Heroin abuse accelerates biological aging: a novel insight from telomerase and brain imaging interaction.

Heroin abuse and natural aging exert common influences on immunological cell functioning. This observation led to a recent and untested idea that aging may be accelerated in abusers of heroin. We examined this claim by testing whether heroin use is associated with premature aging at both cellular and brain system levels. A group of abstinent heroin users (n=33) and matched healthy controls (n=30) were recruited and measured on various biological indicators of aging. These measures included peripheral blood telomerase activity, which reflects cellular aging, and both structural and functional measures of brain magnetic resonance imaging. We found that heroin users were characterized by significantly low telomerase activity (0.21 vs 1.78; 88% reduction; t(61)=6.96, P<0.001; 95% confidence interval=1.12-2.02), which interacted with heroin use to affect the structural integrity of gray and white matter of the prefrontal cortex (PFC; AlphaSim corrected P<0.05), a key brain region implicated in aging. Using the PFC location identified from the structural analyses as a 'seed' region, it was further revealed that telomerase activity interacted with heroin use to impact age-sensitive brain functional networks (AlphaSim corrected P<0.05), which correlated with behavioral performance on executive functioning, memory and attentional control (Pearson correlation, all P<0.05). To our knowledge, this study is the first to attempt a direct integration of peripheral molecular, brain system and behavioral measures in the context of substance abuse. The present finding that heroin abuse is associated with accelerated aging at both cellular and brain system levels is novel and forms a unique contribution to our knowledge in how the biological processes of drug abusers may be disrupted.

Effects of voluntary running on plasma levels of neurotrophins, hippocampal cell proliferation and learning and memory in stressed rats.

Previous studies have shown that a 2-week treatment with 40 mg/kg corticosterone (CORT) in rats suppresses hippocampal neurogenesis and decreases hippocampal brain-derived neurotrophic factor (BDNF) levels and impairs spatial learning, all of which could be counteracted by voluntary wheel running. BDNF and insulin-like growth factor (IGF-1) have been suggested to mediate physical exercise-enhanced hippocampal neurogenesis and cognition. Here we examined whether such running-elicited benefits were accompanied by corresponding changes of peripheral BDNF and IGF-1 levels in a rat model of stress. We examined the effects of acute (5 days) and chronic (4 weeks) treatment with CORT and/or wheel running on (1) hippocampal cell proliferation, (2) spatial learning and memory and (3) plasma levels of BDNF and IGF-1. Acute CORT treatment improved spatial learning without altered cell proliferation compared to vehicle treatment. Acute CORT-treated non-runners showed an increased trend in plasma BDNF levels together with a significant increase in hippocampal BDNF levels. Acute running showed no effect on cognition, cell proliferation and peripheral BDNF and IGF-1 levels. Conversely, chronic CORT treatment in non-runners significantly impaired spatial learning and suppressed cell proliferation in association with a decreased trend in plasma BDNF level and a significant increase in hippocampal BDNF levels. Running counteracted cognitive deficit and restored hippocampal cell proliferation following chronic CORT treatment; but without corresponding changes in plasma BDNF and IGF-1 levels. The results suggest that the beneficial effects of acute stress on cognitive improvement may be mediated by BDNF-enhanced synaptic plasticity that is hippocampal cell proliferation-independent, whereas chronic stress may impair cognition by decreasing hippocampal cell proliferation and BDNF levels. Furthermore, the results indicate a trend in changes of plasma BDNF levels associated with a significant alteration in hippocampal levels, suggesting that treatment with running/CORT for 4 weeks may induce a change in central levels of hippocampal BDNF level, which may not lead to a significant change in peripheral levels.

Does the stress in childhood and adolescence matter? A psychological perspective.

Although stress in adults is well researched and acknowledged, little has been discussed on the existence and reactions of children and adolescents to stress, despite the mounting evidence that they are frequently among the most affected victims of a variety of threatening events. In reality stress is a normal part of a child's or adolescent's life and encompasses common, developmental stressors of daily life and those arising from unusual or traumatic experiences. Apart from more well known stress from family instability, poverty and life transitions, it is easy to forget or ignore the many school pressures and increasingly common social phenomenon of the 'hurried child' in modern life. We can make plans of intervention and prevention only when the condition is recognised by the health care professionals.

Evaluation of two automatic sphygmomanometers in Hong Kong: implications for the future development of automated blood pressure monitors in clinical practice.

The application of automated devices in measuring patients' blood pressure has been widely adopted in nursing practice. This study compared blood pressure recordings of two automated blood pressure monitors which were commonly used in clinical settings in Hong Kong. Single-arm recordings were obtained from 31 subjects with both devices. Ten blood pressure recordings were obtained for each subject, with half of the subjects taking five measurements from one device first and five measurements from the other device second, and vice versa. A total of 155 sets of measurements were available for analysis. The results indicated that there was no significant difference in the variation of systolic, diastolic, mean arterial pressure and heart rate between these two devices. Implications for future research and development of an improved automated blood pressure device are made.

Psychological ill-health in Chinese communities in Hong Kong.

Psychiatric symptoms are widely distributed in the general population while psychiatric impairment or psychological ill-health is prevalent in many communities, especially those with stressful environments. Data concerning Chinese communities are scanty. The present study employed the use of a General Health Questionnaire to screen the general population for psychological ill-health in Hong Kong and the results showed that between 18.3% and 26.3% of Chinese could be considered as probable or potential candidates for mental illness. The authors discuss the significance of these findings.

Isolation of digoxin-like immunoreactive factors from mammalian adrenal cortex.

Endogenous digoxin-like immunoreactive factors (DLIF) are present in serum and tissues of humans and animals. To date, a tissue source for these factors has not been rigorously defined nor have these factors been isolated to identifiable homogeneity. In this study, we define the distribution of DLIF in mammalian tissues, demonstrate the adrenal cortex to be the principal source of this factor in bovine, and isolate DLIF to chromatographic homogeneity using high performance liquid chromatography (HPLC). DLIF concentrations in tissue extracts from rats measured as follows: adrenal glands, 44.3; serum, 6.3; liver, 5.2; kidney, 1.2; heart, brain, or lungs, less than 1.4 ng of digoxin-equivalent per g of protein. Human tissues showed similar results. In dogs, the ratio of the DLIF concentration in lumbar vein serum to that in infrarenal inferior vena cava serum was 3.3 +/- 0.4 (mean +/- S.E., n = 4). Bovine adrenal cortex contained 7 times more DLIF per g of tissue than the adrenal medulla. 70 +/- 4% (n = 7) of the total bovine cortical DLIF activity (6,159 pg of digoxin-equivalent) applied to a reverse phase HPLC column eluted as one definitive fraction. 60% of the digoxin-like immunoreactivity extracted from bovine serum also co-eluted with DLIF from adrenal. None of the 14 steroid molecules or 7 cardiac glycoside congeners co-eluted with the major DLIF activity. Our data indicate that 947 pmol of DLIF is equivalent to 1 pmol of digoxin-equivalent immunoreactivity. Preliminary mass spectral analysis suggests that purified DLIF has a molecular mass of 780 daltons comprised of one 390-dalton aglycone component plus several sugar moieties. This study establishes a definitive link between DLIF in serum and the adrenal cortex as a source tissue. We also demonstrate a method for purifying DLIF to chromatographic homogeneity with an extraction capacity of 1.2 nmol of DLIF per g of adrenal cortex.

Pyroglutamic acidemia in an adult patient.

Pyroglutamic acidemia, a rare metabolic disorder, usually appears in infancy. It is characterized by retardation, ataxia, hemolytic anemia, and chronic acidosis and is caused by a marked deficiency of glutathione synthetase (EC 6.3.2.3) activity. This disease is inherited as an autosomal recessive trait, but the clinical condition is also detected in heterozygotes. We report an unusual case of high-anion-gap metabolic acidosis in a 52-year-old woman who was admitted with neurological complaints and breathing problems but without the characteristic clinical features of congenital glutathione synthetase deficiency. The etiology of the acidosis could not be attributed to ketoacidosis, lactic acidosis, or ingestion of methanol, salicylate, or ethylene glycol. Analysis of the patient's plasma and urine for organic acids revealed the presence of high concentrations of pyroglutamate (5-oxoproline), which remained high throughout her hospitalization.

Reassurance does not always help.

Reassurance is the most commonly misused form of supportive intervention in medical practice. It is superficial in activity and transient in its effects. It does not appear to be a very powerful therapeutic technique. To be effective, it should be realistic, sincere, given at the right time, directed at the appropriate target, based on sound grounds, and provided by a proper authority. It must always be given judiciously.

Criteria for identifying endogenous compounds as digoxin-like immunoreactive factors in humans.

Endogenous digoxin-like immunoreactive factors (DLIF) are factors in plasma that interact with anti-digoxin antibodies. In this report we propose specific empirical criteria that must be satisfied by any group of endogenous compounds purported to account for DLIF activity in human plasma. These criteria include immunoreactive potency relative to existing physiologic concentrations as well as the biochemical and protein binding properties of these compounds. Recent studies have identified several congeners of fatty acids and phospholipids, hydrocortisone, and dehydroepiandrosterone-sulfate as compounds likely to account for DLIF activity in plasma. Using the above criteria we demonstrate that the highest reported plasma concentrations of these compounds combined account for less than 25% of DLIF reported in healthy adult subjects, less than 11% in newborns, less than 27% in pregnant women, and less than 39% in patients with renal failure. Human serum albumin at a concentration of 40 g/l completely abolished any detectable interaction of these compounds with both anti-digoxin antibodies or canine kidney Na/K-ATPase. The immunoreactive and physical properties of these compounds are also not consistent with those reported for DLIF. We conclude that these compounds do not account for the plasma DLIF concentrations measured in human subjects nor are they likely to play a role as specific endogenous regulators of Na/K-ATPase.

Endogenous digoxin-like immunoreactivity in elderly patients with normal serum creatinine concentrations.

The effect of digoxin-like immunoreactive substance (DLIS) on serum digoxin determinations in elderly patients with normal serum creatinine concentrations was studied. Patients in the study group were over 70 years of age; the control population was under 55 years of age. All patients had serum creatinine concentrations of less than or equal to 1.5 mg/dL. Apparent digoxin content of serum samples from patients receiving digoxin and from patients in each age group who were not receiving digoxin was determined in duplicate by each of two radioimmunoassays: RIANEN (New England Nuclear), which detects DLIS, and Immophase (Corning Medical and Scientific), which is far less cross-reactive with DLIS. Results from the patients under 55 years of age were analyzed for inherent bias between the assay methods. In patients over 70 years of age, concentrations of DLIS (differences between serum digoxin concentrations measured by RIANEN and Immophase) were compared with creatinine clearance values. No DLIS was detected in sera of patients who had not received digoxin. For patients who received digoxin, nearly all apparent digoxin concentrations were within the usual therapeutic range. For patients without liver or renal failure who received digoxin, no significant difference in digoxin concentrations was observed between the RIANEN and Immophase assays in either the young (n = 17) or elderly (n = 26) patients. There was no significant increase in the difference between the RIANEN and Immophase results with decreasing creatinine clearance. In the elderly patients with normal serum creatinine concentrations, there was no evidence that measurement of serum digoxin concentration using the RIANEN and Immophase assays was compromised by DLIS.

Endogenous digoxin-like immunoreactivity in blood is increased during prolonged strenuous exercise.

Digoxin-like immunoreactive factors (DLIFs) in serum may represent endogenous cardiotropic agents. We determined if blood levels of these endogenous factors changed during prolonged strenuous exercise. Total and loosely protein-bound (LPB) DLIF were measured by radioimmunoassay in the serum of nine healthy subjects during prolonged exercise to exhaustion. Mean total and LPB serum levels of DLIF increased by 72% (580 to 945 pg/mL) and 63% (53 to 91 pg/mL) over baseline values in digoxin equivalents (p less than 0.01), respectively, after three hours of exercise at 70% of VO2max. The prevalent serum nonesterified fatty acids (arachidonic, linoleic, oleic, palmitic, and stearic acids) as well as hydrocortisone did not account for the observed elevations in DLIF. Percent left ventricular fractional shortening (%FS) and mean velocity of left ventricular circumferential fiber shortening (mVCF) measured echocardiographically were lower (-18.0% and -16.4%, respectively, p less than 0.05) after exercise as compared to prior to exercise. Cardiac left ventricular dysfunction as measured by %FS did correlate with blood levels of DLIF (r = -0.680, p less than 0.02). These observations may suggest a relationship between serum levels of DLIF and cardiac fatigue.

The theophylline method of the Abbott "Vision" analyzer evaluated.

We evaluated the analytical performance of the Abbott "Vision" analyzer for theophylline measurement. The within-day precision (CV) was 1.8% and 3.1% at theophylline concentrations of 15.2 and 25.2 mg/L, respectively; between-day precision was 3.5% and 4.8% at 14.9 and 24.4 mg/L, respectively. Bilirubin (143 mg/L) and triglyceride (7.4 g/L) did not interfere, but hemoglobin caused lower values for apparent theophylline, the magnitude of the decrease being proportional to the hemoglobin concentration. At the cutoff concentration of 1 g/L programmed into the instrument by the manufacturer, hemoglobin reduced the theophylline value by less than 10%. Results by the Vision method (y) compared well with those by the "TDX" procedure (x): r = 0.98, y = 0.978x - 0.270 mg/L. The Vision method gave comparable theophylline values for serum, plasma, and whole-blood samples. We also validated analytically and clinically that capillary blood samples collected by finger stick can be used interchangeably with blood samples collected by venipuncture for monitoring theophylline therapy.

Efflux of adenine nucleotides in mitochondria from rat tumor cells of varying growth rates.

The efflux of adenine nucleotides was studied in mitochondria isolated from normal rat liver, host livers, and the tumors from four Morris hepatoma lines of varying growth rates. [3H]Adenosine diphosphate (ADP) or [3H]adenosine triphosphate (ATP) was preloaded to the energized mitochondria, and the initial rates of exchange with unlabeled extramitochondrial nucleotides were measured with the carboxyatractyloside stop method. Results indicate that the Vmax values of ATP efflux in mitochondria from fast and intermediately growing tumors (hepatoma cell lines 7777, 7800, and 5123D) are significantly smaller than that of host or normal liver mitochondria, while in slow growing tumor (line 16) the Vmax is not different. On the other hand, for ADP efflux, the opposite (namely, higher in tumor than in host) is observed in the mitochondria of fast growing tumors. Preincubation with the divalent cation ionophore A23187 and calcium chelator ethyleneglycolbis(beta-aminoethyl ether)-N,N'-tetraacetic acid increases the efflux of both ATP and ADP (to a lesser extent) in these tumor mitochondria, indicating that the extraordinarily high concentrations of calcium form complexes with adenine nucleotides (particularly ATP) and thus lower the effective concentrations of free nucleotides for translocation. Together with previously published results (R. L. Barbour and S. H. P. Chan, Cancer Res., 43: 1511-1517, 1983) on lower nucleotide uptake rates in these tumor mitochondria, we propose that the lower ATP efflux and higher ADP efflux rates may cause a futile cycle of ADP transport across the mitochondrial membrane which may contribute to high rates of aerobic glycolysis (by stimulating key glycolytic enzymes such as hexokinase and phosphofructokinase) observed in these fast and intermediately growing tumors.

Paths to psychiatric care in Hong Kong.

The pattern of psychiatric consultation in Hong Kong is examined among 226 patients at a public outpatient clinic and 56 patients at a private psychiatric clinic. The approach to psychiatric services is marked by lengthy delay during which patients get help from their family members or close friends. Arrival at the present psychiatric clinic was diverted through other medical resources, primarily Western-style medical services, and to some extent, traditional Chinese medicine. Individual routes were diverse, characterized by frequent switches among resources especially in the private sector. The nature of the patients' presenting complaints as well as the conceptualization of their initial complaints were multi-faceted, including both psychological and somatic factors. The overall consultation pattern of patients in Hong Kong is compared with other studies on Chinese and Western patients. Questions are raised for further analysis.