso de alcohol y otras sustancias: una revisión sistemática

IntroductionBariatric surgery is a relatively safe surgical procedure with a high success rate. However, recent reports indicate a higher prevalence of alcohol or substance abuse disorder in this patient group. The purpose of this study was to review the related evidence to serve as a reference for multidisciplinary teams who treat these patients.MethodsWe searched the PubMed and CENTRAL databases. The odds ratios were extracted from the different articles, comparing the prevalence of the abuse of alcohol or other substances in the postoperative period versus preoperative levels. We also compared the prevalence of alcohol use disorder after different types of bariatric surgery.ResultsA total of 49 121 bariatric patients (80.8% female) were evaluated for alcohol use disorder. In general, bariatric surgery was found to be associated with an increase in the prevalence of alcohol abuse (4.58±5.3 vs. 1.58±10.7% in the preoperative period). We also found that the population of patients who underwent RYGB procedures had a higher prevalence of alcohol use disorder than patients who underwent another type of surgery (OR: 1.83; 95% CI: 1.51-2.21). The prevalence of substance abuse disorder (other than alcohol) after this procedure is less studied, although there appears to be an increased risk of abuse of certain substances.ConclusionsBariatric surgery is the best treatment for obesity and its complications. The evidence reviewed suggests that it correlates with a modest but consistent increase in the prevalence of abuse of alcohol and other substances. Medical teams who treat bariatric patients must be informed about this eventuality for its timely prevention, diagnosis and treatment.     

Immune adjuvants for chemotherapy or radiotherapy in the 9L rat brain tumor model

Summary The therapeutic efficacy and toxicity of three biological response modifiers,Corynebacterium parvum (Cp), Chinese blister beetle extract (CBBE), recombinant human IL-1 (rhIL-1), used alone or in combination with chemotherapy or radiotherapy, were investigated in the intracerebral (ic) rat 9L brain tumor model. Used alone, Cp (2mg/rat, ip plus 70g/rat, ic), CBBE (5l of an ethanol extract, ic), or IL-1 (lg/rat, ic or 1g/rat × 3, q 3 d, ic), had no effect on animal survival compared to the untreated or saline treated controls. When combined with chemotherapy or radiotherapy, the three immunotherapeutic agents did not show any additive effects on survival compared to that observed with systemic BCNU (12mg/kg), local ic bleomycin (0.25 unit), or local radiotherapy (16 Gy). While ic IL-1 did not produce evident toxicity, there was fatal toxicity caused by ic Cp or CBBE treatment in a few animals. The combination of Cp and bleomycin produced severe neurotoxicity, resulting in the early death of animals. This study demonstrates a lack of efficacy of the nonspecific immune adjuvants IL-1, Cp or CBBE, used either alone or combined with cytotoxic chemotherapy or radiotherapy, in this rat brain tumor model.     

Effect of ethanol on dynamic visual acuity during vertical body oscillation in healthy volunteers

Visual orientation is the most important sensory input during locomotion (e.g. walking, driving a car, riding a bicycle). We investigated dynamic visual acuity (DVA) during vertical body-oscillations (amplitude 5 cm; frequency 1.5 Hz) in 12 healthy subjects before and twice after ethanol consumption. During oscillation, vertical eye movements were recorded under two test conditions: with eyes closed (EC) and during DVA testing. A significant increase in vertical eye-amplitude after ethanol ingestion occurred only during EC tests, as a possible sign of vestibular hyperreaction. During vestibular stimulation alone (EC), ethanol did not affect the phase shift between stimulus and eye movements. However, when the subjects were given an additional visual stimulus (DVA), the post-alcohol phase shift rose significantly. Surprisingly, the post-alcohol phase shift values for the two test conditions showed no significant differences. After ethanol ingestion we found no changes in static visual acuity but a significant loss of DVA. Volunteers with a change of DVA threshold (DVAT) showed significantly (P = 0.004) higher post-alcoholic changes in the phase shift. In summary, low doses of ethanol disturbed the visually guided oculomotor response during fixation of an earth-fixed target while the observer was subject to linear vertical acceleration. This effect led to an increasing delay between the beginning of body and eye movements. The consequence was an increasing phase shift and thus a decrease in DVA during whole-body oscillation which was comparable to movements during human locomotion. Received: 8 March 2000 / Accepted: 18 April 2000     

正交试验法优选银翘解毒软胶囊的水煮提取工艺

采用Ｌ９（３＾４）正交设计,以浸膏得率,正丁醇浸出率,绿原酸含量为考察指标,优选银翘解毒软胶囊的水煮提取工艺。结果表明：最佳提取工艺为首次加１０倍量水,浸泡３０ｍｉｎ,煎煮２ｈ,第２次加８倍量水,煎煮１．５ｈ。     

Diazepam prevents progression of kindled alcohol withdrawal behaviour

The purpose of the present experiment was to study the kindling hypothesis of alcohol withdrawal stating that exposure to repeated episodes of alcohol withdrawal results in an increased severity of subsequent withdrawal reactions. Two groups of male Wistar rats were subjected to 13 episodes of 2 days severe alcohol intoxication and 5 days alcohol withdrawal. Animals in the control group (n=80) developed clinical withdrawal signs following each intoxication episode. In the diazepam group (n=80) the withdrawal reactions during episodes 1–9 were blocked by intraperitoneal diazepam administration (0–30 mg/kg) 8, 11 and 15 h into withdrawal. During episode 10–13 diazepam treatment was terminated and convulsive withdrawal behaviour was observed 9–15 h after last alcohol dose. The probability of seizure activity during these four withdrawal episodes was calculated as 0.239 and 0.066 in the control and the diazepam groups, respectively. Based on Monte Carlo simulation techniques, this difference was found to be statistically significant (P<0.05). No differences in the non-convulsive alcohol withdrawal symptoms tremor, hyperactivity and rigidity were detected between controls and diazepam animals after diazepam treatment. It was concluded that the increased convulsive behaviour in the control group was caused by cumulated kindling-like cerebral alterations during the previous repeated alcohol withdrawal phases.     

A dose-response study of the effects of alcohol on the perceptions of pain and discomfort due to electric shock in men at high familial-genetic risk for alcoholism

Alcoholics have previously been found to be more sensitive to painful stimulation than controls, and more sensitive to the pain-reducing effects of alcohol. The present study was designed to examine these effects in men at high familial-genetic risk for alcoholism and controls. Subjects were assigned to one of four alcohol doses [0.135 (active placebo), 0.50, 0.75, or 1.00 ml 95% USP alcohol/kg body weight]. Ratings of the amount of discomfort and pain experienced during an aversive shock procedure were taken immediately post-shock, both while subjects were sober and after they had consumed one of the four alcohol doses. High risk men were found to rate the experience of the shock as more uncomfortable and painful overall than the low risk controls. Pharmacologically significant levels of alcohol were found to reduce or eliminate these group differences, suggesting that alcohol has a normalizing effect on pain and discomfort perceptions in high risk men. Only the higher doses of alcohol were found significantly to dampen subjects' shock rating scores. High risk males' increased sensitivity to pain and discomfort, combined with the negatively reinforcing effects of reducing these perceptions at moderate to high alcohol doses, may play a role in predisposing high risk males for the development of alcoholism.     

The incidence of alcohol-related problems and the risk of alcohol withdrawal in a general hospital population

A survey was carried out using the Canterbury Alcohol Screening Test (CAST) and clinical criteria for risk of alcohol withdrawal of 2000 randomly selected hospital in-patients in order to determine the prevalence of alcohol-related problems, the work-load for a specialist alcohol withdrawal service and the target group for early intervention. Patients at risk of alcohol withdrawal were followed prospectively.

The major findings were: 14.3% of patients had a positive CAST and 8% were at risk of alcohol withdrawal; the prevalence of positive clinical criteria was greatest in men under the age of 30 years (OR 3.6) and very low (OR 0.34) in women over 60 years. In addition, patients who were too sick or refused to complete the questionnaire had high rates of being at risk for alcohol withdrawal. The prevalence of CAST positivity was greatest in men under the age of 40 years (OR 3.7) and lowest in women over 70 years (OR 0.2).

It is concluded that 15-20% of in-patients have alcohol problems and 8% are at risk of withdrawal; questionnaires will produce underestimates of the order of 25%; and female in-patients over the age of 60 years are extremely unlikely to have problems with alcohol.     

黑河上蔡段河水及饮用水的致突变性

目的：探讨黑河上蔡段癌症高发区河水及饮用水的致突变性。方法：采集严重污染的黑河河水及沿岸浅井水分别进行以下试验。①用ＸＡＤⅡ树脂提取各水样中的有机提取物作为待测样品,以呋喃基康酰胺和叠氮钠作阳性对照,以自发回变率为阴性对照,用鼠伤寒沙门氏菌属ＴＡ９８ 、ＴＡ１００ 菌株进行Ａｍｅｓ 试验。以突变比ＭＲ 值评价试验结果。②松滋青皮蚕豆温浸芽约２ ｃｍ ,分别取３ ～４ 粒放入不同水样中处理,同时以蒸馏水、郑州市自来水作阴性对照,环磷酰胺（１ ｍｇ／Ｌ） 作阳性对照进行微核试验。显微镜下观察根尖细胞微核数,统计微核千分率（ＭＣＮ‰） 。结果：①河水有机提取物对ＴＡ９８、ＴＡ１００ 菌株均可诱发阳性回变;②沿岸浅井水有机提取物能诱发ＴＡ９８菌株的阳性回变;③河水、井水均可致蚕豆根尖细胞微核率（ＭＣＮ‰） 明显增高。④浅井水和河水的致突变性及毒性（ 抑菌圈直径大小） 基本相同。结论：①由于浅井水和河水的致突变性及毒性基本相同,故浅井水中的致突变物质可能来源于河水的水平渗透;②沿岸居民癌症高发与河水污染的潜在致癌性有密切关系,应予以高度重视     

中草药在光合细菌开发中的应用

在培养基中添加一定浓度的木瓜,栝楼,女贞子,郁金等中草药的浸提液,可明显促进光合细菌的生长,其中以栝楼的效果最明显。某些中草药除本身有一定的抑菌作用外,不对光合细菌的抑菌作用有一定程度的提高。指出在水产养殖等实际应用中,添加某些中草药既能促进光合细菌的生长,又可增强其抑制其它细菌生长的能力。     

Chronic ethanol treatment alters AMPA-induced calcium signals in developing Purkinje neurons

Cerebellar Purkinje neurons developing in culture were treated chronically with 30 mM (140 mg%; 3-11 days in vitro) ethanol to study the actions of prolonged ethanol exposure on responses to exogenous application of AMPA, a selective agonist at the AMPA subtype of ionotropic glutamate receptors. There was no consistent difference between control and chronic ethanol-treated neurons in resting membrane potential, input resistance, or the amplitude or duration of the membrane responses to AMPA (1 or 5 microM applied by brief microperfusion) as measured using the nystatin patch method of whole cell recording. In additional studies, the Ca2+ signal to AMPA was examined using the Ca2+ sensitive dye fura-2. The mean peak Ca2+ signal elicited by 5 microM AMPA was enhanced in the dendritic region (but not the somatic region) of chronic ethanol-treated Purkinje neurons compared to control neurons. In contrast, there was no difference between control and chronic ethanol-treated neurons in the peak amplitude of the Ca2+ signal to 1 microM AMPA, whereas the recovery of the Ca2+ signals was more rapid in both somatic and dendritic regions of ethanol-treated neurons. Resting Ca2+ levels in the somatic and dendritic regions were similar between control and ethanol-treated neurons. These data show that the membrane and Ca2+ responses to AMPA in Purkinje neurons are differentially affected by prolonged ethanol exposure during development. Moreover, chronic ethanol exposure produces a selective enhancement of AMPA-evoked dendritic Ca2+ signals under conditions reflecting intense activation (i.e., 5 microM AMPA), whereas both somatic and dendritic Ca2+ signals are attenuated with smaller levels of activation (i.e., 1 microM AMPA). Because Ca2+ is an important regulator of numerous intracellular functions, chronic ethanol exposure during development could produce widespread changes in the development and function of the cerebellum.