延胡索对缺血再灌注损伤大鼠局灶性脑梗死的作用

目的：探讨延胡索对局灶性脑梗死的作用。方法：总共有30只Sprague-Dawley(SD)大鼠被用来研究。局灶性脑梗死动物模型的建立是将两侧的颈总动脉和右侧的中大脑动脉的血流阻断90min后,再经24h的灌注,然后评估它们的神经状态,大鼠被牺牲取脑,并作成切片用2,3,5-triphenyl-tetrazolium chloride染色。以神经的状态和脑梗死面积的变化作为指标来评估延胡索对脑梗死的作用。另外,24只SD大鼠腹腔注射延胡索,经24h后从心脏采血测量血液的变化。结果：延胡索100mg/kg腹腔注射能够改善大鼠神经缺损的症状和减少脑梗死的面积以及能增加全血中红血球的数目和提高血比容（hematocrit)。结论：延胡索在缺血再灌流损伤大鼠能改善神经状态和减少脑梗死面积。     

Tretinoin overdose: A first case report

Introduction

Tretinoin (Vesanoid) is an all-trans-retinoic acid, and is related to retinol (Vitamin A). To date, there have been several case reports on overdose with its isomer isotretinoin, but none involving overdose of tretinoin. We report the first known case of a patient who ingested a massive overdose of tretinoin.

Case Report

A 31-year-old man ingested 1000 mg of tretinoin (100 pills of Vesanoid 10 mg) in a suicide attempt. He developed nonbloody diarrhea, but otherwise had no complaints. Clinical examination was normal. The patient was treated with activated charcoal and was hydrated. The patient’s blood results did not show any deterioration on the third consecutive day. He was discharged well on the third day, but was subsequently lost to follow-up.

Discussion

Although there has been no reported experience with acute tretinoin overdose in humans, our patient took a dose approximately 3 times the recommended maximum tolerated daily dose in patients with myelodysplastic syndrome or solid tumors (195 mg/m² per day). Overdose with other retinoids such as isotretinoin have been associated with only minor symptoms that resolved quickly. Our patient had diarrhea, which also resolved quickly with symptomatic treatment and hydration.

Conclusion

We believe this to be the first case report of an acute oral overdose of tretinoin. The patient developed diarrhea, but was otherwise asymptomatic.     

Gastrodia elata modulated activator protein 1 via c-Jun N-terminal kinase signaling pathway in kainic acid-induced epilepsy in rats

Gastrodia elata (Orchidaceae) is a Chinese herb. Our previous study showed that Gastrodia elata is able to reduce epileptic seizures, oxygen free radicals, microglia activation, and apoptosis in kainic acid (KA)-treated rats. Activator protein 1 (AP-1) is involved in modulating the neuronal plasticity and apoptosis. Therefore, the aim of this study was to investigate the role of AP-1 in antiepileptic effect of Gastrodia elata. Gastrodia elata (0.5, 1.0g/kg) or valproic acid (VA, 250mg/kg) was administered orally in Sprague-Dawley rats for 1 week before and 2 weeks after intraperitoneal injection of KA. Protein levels of AP-1 were determined by measuring c-Jun and c-Fos proteins, and the mitogen-activated protein (MAP) kinases activations were determined by measuring the phosphorylations of extracellular signal-regulated kinases, p38, and c-Jun N-terminal kinases (JNKs) in the frontal cortex and the hippocampus of rat brain using Western blotting. These results indicated that pre-treatment with Gastrodia elata or VA activated JNK signal pathway and c-Jun expression, while post-treatment with Gastrodia elata or VA suppressed both the JNK signaling pathway and the c-Jun expression induced by KA. These findings suggested that Gastrodia elata regulated the AP-1 expression via the JNK signaling pathway in KA-induced epilepsy.     

Serum resistin level is a predictor of ovarian response in in vitro fertilisation cycle

OBJECTIVES: To measure serum resistin levels in infertile women undergoing in vitro fertilisation-embryo transfer (IVF-ET), and to find any correlations between serum resistin levels and body weight, body mass index, the number of oocytes retrieved, and the outcome of IVF-ET. In addition, to assess whether there is any difference in serum resistin levels between infertility caused by polycystic ovary syndrome (PCOS) and infertility caused by other female factors. METHODS: We designed a case-control study, and a total of 44 infertile women were enrolled. The blood samples for resistin measurement were collected on day 3 of the menstrual cycle prior to the administration of gonadotropin during in vitro fertilisation. These cases were then divided into 2 subgroups (PCOS group versus non-PCOS group) and a number of variables were measured and compared, including serum resistin levels. RESULTS: Serum resistin levels were inversely correlated with the number of oocytes retrieved (r=-0.371, p=0.013). No significant correlation was found between serum resistin levels and body mass index or body weight, either in the whole group or in the 2 subgroups. Serum resistin levels in the non-PCOS group were significantly higher than in the PCOS group (p=0.049). Serum resistin levels in the non-PCOS group were inversely correlated to the number of oocytes retrieved (r=-0.386, p=0.039), but no similar correlation was found in the PCOS group. There was no correlation between serum resistin levels and fertility rate or clinical pregnancy rate in either subgroup. CONCLUSIONS: We observed a negative correlation between serum resistin levels and the number of oocytes retrieved during IVF. However, this phenomenon was only present in the non-PCOS group. This result suggests that serum resistin levels might be a good predictor of ovarian response in infertile women without PCOS during IVF. The role of serum resistin in response to inflammation caused by endometriosis or chronic pelvic infection, both of which are major causes of female infertility, should be examined in a further study.     

Healthcare professionals’ perceptions of psychological treatment for chronic pain in Singapore: challenges,barriers, and the way forward

Purpose: There are very few studies on healthcare providers’ experiences of delivering treatment for chronic pain in a Southeast Asian setting. The aims of this study are to understand the experiences of professionals delivering treatment for people with chronic pain in Singapore and identify possible barriers to psychological treatment for this condition within the broader experiences of these professionals. Method: Healthcare professionals with at least 1-year experience treating chronic pain were recruited and purposefully sampled. Fifteen inductive semi-structured interviews were conducted to explore healthcare professionals’ experiences of treating people with chronic pain. Interviews were transcribed verbatim and analysed using thematic analysis. Results: Four main themes were identified: ‘System Barriers’, ‘Core Beliefs and management of Chronic Pain’, ‘Engaging Patients in treatment’ and ‘Creating Awareness for Chronic Pain Management’. Professionals trained in a multidisciplinary approach to pain management were seen as rare. Professionals who could refer patients for psychological treatment do not refer due to costs, and their perception that patients may lack understanding of such a treatment. Conclusion: Reducing barriers in the access to psychological treatment in settings like Singapore will require a multifaceted approach.

• Implications for Rehabilitation

• A multifaceted approach is required to reduce barriers to psychological treatment for chronic pain in settings like Singapore.

• Educating healthcare professionals on the need for a multidisciplinary approach to chronic pain could help in reducing misconceptions and increase understanding of the benefits of psychological approaches.

• Utilizing both media and technological platforms as a means to facilitate psychological treatment uptake for chronic pain may be a way forward for a technological savvy generation.

     

Ellagic acid suppresses oxidised low-density lipoprotein-induced aortic smooth muscle cell proliferation: studies on the activation of extracellular signal-regulated kinase 1/2 and proliferating cell nuclear antigen expression

Proliferation of intimal vascular smooth muscle cells is an important component in the development of atherosclerosis. Ellagic acid is a phenolic compound present in fruits (raspberries, blueberries, strawberries) and walnuts. The present study investigated the effect of ellagic acid on the oxidised LDL (ox-LDL)-induced proliferation of rat aortic smooth muscle cells (RASMC). The study found that ellagic acid significantly inhibited ox-LDL-induced proliferation of RASMC and phosphorylation of extracellular signal-regulated kinase (ERK) 1/2. Furthermore, ellagic acid also blocked the ox-LDL-induced (inducible) cell-cycle progression and down regulation of the expression of proliferating cell nuclear antigen (PCNA) in RASMC. Therefore, ellagic acid reduced the amount of ox-LDL-induced proliferation of RASMC via inactivation of the ERK pathway and suppression of PCNA expression. These results may significantly advance the understanding of the role that antioxidants play in the prevention of atherosclerosis.     

Higher basal adiponectin levels are associated with better ovarian response to gonadotropin stimulation during in vitro fertilization

AIMS: To measure adiponectin levels in the serum samples from day 3 of the menstrual cycle prior to the administration of gonadotropin during in vitro fertilization, and to measure any correlations between adiponectin levels and the number of oocytes retrieved, body weights and body mass indexes. Also, to examine whether there is a difference in adiponectin levels between women who conceive and those who do not. METHODS: In a case-control design, 56 women undergoing in vitro fertilization procedures were included in this study: 28 women who conceived were matched with 28 women who did not conceive. Adiponectin levels in serum were determined by radioimmunoassay and compared. RESULTS: The adiponectin levels were positively correlated with the number of oocytes retrieved (r = 0.306, p = 0.022), but negatively correlated with body mass index and body weight (r = -0.367, p = 0.005; r = -0.326, p = 0.014). No significant correlations were found between the number of oocytes retrieved and body mass index or body weight (r = 0.020, p = 0.882; r = 0.069, p = 0.613). We further observed that adiponectin levels in women who conceived (23.0 +/- 2.0 microg/ml) were found to be significantly higher (p = 0.026) than those in women who did not conceive (17.3 +/-1.4 microg/ml). The number of oocytes retrieved from women who conceived (13.3 +/- 0.9) was also higher than that in women who did not (10 +/- 1.2; p = 0.029). CONCLUSIONS: The number of oocytes retrieved was found to correlate positively with the adiponectin levels on the day prior to the administration of gonadotropin. In addition, basal adiponectin levels were significantly higher in those women who conceived. Therefore, adiponectin is a better marker of adequate follicular development during in vitro fertilization than is body weight or body mass index.     

Intraosseous vascular access in adults using the EZ-IO in an emergency department

Background

Intraosseous (IO) access is an alternative to conventional intravenous access.

Aims

We evaluate the use of the EZ-IO? as an alternative vascular access for patients in the emergency department.

Methods

A non-randomized, prospective, observational study was performed in adults using the EZ-IO? powered drill device.

Results

Twenty-four patients were recruited. There were 35 intraosseous insertions, including 24 tibial and 11 humeral insertions. All EZ-IO? insertions were achieved within 20 s and were successful at the first attempt except for one. Of the intraosseous insertions, 88.6% were reported to be easier than intravenous cannulation. We found flow rates to be significantly faster using a pressure bag. The seniority of operators did not affect the success of insertion. Complications included a glove being caught in the drill device and extravasation of fluid although they were easily preventable.

Conclusion

The use of the EZ-IO? provides a fast, easy and reliable alternative mode of venous access, especially in the resuscitation of patients with no venous vascular access in the emergency department. Flow rates may be improved by the use of pressure bags.