Laser Printer Particles, More Dangerous than Cigarette

Smokers have been banished from the office - but another threat, potentially as dangerous, may still be lurking by the water cooler.
It is the laser printer, says Lidia Morawska, a Queensland University of Technology professor.
A study led by the physics professor found many laser printers emit clouds of ultra-fine particles that she compared with cigarette smoke and motor vehicle emissions. "They are so small you can't see them."
Although her team has yet to analyse their chemistry, she warned that such small particles "can get deep into the lungs", leading to respiratory and cardiovascular problems. Some particles were potential carcinogens.
Professor Morawska said that of about 40 models of laser printers her team had tested, 13 were "high emitters" of particles from the toner. All were relatively new. Office photocopiers failed to produce similar particles.
The emissions were detected when the researchers, undertaking a joint project with the Queensland Department of Public Works, began studying the efficiency of office air ventilation and filtration systems.
They discovered concentrations of microscopic particles five times higher than outdoor levels often produced by traffic.
Using an electronic sniffer they traced the emissions to the office laser printers. "Concentrations were considerably higher than outdoors by a busy road. We didn't expect the emissions could be so high."
Concerned by the discovery, staff in her university office checked their own printers, and those found to be high emitters were relocated away from people.
She now wants to conduct another study, looking at the chemistry of the particles, and called for rules to regulate emissions from office equipment.
"Governments regulate emission levels from outdoor devices, such as motor vehicles, power stations and factories, so why not printers?"
Bill Physick, a CSIRO atmospherics air quality scientist, said the danger created by ultra-fine particles only began to be appreciated in the 1990s.
"While large particles get trapped in the hairs of the nose or only go partially down into the respiratory system, ultra-fine particles are so small they can get to the very lowest reaches of the lungs," Dr Physick said.
"The current thinking is that it's other toxic chemicals, which adhere to the ultra-fine particles, that could be the source of the health problems."

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Obesity From Liver Defect

Scientists at the Monell Chemical Senses Center have identified a genetically-transmitted metabolic defect that can lead to obesity in some individuals. The defect involves decreased production of liver enzymes needed to burn fat and may help to explain why some people become obese while others remain thin.

The global obesity epidemic is believed to be caused in part by the increased availability and intake of high calorie foods rich in fat and carbohydrates. These foods promote weight gain in humans and other animals, leading to a diet-induced obesity. The propensity to gain weight and become obese when consuming a high-fat diet is at least partially controlled by genes.

Results of this study help explain the interaction between genes and diet that underlies diet-induced obesity, comments senior author Mark Friedman. They also point to a way to identify individuals at risk for dietary obesity, perhaps even during childhood before the development of unhealthy eating habits.

The current study, reported in the recent issue of Metabolism, demonstrates that genetic susceptibility to diet-induced obesity is due to a reduced capacity to burn fat.

Fat is one of the fuels that the bodys cells burn to provide energy. This process, known as fat oxidation, takes place inside mitochondria, the cells power plants for generating energy.

If the ability to oxidize fat is impaired, the bodys capacity to make energy is reduced. This leads to increased hunger and overeating, as the body tries to increase the amount of energy available to meet its needs.

When the diet is low in fat, a reduced ability to burn fat has relatively little impact on energy production. However, if fat oxidation is impaired and the diet is high in fat, a greater proportion of calories cannot be used and food intake increases to cover the energy deficit. Because fat fuels are stored in fat tissue when theyre not oxidized, the increased food intake causes weight gain.

To determine whether preexisting differences in fat oxidation might contribute to individual susceptibility to diet-induced obesity, Friedman and lead author Hong Ji used rats that differ in their genetic predisposition to gain weight and become obese when fed a high-fat diet.

The closely-related strains weigh the same and eat the same amount of calories when fed a low-fat diet. However, when switched to a high-fat diet, the strain that is obesity-prone overeats and becomes obese, while the obesity-resistant strain does not.

The scientists observed that even when eating a low-fat diet and still lean, the obesity-prone rats were less able to burn fat than were the obesity-resistant rats. This intrinsic deficit in fat oxidation was linked to a decrease in the capacity to make two liver enzymes. One, CD36, is responsible for transferring fat fuels into liver cells, while the second enzyme, acyl-coenzyme A dehydrogenase, begins the oxidation process in mitochondria.

When fed a high-fat diet, the obesity-prone rats overate and became obese, gaining 36% more weight than resistant animals. Fat oxidation was further compromised due to a decreased ability to make CPT1A, the liver enzyme responsible for transporting fat into mitochondria.

The inherited propensity to gain weight when eating a high-fat diet appears to be due to a preexisting limit on the ability to burn fat in the liver. This defect persists during the development of obesity and is then further compounded by additional deficits in the fat oxidizing machinery, comments Friedman.

Other studies in Friedmans laboratory have demonstrated that a decrease in fat oxidation and energy production in the liver generates a signal that stimulates eating. Experiments in his and other laboratories have also observed that therapys that increase fat oxidation reduce food intake and cause weight loss in obese rodents.

With this in mind, Friedman notes, The present findings point to fat oxidation in the liver as a target for the development of drugs that suppress appetite and promote weight loss in obese individuals.

Future studies will guide development of such interventions by examining more closely the function and activity of the target enzymes.

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Changing Your Lifestyle to Manage Menopause Efficiently


The following lifestyle changes may help reduce bothersome symptoms and decrease health risks associated with menopause:

Increase Your Intake of Phytoestrogens

A high intake of phytoestrogens (isoflavones and lignans) may help reduce your menopausal symptoms. They may also reduce your risk for diseases associated with estrogen loss. Phytoestrogens occur naturally in certain foods:

Isoflavones: soybeans, chickpeas, and legumes

Lignans: flaxseeds, whole grains, and some fruits and vegetables

It’s also been suggested that vitamin E, wild yams, and black cohosh may help relieve menopausal symptoms.

Eat a Healthful Diet

A healthful diet during menopause can improve your sense of well-being. It may also reduce the risk of heart disease, osteoporosis, and certain cancers. Your diet should be low in saturated fat and high in fruits, vegetables, and grains. An adequate intake of calcium (1200 to 1500 mg per day) can help lower your risk of osteoporosis. You can increase the calcium in your diet by eating more calcium-rich dairy foods (low-fat or nonfat preferred), leafy green vegetables, and calcium-fortified foods and juices. Vitamin D, found in sunlight and certain foods (fortified milk, liver and tuna), helps your body absorb calcium.

Limit Caffeine and Alcohol

Cutting back on caffeine and alcohol may reduce symptoms of anxiety and insomnia. It may also reduce the loss of calcium from your body and reduce your risk of other health problems.


Quit Smoking

Smoking is the number one preventable cause of premature death. Giving up smoking can reduce your risk of early menopause, heart disease, osteoporosis, and many types of cancer, including lung and cervical cancer. Many women quit smoking successfully, often after several attempts. Your health care provider may offer medication that can help, such as the antidepressant Zyban (bupropion) and other smoking cessation aids, such as nicotine patches and gums. Support groups and smoking cessation classes can also help. The most successful smoking cessation programs involve a combination of behavior modification techniques and drug therapy.

Exercise Regularly

Regular exercise is a great remedy for many symptoms of menopause. It helps promote better sleep, stimulates brain chemicals that can reduce negative feelings and depression, and may reduce hot flashes. Weight-bearing exercises such as walking, climbing stairs, and resistance exercises such as lifting weights help to strengthen your bones and decrease your risk of osteoporosis.

Manage Stress

During menopause you may be facing many stressors, such as raising children or having children leave home, caring for elderly parents, and juggling a number of responsibilities. You can reduce stress by taking care of your whole self. This means eating a healtful diet, getting plenty of sleep, exercising regularly, and having enough time for rest and recreation. A variety of relaxation techniques can also help you to cope more effectively with stress. Examples include meditation, deep breathing, progressive relaxation, yoga and biofeedback.

Stay Cool

If you are having hot flashes, try making a diary of when they happen and what seems to trigger them. This may help you find out what to avoid. Otherwise:

* When a hot flash starts, go somewhere that is cool.

* Sleeping in a cool room may keep hot flashes from waking you up during the night.

* Dress in layers that you can take off if you get warm.

* Use sheets and clothing that let your skin "breathe."

* Carry a small, battery operated fan in your briefcase or purse

* Try having a cold drink (water or juice) at the beginning of a hot flash.

* Avoid hot foods like soup or spicy foods

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Preventing Heat Exhaustion This Summer


Blue skies and brilliant sunshine lure exercisers outdoors like a Porsche attracts speeding tickets. Just throw on shorts and a T-shirt and go. But if you don't pay attention to your body's reaction to the heat and humidity, a heat-related injury can quickly put an end to your fun, and lead to more serious problems. Fortunately, heat-related illnesses are easy to prevent, and if caught early, simple to treat.

Robert Karch, Ed.D., director of the National Center for Health and Fitness at American University in Washington D.C., likens the body's cooling system to that of a car. As your car engine produces heat, coolant carries the heat to the radiator, where it dissipates into the surrounding environment. Without the coolant, the radiator can't do its job, the engine overheats and breaks down.

Your body works the same way as a car engine. When you exercise, your muscles (the engine) produce heat. Skin is your radiator, and water—in the form of sweat—is your coolant. Sweat carries the heat from your body's core to your skin, where it dissipates. If the system breaks down, you will overheat and eventually, break down.

Prevention

Long exposure to extreme heat or too much activity in the hot sun causes excessive sweating, which removes large quantities of salt and fluids from the body. When the amount of salt and fluids falls too far below normal, overheating can result.

The key to keeping yourself from becoming overheated is to keep your body well supplied with its coolant—water. That means drinking before and during exercise. "For about every thirty minutes of exercise, a person should drink about a cup of water or sports drink," advises Jane Corboy, MD, a family practitioner and marathoner in Houston, Texas. If you're exercising for less than 45 minutes, water is best, says Dr. Corboy. For longer sessions, your body will benefit from the sodium, chloride, sugars, and other ingredients found in sports drinks. Take water stops even if you don't feel thirsty—by the time thirst kicks in, you've already begun to dehydrate. Before you even feel thirsty, sweating can result in a loss of 2-3% of your body weight.

Certain medications—including many psychiatric drugs and blood pressure medications—affect your body's water balance. People who take them need to drink more than those who don't. Beverages that contain alcohol and caffeine have a paradoxic diuretic effect—even though you are consuming liquid, they actually cause your body to excrete extra fluids. Drinking beer, coffee, or caffeinated sodas can actually decrease your hydration level.

Athletes who exercise regularly should watch out for cumulative dehydration during hot weather. "Lose a little today, a little tomorrow, and a little the next day, and then you wonder why you're feeling lightheaded a week down the road," says Dr. Karch.

On hot days, choose clothing with heat control in mind. A well-ventilated cap will help you keep cool, but one made of dense fabric will actually cut down on your ability to dissipate heat. Light-weight, light-colored clothing will keep you coolest. Going shirtless is an option, but if you do, remember to put on sunscreen to avoid sun damage. According to Dr. Corboy, water, and alcohol-based sunscreens work best for athletes because they don't inhibit sweating.

On extremely hot and humid days, reduce the intensity of your workout and move it into an air-conditioned room.

Symptoms and Treatment

In addition to knowing how to prevent heat-related illnesses, you should also learn how to recognize and treat them. The three forms of heat illness are heat cramps, heat exhaustion, and heat stroke. These aren't really three separate conditions, just increasingly severe stages of overheating.

Heat cramps are basically muscle cramps. According to Dr. Corboy, they happen when dehydrated muscles clamp up in an attempt to hold onto the water they have left. They usually occur in the whichever muscles are being used most. A soccer player or sprinter, for example, would get them in his calf muscles.

Treatment of heat cramps is straightforward and self-administered. Stop the activity, go to a cool place if possible, and drink cool liquids. Gentle massage or firm pressure to the affected muscles will relieve the cramping. It's okay to resume the exercise when the cramps are gone.

If you're a victim of heat exhaustion, you will feel a little bit light-headed or dizzy and will probably develop heat cramps. You may also feel nauseous, a bit disoriented, and you will usually be sweating profusely. As heat exhaustion progresses, you will first look very flushed, and then become pale. "At the end of this stage the skin is cold to touch with goose bumps and shivering. Those are pretty serious signs," says Dr. Corboy.

Treatment of heat exhaustion is similar to treatment for heat cramps, but more aggressive. You should stop exercising immediately, move to a cool area, and drink cool (not iced) fluids. "At this point it's useful to have some cooling blankets or wet towels that have been soaked in ice to put on your skin to help cool off," says Dr. Corboy.

Heat stroke is the most serious of the heat conditions and is considered a medical emergency. People with heat stroke may have the symptoms of heat exhaustion. However, their skin is hot and dry—not cold— because the body loses its ability to sweat and cool itself. People with heat stroke also have an extremely rapid pulse and may be delirious or combative and even pass out. Their body temperature is usually over 104°F, as they have lost the ability to cool down.

If you suspect someone is suffering from heat stroke, call an ambulance immediately. Move the victim to a cool area and use ice, fans, and other methods to lower their body temperature while you wait for help to arrive.

It's important to remember that heat illnesses can strike suddenly and severely. "There are people who don't experience some of the earlier signs and they can very quickly become seriously ill with heat stroke," explains Dr. Corboy.

"The reality is that most people won't be affected by it [heat injuries], but the risk is present for everybody," adds Dr. Karch. So when you're enjoying the outdoors this summer, remember to pay attention to the temperature and keep your body's radiator topped off with water, because even a Porsche will overheat if its fluid level drops too low.

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Walk To Improve Your Health


These days, its easy for people to get confused about exercise -- how a number of minutes a day should they spend working out, for how long and at what exertion level" Conflicting facts and opinions abound, but one Mayo Clinic doctor says the bottom line is this: walking is good, whether the outcome measurement is blood pressure, diabetes, cardiovascular disease, joint problems or mental health.

Getting out there and taking a walk is what its all about, says James Levine, M.D., Ph.D., and a Mayo Clinic expert on obesity. You dont have to join a gym, you dont have to check your pulse. You just have to switch off the TV, get off the sofa and go for a walk.

The health benefit linked to walking is the subject of Dr. Levines editorial in the recent issue of Mayo Clinic Proceedings. Dr. Levines piece is entitled, Exercise: A Walk in the Park" and accompanies a Proceedings article that showcases the merits of walking as beneficial exercise.

The study, undertaken by physicians from the Shinshu University Graduate School of Medicine in Matsumoto, Japan, determined that high-intensity interval walking may protect against hypertension and decreased muscle strength among older people.

Over five months, the Japanese scientists studied 246 adults who engaged in either no walking or moderate to high-intensity walking. The group who engaged in high-intensity walking experienced the most significant improvement in their health, the scientists found.
In his editorial, Dr. Levine says the study lends credence to the notion that walking is a legitimate, worthy mode of exercise for all people. Dr. Levine says its a welcome message for his patients, who fight obesity and appreciate that a walk is one way to improve their health.
Unlike a health club membership or personal trainer, walking is there for everyone, Dr. Levine says. Walking doesnt cost you anything, you can do it barefoot and you can do it now, this minute.
Sitting is bad for cholesterol, its bad for your back and muscles, Dr. Levine says. Its such a terrible thing for our bodies to do and the less of it you do, the better. But activity is not easy. If it were easy, everyone would do it.

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Getting Addicted - How Does It Happen?


MICHAEL D. LEMONICK & ALICE PARK


I was driving up the Massachusetts Turnpike one evening last February when I knocked over a bottle of water. I grabbed for it, swerved inadvertently--and a few seconds later found myself blinking into the flashlight beam of a state trooper. "How much have you had to drink tonight, sir?" he demanded. Before I could help myself, I blurted out an answer that was surely a new one to him. "I haven't had a drink," I said indignantly, "since 1981."

It was both perfectly true and very pertinent to the trip I was making. By the time I reached my late 20s, I'd poured down as much alcohol as normal people consume in a lifetime and plenty of drugs--mostly pot--as well. I was, by any reasonable measure, an active alcoholic. Fortunately, with a lot of help, I was able to stop. And now I was on my way to McLean Hospital in Belmont, Mass., to have my brain scanned in a functional magnetic-resonance imager (fMRI). The idea was to see what the inside of my head looked like after more than a quarter-century on the wagon.

Back when I stopped drinking, such an experiment would have been unimaginable. At the time, the medical establishment had come to accept the idea that alcoholism was a disease rather than a moral failing; the American Medical Association (AMA) had said so in 1950. But while it had all the hallmarks of other diseases, including specific symptoms and a predictable course, leading to disability or even death, alcoholism was different. Its physical basis was a complete mystery--and since nobody forced alcoholics to drink, it was still seen, no matter what the AMA said, as somehow voluntary. Treatment consisted mostly of talk therapy, maybe some vitamins and usually a strong recommendation to join Alcoholics Anonymous. Although it's a totally nonprofessional organization, founded in 1935 by an ex-drunk and an active drinker, AA has managed to get millions of people off the bottle, using group support and a program of accumulated folk wisdom.

While AA is astonishingly effective for some people, it doesn't work for everyone; studies suggest it succeeds about 20% of the time, and other forms of treatment, including various types of behavioral therapy, do no better. The rate is much the same with drug addiction, which experts see as the same disorder triggered by a different chemical. "The sad part is that if you look at where addiction treatment was 10 years ago, it hasn't gotten much better," says Dr. Martin Paulus, a professor of psychiatry at the University of California at San Diego. "You have a better chance to do well after many types of cancer than you have of recovering from methamphetamine dependence."

That could all be about to change. During those same 10 years, researchers have made extraordinary progress in understanding the physical basis of addiction. They know now, for example, that the 20% success rate can shoot up to 40% if treatment is ongoing (very much the AA model, which is most effective when members continue to attend meetings long after their last drink). Armed with an array of increasingly sophisticated technology, including fMRIs and PET scans, investigators have begun to figure out exactly what goes wrong in the brain of an addict--which neurotransmitting chemicals are out of balance and what regions of the brain are affected. They are developing a more detailed understanding of how deeply and completely addiction can affect the brain, by hijacking memory-making processes and by exploiting emotions. Using that knowledge, they've begun to design new drugs that are showing promise in cutting off the craving that drives an addict irresistibly toward relapse--the greatest risk facing even the most dedicated abstainer.

"Addictions," says Joseph Frascella, director of the division of clinical neuroscience at the National Institute on Drug Abuse (NIDA), "are repetitive behaviors in the face of negative consequences, the desire to continue something you know is bad for you."

Addiction is such a harmful behavior, in fact, that evolution should have long ago weeded it out of the population: if it's hard to drive safely under the influence, imagine trying to run from a saber-toothed tiger or catch a squirrel for lunch. And yet, says Dr. Nora Volkow, director of NIDA and a pioneer in the use of imaging to understand addiction, "the use of drugs has been recorded since the beginning of civilization. Humans in my view will always want to experiment with things to make them feel good."

That's because drugs of abuse co-opt the very brain functions that allowed our distant ancestors to survive in a hostile world. Our minds are programmed to pay extra attention to what neurologists call salience--that is, special relevance. Threats, for example, are highly salient, which is why we instinctively try to get away from them. But so are food and sex because they help the individual and the species survive. Drugs of abuse capitalize on this ready-made programming. When exposed to drugs, our memory systems, reward circuits, decision-making skills and conditioning kick in--salience in overdrive--to create an all consuming pattern of uncontrollable craving. "Some people have a genetic predisposition to addiction," says Volkow. "But because it involves these basic brain functions, everyone will become an addict if sufficiently exposed to drugs or alcohol."

That can go for nonchemical addictions as well. Behaviors, from gambling to shopping to sex, may start out as habits but slide into addictions. Sometimes there might be a behavior-specific root of the problem. Volkow's research group, for example, has shown that pathologically obese people who are compulsive eaters exhibit hyperactivity in the areas of the brain that process food stimuli--including the mouth, lips and tongue. For them, activating these regions is like opening the floodgates to the pleasure center. Almost anything deeply enjoyable can turn into an addiction, though.

Of course, not everyone becomes an addict. That's because we have other, more analytical regions that can evaluate consequences and override mere pleasure seeking. Brain imaging is showing exactly how that happens. Paulus, for example, looked at methamphetamine addicts enrolled in a VA hospital's intensive four-week rehabilitation program. Those who were more likely to relapse in the first year after completing the program were also less able to complete tasks involving cognitive skills and less able to adjust to new rules quickly. This suggested that those patients might also be less adept at using analytical areas of the brain while performing decision-making tasks. Sure enough, brain scans showed that there were reduced levels of activation in the prefrontal cortex, where rational thought can override impulsive behavior. It's impossible to say if the drugs might have damaged these abilities in the relapsers--an effect rather than a cause of the chemical abuse--but the fact that the cognitive deficit existed in only some of the meth users suggests that there was something innate that was unique to them. To his surprise, Paulus found that 80% to 90% of the time, he could accurately predict who would relapse within a year simply by examining the scans.

Another area of focus for researchers involves the brain's reward system, powered largely by the neurotransmitter dopamine. Investigators are looking specifically at the family of dopamine receptors that populate nerve cells and bind to the compound. The hope is that if you can dampen the effect of the brain chemical that carries the pleasurable signal, you can loosen the drug's hold.

One particular group of dopamine receptors, for example, called D3, seems to multiply in the presence of cocaine, methamphetamine and nicotine, making it possible for more of the drug to enter and activate nerve cells. "Receptor density is thought to be an amplifier," says Frank Vocci, director of pharmacotherapies at NIDA. "[Chemically] blocking D3 interrupts an awful lot of the drugs' effects. It is probably the hottest target in modulating the reward system."

But just as there are two ways to stop a speeding car--by easing off the gas or hitting the brake pedal--there are two different possibilities for muting addiction. If dopamine receptors are the gas, the brain's own inhibitory systems act as the brakes. In addicts, this natural damping circuit, called GABA (gamma-aminobutyric acid), appears to be faulty. Without a proper chemical check on excitatory messages set off by drugs, the brain never appreciates that it's been satiated.

As it turns out, vigabatrin, an antiepilepsy treatment that is marketed in 60 countries (but not yet in the U.S.), is an effective GABA booster. In epileptics, vigabatrin suppresses overactivated motor neurons that cause muscles to contract and go into spasm. Hoping that enhancing GABA in the brains of addicts could help them control their drug cravings, two biotech companies in the U.S., Ovation Pharmaceuticals and Catalyst Pharmaceuticals, are studying the drug's effect on methamphetamine and cocaine use. So far, in animals, vigabatrin prevents the breakdown of GABA so that more of the inhibitory compound can be stored in whole form in nerve cells. That way, more of it could be released when those cells are activated by a hit from a drug. Says Vocci, optimistically: "If it works, it will probably work on all addictions."

Another fundamental target for addiction treatments is the stress network. Animal studies have long shown that stress can increase the desire for drugs. In rats trained to self-administer a substance, stressors such as a new environment, an unfamiliar cage mate or a change in daily routine push the animals to depend on the substance even more.

Among higher creatures like us, stress can also alter the way the brain thinks, particularly the way it contemplates the consequences of actions. Recall the last time you found yourself in a stressful situation--when you were scared, nervous or threatened. Your brain tuned out everything besides whatever it was that was frightening you--the familiar fight-or-flight mode. "The part of the prefrontal cortex that is involved in deliberative cognition is shut down by stress," says Vocci. "It's supposed to be, but it's even more inhibited in substance abusers." A less responsive prefrontal cortex sets up addicts to be more impulsive as well.

Hormones--of the male-female kind--may play a role in how people become addicted as well. Studies have shown, for instance, that women may be more vulnerable to cravings for nicotine during the latter part of the menstrual cycle, when the egg emerges from the follicle and the hormones progesterone and estrogen are released. "The reward systems of the brain have different sensitivities at different points in the cycle," notes Volkow. "There is way greater craving during the later phase."

That led researchers to wonder about other biological differences in the way men and women become addicted and, significantly, respond to treatments. Alcohol dependence is one very promising area. For years, researchers had documented the way female alcoholics tend to progress more rapidly to alcoholism than men. This telescoping effect, they now know, has a lot to do with the way women metabolize alcohol. Females are endowed with less alcohol dehydrogenase--the first enzyme in the stomach lining that starts to break down the ethanol in liquor--and less total body water than men. Together with estrogen, these factors have a net concentrating effect on the alcohol in the blood, giving women a more intense hit with each drink. The pleasure from that extreme high may be enough for some women to feel satisfied and therefore drink less. For others, the intense intoxication is so enjoyable that they try to duplicate the experience over and over.

But it's the brain, not the gut, that continues to get most of the attention, and one of the biggest reasons is technology. It was in 1985 that Volkow first began using PET scans to record trademark characteristics in the brains and nerve cells of chronic drug abusers, including blood flow, dopamine levels and glucose metabolism--a measure of how much energy is being used and where (and therefore a stand-in for figuring out which cells are at work). After the subjects had been abstinent a year, Volkow rescanned their brains and found that they had begun to return to their predrug state. Good news, certainly, but only as far as it goes.

"The changes induced by addiction do not just involve one system," says Volkow. "There are some areas in which the changes persist even after two years." One area of delayed rebound involves learning. Somehow in methamphetamine abusers, the ability to learn some new things remained affected after 14 months of abstinence. "Does treatment push the brain back to normal," asks NIDA's Frascella, "or does it push it back in different ways?"

If the kind of damage that lingers in an addict's learning abilities also hangs on in behavioral areas, this could explain why rehabilitation programs that rely on cognitive therapy--teaching new ways to think about the need for a substance and the consequences of using it--may not always be effective, especially in the first weeks and months after getting clean. "Therapy is a learning process," notes Vocci. "We are trying to get [addicts] to change cognition and behavior at a time when they are least able to do so."

One important discovery: evidence is building to support the 90-day rehabilitation model, which was stumbled upon by AA (new members are advised to attend a meeting a day for the first 90 days) and is the duration of a typical stint in a drug-treatment program. It turns out that this is just about how long it takes for the brain to reset itself and shake off the immediate influence of a drug. Researchers at Yale University have documented what they call the sleeper effect--a gradual re-engaging of proper decision making and analytical functions in the brain's prefrontal cortex--after an addict has abstained for at least 90 days.

This work has led to research on cognitive enhancers, or compounds that may amplify connections in the prefrontal cortex to speed up the natural reversal. Such enhancement would give the higher regions of the brain a fighting chance against the amygdala, a more basal region that plays a role in priming the dopamine-reward system when certain cues suggest imminent pleasure--anything from the sight of white powder that looks like cocaine to spending time with friends you used to drink with. It's that conditioned reflex--identical to the one that caused Ivan Pavlov's famed dog to salivate at the ringing of a bell after it learned to associate the sound with food--that unleashes a craving. And it's that phenomenon that was the purpose of my brain scans at McLean, one of the world's premier centers for addiction research.

In my heyday, I would often drink even when I knew it was a terrible idea--and the urge was hardest to resist when I was with my drinking buddies, hearing the clink of glasses and bottles, seeing others imbibe and smelling the aroma of wine or beer. The researchers at McLean have invented a machine that wafts such odors directly into the nostrils of a subject undergoing an fMRI scan in order to see how the brain reacts. The reward circuitry in the brain of a newly recovering alcoholic should light up like a Christmas tree when stimulated by one of these alluring smells.

I chose dark beer, my absolute favorite, from their impressive stock. But I haven't gotten high for more than a quarter-century; it was an open question whether I would react that way. So after an interview with a staff psychiatrist to make sure I would be able to handle it if I experienced a craving, I was fitted with a tube that carried beer aroma from a vaporizer into my nose. I was then slid into the machine to inhale that still familiar odor while the fMRI did its work.

Even if the smells triggered a strong desire to drink, I had long since learned ways to talk myself out of it--or find someone to help me do so. Like the 90-day drying-out period that turns out to parallel the brain's recovery cycle, such a strategy is in line with other new theories of addiction. Scientists say extinguishing urges is not a matter of getting the feelings to fade but of helping the addict learn a new form of conditioning, one that allows the brain's cognitive power to shout down the amygdala and other lower regions. "What has to happen for that cue to extinguish is not for the amygdala to become weaker but for the frontal cortex to become stronger," says Vocci.

While such relearning has not been studied formally in humans, Vocci believes it will work, on the basis of studies involving, of all things, phobias. It turns out that phobias and drugs exploit the same struggle between high and low circuits in the brain. People placed in a virtual-reality glass elevator and treated with the antibiotic D-cycloserine were better able to overcome their fear of heights than those without benefit of the drug. Says Vocci: "I never thought we would have drugs that affect cognition in such a specific way."

Such surprises have even allowed experts to speculate whether addiction can ever be cured. That notion goes firmly against current beliefs. A rehabilitated addict is always in recovery because cured suggests that resuming drinking or smoking or shooting up is a safe possibility--whose downside could be devastating. But there are hints that a cure might not in principle be impossible. A recent study showed that tobacco smokers who suffered a stroke that damaged the insula (a region of the brain involved in emotional, gut-instinct perceptions) no longer felt a desire for nicotine.

That's exciting, but because the insula is so critical to other brain functions--perceiving danger, anticipating threats--damaging this area isn't something you would ever want to do intentionally. With so many of the brain's systems entangled with one another, it could prove impossible to adjust just one without throwing the others into imbalance.

Nevertheless, says Volkow, "addiction is a medical condition. We have to recognize that medications can reverse the pathology of the disease. We have to force ourselves to think about a cure because if we don't, it will never happen." Still, she is quick to admit that just contemplating new ideas doesn't make them so. The brain functions that addiction commandeers may simply be so complex that sufferers, as 12-step recovery programs have emphasized for decades, never lose their vulnerability to their drug of choice, no matter how healthy their brains might eventually look.

I'm probably a case in point. My brain barely lit up in response to the smell of beer inside the fMRI at McLean. "This is actually valuable information for you as an individual," said Scott Lukas, director of the hospital's behavioral psychopharmacology research laboratory and a professor at Harvard Medical School who ran the tests. "It means that your brain's sensitivity to beer cues has long passed."

That's in keeping with my real-world experience; if someone has a beer at dinner, I don't feel a compulsion to leap across the table and grab it or even to order one for myself. Does that mean I'm cured? Maybe. But it may also mean simply that it would take a much stronger trigger for me to fall prey to addiction again--like, for example, downing a glass of beer. But the last thing I intend to do is put it to the test. I've seen too many others try it--with horrifying results.

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Are You Suffering From Sex Dependency Disorder?

Masuo Kamiyama

About two years ago, 29-year-old Asuka Hisamoto, who describes herself as a "completely ordinary" housewife, developed an irresistible itch for coitus.

"I wanted to do it every night," the Hyogo Prefecture resident relates in Uramono Japan. "It got to the point that my husband couldn't stand it any longer and began sleeping on the sofa.

"As a woman, I found that insulting. So I had no choice but to turn to masturbation. Before long I was doing it constantly, bringing myself to orgasm like, uh, 15 times a day.

"But it wasn't enough to satisfy me. I eventually turned to prowling encounter sites on the Web looking for a man who could do me properly."

But that wasn't as easy as it seemed. Hisamoto continues:

"I figured one guy would be enough to satisfy me, but wound up doing it with about 30 guys. Multiple times too. Must have come to 300 or 400 all together."

Hisamoto consulted a physician and after undergoing a battery of self-administered tests and consultations, was informed by the doc that she suffered from full-blown sex dependency disorder.

She was prescribed an antidepressant, but the medication didn't have any dramatic effect. Thinking some group therapy might be beneficial, the doctor advised her to attend a meeting of "Circle X."

Last February, Hisamono relates in her Uramono Japan monologue, 16 of them -- young, old, male and female -- got together in Osaka for a group therapy session. Seated in a circle, they began to relate their tales of woe.

From the topics they discussed, this group of sexaholics might have been more appropriately named "Circle XXX."

"My name is Acchan and I'm from Kobe," the first man, eyes cast downward, mutters in the way of self introduction. "I was so hooked to adult sites on the Internet that I'd spend all day in net cafes, and never go to work."

"When I turned 60, my wife divorced me after I forced her to attend a swapping party," a second confesses.

"I was sentenced to do time in prison for procuring underaged teenage hookers," another one admits. "I did it with 80 of them."

As Hisamoto sat there, transfixed, the tales of sexual woes became increasingly extreme.

"I procured porno videos and women's erotic manga by the hundreds," weeps a 19-year-old youth. "Their accumulated weight became so heavy it nearly caused the second story floor of my house to collapse."

"I'm gay," confesses a 24-year-old employed at a night club. "My lifestyle was so promiscuous I developed a prolapsed rectum and it eventually became malignant."

Some participants found it excruciatingly hard to get their problems off their chest. Understandable, perhaps, in the following case.

"I ... I ... I ... have always liked animals ..." a middle-aged male of short stature stammers. But try as he might, he couldn't bring himself to get to the root of his rooting problem, as they say in Australia.

"Come on," another member exhorts him. "It's all right. We're all together on this. Give it your best shot."

"I ... I screwed ... a ... fish!!" he finally blurts out. "A Prussian carp. And other species."

His listeners' jaws slackened in amazement. You could have heard a pin drop at that moment.

Thanks to the group therapy sessions and support from her understanding hubby, Hisamoto tells Uramono Japan that she's on the road to both psychological and physical satisfaction.

Wait a second, did she say "satisfaction"? And suspiciously, the word "recovery" appears to be lacking entirely. Er, madam, can you be a little more specific about that reference to satisfaction?

Oho -- it seems that Hisamoto hooked up with one of the hornier male members of Circle X, and the two of them have discovered that their perennially horny condition can be alleviated by mutual therapy, between consenting adults in private, as it goes.

So for the time being, at least, Hisamoto and her newfound friend are having too much fun fornicating to seek a further therapy.

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Cardiac Surgery In Patients With Severe Liver Cirrhosis Less Likely To Survive

Amy Molnar
A new study on the outcome of cardiac surgery in patients with liver cirrhosis found that the surgery can safely be performed in patients with milder disease, while those with more severe cirrhosis are less likely to survive.
The results of this study appear in the July 2007 issue of Liver Transplantation, the official journal of the American Association for the Study of Liver Diseases (AASLD) and the International Liver Transplantation Society (ILTS). The journal is published on behalf of the societies by John Wiley & Sons, Inc. and is available online via Wiley InterScience at http://www.interscience.wiley.com/journal/livertransplantion.
In abdominal surgery, it is well known that the severity of liver cirrhosis, as measured by the Child-Pugh classification (a scoring system used to gauge the severity of liver disease) correlates directly with surgical outcome. However, few studies have reported how these patients fare when undergoing cardiac surgery.
Led by Farzan Filsoufi, of Mt. Sinai Hospital in New York, NY, researchers conducted a retrospective study of patients who underwent cardiac surgery at Mt. Sinai Medical Center between January 1998 and December 2004, and identified 27 patients who had cirrhosis. Of these, 18 patients had cardiac surgery with cardiopulmonary bypass (heart-lung machine) while the other 9 had surgery without using the heart-lung machine.
The results showed that hospital mortality increased significantly according to the Child-Pugh classification, with a mortality rate of 10 percent for those with class A, 18 percent for those with class B, and 67 percent for those with class C. Postoperative complications were also higher in class B and C than in class A. There was no correlation between mortality and the MELD (Model for End-Stage Liver Disease) score, however. Early studies reported a higher mortality for class B and C patients than seen in this study, but more recent studies have shown an improvement in survival rates. The current study confirms lower mortality for class B patients, which is probably due to improvements in surgical techniques and the management of cardiac surgery patients. In addition, there was no mortality for those who had coronary artery bypass surgery off-pump (without the heart-lung machine).
The authors note that alternative treatment strategies are needed for patients with advanced cirrhosis and cardiovascular diseases that require surgery. One potential approach is a combined liver transplant and cardiac operation, and there have been a few positive reports documenting such cases. "Despite early promising results with this combined approach the number of publications remains very limited and further investigations are required to determine the role of this treatment strategy in the armamentarium of cardiac and transplantation surgeons," the authors state. Although hospital mortality decreased in this study, the rates of postoperative complications in class B and C were 55 percent and 100 percent respectively. Surgical trauma and the deleterious effects of cardiopulmonary bypass may explain the increased rate of complications, according to the authors.
The authors conclude that "cardiac surgery can be performed with low operative mortality and good mid-term survival in patients with Child-Pugh class A." Acceptable results are also possible with class B patients, especially those who do not have surgery using the heart-lung machine, while for class C patients, who have cardiac surgery because of a life threatening condition, operative mortality remains high. The authors conclude: "Careful selection is critical in order to improve surgical outcome in patients with liver cirrhosis."
In an accompanying editorial in the same issue, Gonzalo Gonzalez-Stawinski, of Cleveland Clinic in Cleveland, OH, notes that cirrhotic patients requiring open heart surgery are among the most challenging and complex patients seen in cardiac surgery. The author notes that the current study raises the question of whether elective cardiac interventions should be offered to patients with advanced cirrhosis, in the hopes of improving their survival and quality of life. He states that "caution needs to be exercised when taking on cirrhotic patients as data provided by Filsoufi, et. al would suggest that most patients with either Childs-Pugh B or C do not gain a survival advantage by correcting their cardiac pathology." As an alternative, he suggests delaying and medically managing their heart disease in the hopes that they can undergo combined cardiac surgery and liver transplant, although not all patients would want or be eligible for such a solution and only a handful of centers in the U.S. have the capabilities to undertake it. He concludes, "Despite the challenges linked to the cirrhotic cardiac surgery patient, cardiac surgeons and hepatologists/liver transplant specialists need to continue to work in unison in hopes of improving the outcomes associated to this difficult patient population."

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