Extremely low-frequency electromagnetic field exposure during chronic morphine treatment strengthens downregulation of dopamine D2 receptors in rat dorsal hippocampus after morphine withdrawal

The aim of this study was to investigate the effect of extremely low-frequency electromagnetic field (ELF-EMF) exposure during morphine treatment on dopamine D2 receptor (D2R) density in the rat dorsal hippocampus following withdrawal. Rats were exposed t

Effects of addiction-associated and affective stimuli on the attentional blink in a sample of abstinent opiate dependent patients

The attentional blink reveals the limits of the brain's ability in information processing. It has been extensively studied in people with neurological and psychiatric disturbances to explore the temporal characteristics of information processing and exami

Chronic morphine selectively impairs cued fear extinction in rats: Implications for anxiety disorders associated with opiate use

Previous studies have shown that opioid transmission plays an important role in learning and memory. However, little is known about the course of opiate-associated learning and memory deficits after cessation of chronic opiate use in a behavioral animal m

Morphine withdrawal modifies antinociceptive effects of acute morphine in rats

Repeated opioid use is known to cause tolerance of antinociceptive effects. Whether opioid abstinence modifies antinociceptive effects is unknown. Here we reported that morphine withdrawal for 18 h and 4 days after repeated morphine treatment largely redu

Morphine withdrawal affects both delayed-escape behaviour in Morris water maze and hippocampal NR2A/2B expression ratio

Repeated low-dose morphine treatment facilitates delayed-escape behaviour of hippocampus-dependent Morris water maze and morphine withdrawal influences hippocampal NMDA receptor-dependent synaptic plasticity. Here, we examined whether and how morphine wit

Opioid Withdrawal for 4 Days Prevents Synaptic Depression Induced by Low Dose of Morphine or Naloxone in Rat Hippocampal CA1 Area In Vivo

The formation of memory is believed to depend on experience- or activity-dependent synaptic plasticity, which is exquisitely sensitive to psychological stress since inescapable stress impairs long-term potentiation (LTP) but facilitates long-term depression (LTD). Our recent studies demonstrated that 4 days of opioid withdrawal enables maximal extents of both hippocampal LTP and drug-reinforced behavior; while elevated-platform stress enables these phenomena at 18 h of opioid withdrawal. Here, we examined the effects of low dose of morphine (0.5 mg kg(-1), i.p.) or the opioid receptor antagonist naloxone (1 mg kg(-1), i.p.) on synaptic efficacy in the hippocampal CA1 region of anesthetized rats. A form of synaptic depression was induced by low dose of morphine or naloxone in rats after 18 h but not 4 days of opioid withdrawal. This synaptic depression was dependent on both N-methyl-D-aspartate receptor and synaptic activity, similar to the hippocampal long-term depression induced by low frequency stimulation. Elevated-platform stress given 2 h before experiment prevented the synaptic depression at 18 h of opioid withdrawal; in contrast, the glucocorticoid receptor (GR) antagonist RU38486 treatment (20 mg kg(-1), s.c., twice per day for first 3 days of withdrawal), or a high dose of morphine reexposure (15 mg kg(-1), s.c., 12 h before experiment), enabled the synaptic depression on 4 days of opioid withdrawal. This temporal shift of synaptic depression by stress or GR blockade supplements our previous findings of potentially correlated temporal shifts of LTP induction and drug-reinforced behavior during opioid withdrawal. Our results therefore support the idea that stress experience during opioid withdrawal may modify hippocampal synaptic plasticity and play important roles in drug-associated memory. (C) 2009 Wiley-Liss, Inc.

Blocking central opiate function modulates hedonic impact and anterior cingulate response to rewards and losses.

Reward processing is linked to specific neuromodulatory systems with a dopaminergic contribution to reward learning and motivational drive being well established. Neuromodulatory influences on hedonic responses to actual receipt of reward, or punishment, referred to as experienced utility are less well characterized, although a link to the endogenous opioid system is suggested. Here, in a combined functional magnetic resonance imaging-psychopharmacological investigation, we used naloxone to block central opioid function while subjects performed a gambling task associated with rewards and losses of different magnitudes, in which the mean expected value was always zero. A graded influence of naloxone on reward outcome was evident in an attenuation of pleasure ratings for larger reward outcomes, an effect mirrored in attenuation of brain activity to increasing reward magnitude in rostral anterior cingulate cortex. A more striking effect was seen for losses such that under naloxone all levels of negative outcome were rated as more unpleasant. This hedonic effect was associated with enhanced activity in anterior insula and caudal anterior cingulate cortex, areas implicated in aversive processing. Our data indicate that a central opioid system contributes to both reward and loss processing in humans and directly modulates the hedonic experience of outcomes.

吗啡给药及戒断期间大鼠眶额叶脑区功能活动特征户外环境下自由活动猕猴顶叶及海马神经元单位放电的胞外记录方法

已有的研究表明，眶额叶在解剖上与现在已知的药物滥用相关的脑区是紧密联系在一起的。例如，眶额叶在药物滥用和强迫性重复行为中起作用，且随着脑成像技术的应用，越来越多的证据表明眶额叶参与了药物滥用。但是我们并不了解在阿片给药和戒断期间眶额叶脑区活动是如何变化的。因此，我们在实验中采用了Mn2+增强的核磁共振成像（Manganese-enhanced magnetic resonance　imaging，MEMRI，4.7T）技术和脑电（EEG）记录的方法，以研究大鼠眶额叶在给与阿片类药物（盐酸吗啡）以及戒断过程中的动态变化。 MEMRI是一种近年才发展起来的新型技术。研究表明，Mn2+是Ca2+的类似物，可以通过Ca2+通道进入兴奋性的神经元里面并结合到胞内的蛋白质和核酸上的Ca2+和Mg2+结合位点上 (MILDVAN and COHN, 1963; EISINGER et al., 1965)。另外，Mn2+的顺磁性也为它成为核磁共振成像的造影剂提供了前提条件。可是成功应用MEMRI的前提就是要在适当的时间把合适剂量的Mn2+传递到靶点上。因此，Mn2+在注射到靶点后，是否能够在有效的时间内反映大脑活动的变化就成为一个非常重要并且在技术上较为棘手的问题。在给实验大鼠脑区微量注射Mn2+（80mMol/L，200nl）的同时，通过微量注射兴奋性神经递质谷氨酸（Glu 0.5mM/L）或抑制性递质γ-aminobutyric acid（GABA 0.5M/L）以改变靶点神经元兴奋性的方法，检测Mn2+能否反映脑区的活动变化。另外，我们随机选取实验动物，分别在注射Mn2+ 3小时、5小时和8小时后对三组大鼠（n=5）进行10％福尔马林灌流，并且通过观察大鼠眶额叶脑区Mn2+强度的变化来研究最佳的灌流时间。我们的实验结果表明，Mn2++Glu组的右侧脑区/左侧脑区的Mn2+亮度比Mn2+空白对照组增加了20％（p=0.016, student t-test, *p <0.05），也远大于Mn2++GABA组（p=0.047, *p<0.05）。结果表明，当神经元被兴奋的时候，较多的Mn2+可以通过Ca2+通道进入兴奋的神经元内，使得Mn2+的成像亮度增加。由于Mn2+成像亮度的增加可以反映神经元的兴奋活动，因此可以显示出靶点区的脑活动。另外，在研究灌流时间对Mn2+亮度影响的实验中发现，注射Mn2+ 5小时后灌流得到的信噪比分别比注射Mn2+3小时（p＝0.055）和8小时（p=0.004，*p<0.05）高出24％和32％。总之，我们采用微量注射Mn2+（80mM/L,200nl）后5小时用10%福尔马林心脏灌流的方法获得了较好的结果。另外在试验中我们首先观测了大鼠吗啡戒断后的行为学指标和检测大鼠戒断后条件化位置偏好的程度。实验结果表明大鼠可以建立非常明显的条件化位置偏好，但在湿狗抖等行为学指标上无明显症状。这说明大鼠对于吗啡(10mg/kg, 一天两次，持续12天)形成了明显的心理依赖而无明显的生理依赖。此外，MEMRI的结果表明，在吗啡给药的第1天和第6天，大鼠眶额叶的Mn2+强度与空白对照组相比有显著的降低( one-way ANOVA, Post Hoc Dunnett’s C Tests), F (6,28)=7.242, P<0.001)；而在戒断第3天又恢复到正常水平，在戒断第5天和第7天Mn2+强度跟空白对照组相比没有显著性差别(one-way ANOVA, *p<0.05)。脑电（EEG）的结果表明，急性吗啡诱导的gamma波段的EEG显著降低(Two-way ANOVA, F(1,10)=13.626,p=0.006)。然而在戒断第1天gamma波段的EEG与空白对照组相比是增加的。在戒断第3天和戒断第5天，gamma波段的EEG与空白对照组相比也有显著性增强。以上研究结果表明：大鼠眶额叶脑区的动态变化与整个吗啡给药和戒断过程是密切相关的；此外，MEMRI在探讨药物滥用以及成瘾等机制上有很大的应用前景。

Bacteremic pneumonia before and after withdrawal of 13-valent pneumococcal conjugate vaccine from a public vaccination program in Spain: a case-control study

The objective of this study is to compare the incidence and epidemiology of bacteremic community-acquired pneumonia (CAP) in the setting of changes in 13-valent pneumococcal conjugate vaccine (PCV13) coverage. In the region of Madrid, universal immunization with the PCV13 started in May 2010. In July 2012, public funding ceased. Vaccination coverage decreased from >95% to 82% in 2013 and to 67% in 2014. We performed a multicenter surveillance and case-control study from 2009-2014. Cases were hospitalized children with bacteremic CAP. Controls were children selected 1:1 from next-admitted with negative blood cultures and typical, presumed bacterial CAP. Annual incidence of bacteremic CAP declined from 7.9/100 000 children (95% CI 5.1-11.1) in 2009 to 2.1/100 000 children (95% CI 1.1-4.1) in 2012. In 2014, 2 years after PCV13 was withdrawn from the universal vaccination program, the incidence of bacteremic CAP increased to 5.4/100 000 children (95% CI 3.5-8.4). We enrolled 113 cases and 113 controls. Streptococcus pneumoniae caused most of bloodstream infections (78%). Empyema was associated with bacteremia (P = .003, OR 3.6; 95% CI 1.4-8.9). Simple parapneumonic effusion was not associated with bacteremia. Incomplete PCV immunization was not a risk factor for bacteremic pneumonia.

Multicenter Randomized Controlled Trial of Withdrawal of Inhaled Corticosteroids in Cystic Fibrosis

Rationale: Lung inflammation and injury is critical in cystic fibrosis. An ideal antiinflammatory agent has not been identified but inhaled corticosteroids are widely used despite lack of evidence.

Objectives: To test the safety of withdrawal of inhaled corticosteroids with the hypothesis this would not be associated with an earlier onset of acute chest exacerbations.

Methods: Multicenter randomized double-blind placebo-controlled trial in 18 pediatric and adult UK centers. Eligibility criteria included age > 6.0 yr, FEV1 ? 40% predicted, and corticosteroid use > 3 mo. During the 2-mo run-in period, all patients received fluticasone; they then took either fluticasone or placebo for 6 mo.

Measurements and Main Results: Fluticasone group: n = 84, median age 14.6 yr, mean (SD) FEV1 76% (18); placebo group: n = 87, median age 15.8 yr, mean (SD) FEV1 76% (18). There was no difference in time to first exacerbation (primary outcome) with hazard ratio (95% confidence interval) of 1.07 (0.68 to 1.70) for fluticasone versus placebo. There was no effect of age, atopy, corticosteroid dose, FEV1, or Pseudomonas aeruginosa status. There was no change in lung function or differences in antibiotic or rescue bronchodilator use. Fewer patients in the fluticasone group withdrew from the study due to lung-related adverse events (9 vs. 15%); with a relative risk (95% confidence interval) of 0.59 (0.23–1.48) fluticasone versus placebo.

Conclusions: In this study population (applicable to 40% of patients with cystic fibrosis in the UK), it appears safe to consider stopping inhaled corticosteroids. Potential advantages will be to reduce the drug burden on patients, reduce adverse effects, and make financial savings.