Histologic findings of the sinus node and the perinodal area in street heroin addicts, victims of sudden unexpected death

Sudden unexpected death is frequent in street heroin addicts. We conducted a histologic study of the sinus node (SN) to offer some evidence about the possible arrhythmogenic cause of death. Postmortem coronary angiography and microscopic examination of the SN and the perinodal area were performed in 50 heroin addicts (group 1) and in 50 nonaddicts (group 2), all men (16-40 years old). In heroin addicts, fatty and/or fibrous tissue replaced SN tissue in 21 cases (42%). Perinodal infiltration was found in 15 cases (30%). Fibromuscular dysplasia in branches of the sinus node artery (SNA) was found in eight cases (16%). Inflammation with focal and/or diffuse concentration of round cells was detected in the SN in 22 cases (44%). Old mural thrombi were also found in 13 cases (26%). The histologic changes in the SN and perinodal area offer an explanation about the possible mechanism of arrhythmia and sudden death in this population.     

艾灸三阴交和关元对女性海洛因依赖者月经不调及性激素水平的调整作用

［摘要］目的 观察艾灸三阴交、关元对女性海洛因依赖者月经不调和性激素水平的调整作用,并比较艾灸与艾油的临床疗效。方法 选择安徽省戒毒康复中心收治符合纳入标准的海洛因依赖者月经紊乱患者90例,随机分为艾灸组、艾油组和对照组,各30例。艾灸组用艾条灸双侧三阴交和关元穴,每穴每次15 min,隔日1次,1个月为1个疗程,连续3个疗程;艾油组用艾油涂抹双侧三阴交和关元穴,疗程同艾灸组;对照组不予任何干预。观察3组治疗前后中医症状积分变化和月经不调的临床疗效,并于治疗前后采用化学发光法检测3组患者血清雌二醇(estradiol, E2)、卵泡刺激素(follicle stimulating hormone, FSH)、促黄体生成素(luteinizing hormone, LH)、催乳素（prolactin, PRL）、孕酮（progesterone, P）水平。结果 艾灸组治疗后,患者中医症状积分较治疗前明显降低(P<0.01),亦明显低于艾油组(P<0.05)及对照组(P<0.01);艾油组与对照组治疗前后中医症状积分变化不明显(P>0.05);艾灸组月经不调的临床疗效总有效率达80.00%,高于对照组（16.67%）和艾油组（30.00%）,差异具有统计学意义（P<0.01）。治疗后,艾灸组血清E2含量显著升高(P＜0.01),FSH和LH含量显著降低(P＜0.05),与艾油组和对照组比较,差异均具有统计学意义（P<0.05,或P<0.01）;3组PRL和P水平治疗前后以及治疗后组间比较,差异均无统计学意义（P>0.05)。结论 艾灸三阴交、关元对海洛因依赖患者月经不调及性激素紊乱具有较好的调整作用。     

Signature Profiling and Classification of Illicit Heroin by GC-MS Analysis of Acidic and Neutral Manufacturing Impurities

Abstract:  The illicit manufacture of heroin results in the formation of trace level acidic and neutral impurities. These impurities are detectable in illicit heroin and provide valuable information about the manufacturing process used. The isolation, derivatization, and semiquantitative analysis of neutral and acidic heroin manufacturing impurities by programmed temperature vaporizing injector-gas chromatography-mass spectrometry (PTV-GC-MS) is described. Trace acidic and neutral heroin impurities were isolated from basic fractions using liquid–liquid extraction. Extracted impurities were treated with N -Methyl- N -trimethylsilyltrifluoroacetamide followed by PTV-GC-MS analyses. Semiquantitative data were obtained using full scan mass spectrometry utilizing unique ions or ion combinations for 36 trace impurities found in crude and/or highly refined heroin samples. Minimum detection limits for acidic and neutral impurities were estimated to be at the 10⁻⁷ level relative to total morphine. Over 500 authentic heroin samples from South America, Mexico, Southwest Asia, and Southeast Asia were analyzed. Classification of illicit heroin based on the presence or absence and relative amounts of acidic and neutral impurities is presented.     

海洛因依赖对大鼠杏仁核突触数量及结构的影响

目的观察不同海洛因依赖时间大鼠杏仁核的超微结构变化,探讨海洛因对突触数量及结构的影响。方法采用腹腔内递增注射海洛因的方法,建立海洛因依赖9d、18d和36d的染毒模型,用透射电镜观察杏仁核突触的超微结构变化,并与生理盐水对照组进行比较。结果海洛因依赖大鼠杏仁核突触数量增多,突触间隙宽度变窄,突触后致密质增厚,活性区长度延长,突触界面曲率变大,并随海洛因依赖时间的延长而更加明显(P0.05)。结论海洛因依赖可影响杏仁核突触数量及结构。     

利用红外光谱法检验海洛因及其掺杂物

利用傅立叶红外光谱（DAC）法对海洛因及其掺杂物的混合物的红外光谱图进行分析,可以找出海洛因及其掺杂物的傅立叶变换红外光谱的特征吸收峰,确定根据红外光谱图直接认定海洛因及其掺杂物的方法。该方法具有操作简单、速度快、不用其他试剂、不污染检材、样品量小、结果准确等特点。     

浅议网络成瘾对青少年社会化的影响

要了解网络成瘾对青少年社会化的影响,首先必须了解造成青少年网络成瘾的社会背景和原因。在信息时代,青少年在学习、交友、家庭教育等方面不可避免地会遇到大量的问题和冲突,这也大大增加了他们惠上网络成瘾的可能性。青少年一旦成为网络成瘾者,他们的正常社会化进程将受到严重影响,具体表现在社会权威的树立、社会角色的形成、社会交往的模式三个方面。     

Concurrent detection of heroin, fentanyl, and xylazine in seven drug-related deaths reported from the Philadelphia Medical Examiner's Office

Recreational drugs, such as cocaine and heroin, are often adulterated with other pharmacological agents to either enhance or diminish the drug effects. Between April 21, 2006 and August 8, 2006, the Philadelphia Medical Examiner's Office detected xylazine (a veterinary sedative) and fentanyl (a synthetic opioid) in specimens taken from seven cases. Initial immunoassay screening was performed on urine and blood for fentanyl, opiate, cocaine, phencyclidine (PCP), and benzodiazepines. All tests reported positive were confirmed by gas chromatography-mass spectrometry. All seven xylazine positive cases tested positive for fentanyl and six cases tested positive for 6-acetylmorphine (a metabolite and definitive marker for heroin). The seventh case was positive for morphine and had a history of heroin abuse. Xylazine was present in urine in all seven cases and blood levels were detected in three cases. The blood concentrations ranged from trace to 130 ng/mL. Fentanyl was present in the blood and urine in each case and blood concentrations ranged from 4.7 to 47 ng/mL. Adulteration of illicit drugs has become an epidemic health concern for drug users. Healthcare professionals need to be aware of this issue, so the patients can be treated in an effective, timely manner.     

Trends in Substance Use by Gender Among Participants in a Jail-Based Substance Use Disorder Treatment Program: 1998–2016

Understanding trends in substance use by gender among jail-based treatment program participants can inform policies and programs tailored to this population. Preprogram assessment data from 3509 individuals entering a jail-based substance use disorder treatment program in Missouri between 1998 and 2016 were analyzed. Primary outcome was program participants’ strongly preferred substances. Demographic covariates and drug preferences were compared between males and females. Average yearly trends in preferred substances were calculated. While 25.8% of the sample preferred heroin, it was more strongly preferred by women (36.4%) than men (22.0%, p < 0.0001). Alcohol and marijuana were preferred more by males. Overall, preferences for heroin and methamphetamine increased over time while alcohol, marijuana, and other stimulants decreased. Women being more likely to prefer heroin and the increasing preference for heroin over time are consistent with national trends. Offering evidence-based treatment like pharmacotherapy and gender-sensitive approaches can help address the needs of this vulnerable population.     

Postmortem Liver and Kidney Tissue Concentrations of Heroin Biomarkers and Their Metabolites in Heroin-Related Fatalities*†

A method was developed and validated for analyzing 6-monoacetylmorphine, morphine, 6-acetylcodeine, and codeine in routine postmortem liver and kidney specimens using liquid chromatography–tandem mass spectrometry. Samples were prepared with a Stomacher instrument followed by solid-phase extraction. All calibration curves [0.5–1000 ng/g] were linear with coefficients of determination greater than 0.99 and limits of quantification of 1.0 ng/g. Within-run precision ranged between 2.0% and 8.0%, between-run precision ranged between 1.0% and 9.0%, and accuracy ranged between −5.0% and +3.0%. Matrix effects ranged from −18% to +9%. After matrix effects were excluded, analytical recoveries ranged from 76% to 94%. The distributions of 6-monoacetylmorphine, morphine, 6-acetylcodeine, and codeine were investigated in 31 postmortem cases in which heroin was the primary cause of death. In the current study, the median free morphine ratios were calculated for liver to blood and kidney to blood, which were 2.2 and 4.0, respectively. The current report highlights the importance of testing multiple specimens, including liver and kidney, in heroin-related deaths, especially if no blood samples are available. Furthermore, this work presents new information regarding the distribution of heroin metabolites in liver and kidney.     

Spirit and being: interdisciplinary reflections on drugs across history and politics

Abstract

Few commodities are as global as drugs. Cannabis, opium, heroin, amphetamines, lysergic acid diethylamide (LSD), khat, psychedelic cacti and mushrooms as well as an interminable list of other natural or synthesised substances travel and are consumed around the globe for all possible reasons. Human migration, trade, cultural trends, medical practice, political repression: together they constitute the drug phenomenon today – and indeed in much of human history. In this, drugs are spirit-like commodities, their value resting upon a fundamental ambiguity made up of individual, psychological, social, cultural, economic and medical circumstances. Defining a drug is an attempt at defining a spirit on the edge, which metamorphoses in time and space. At the same time, drugs remain a fundamentally political object. They are substances controlled by states, through mechanisms of policing, legitimated by judicial and medical evaluation, condemned often on moral grounds. Situated between a fluid social existence and a static legal dimension, drugs can become inspiring hermeneutic objects of study.