Risk of adrenal crisis in dental patients: Results of a systematic search of the literature

BackgroundThe authors performed a systematic search of the literature to identify the frequency of, risk of experiencing and factors associated with adrenal crises in dental patients.MethodsThe authors searched PubMed and Ovid MEDLINE (1947-June 20, 2012) and Embase (1974-2012) for English-language articles related to cases of adrenal crisis in dentistry and extracted and analyzed data from the articles. The six authors determined whether the cases identified met a consensus definition of adrenal crisis.ResultsOf 148 articles identified in the initial screening, 34 articles were included in the final review, from which six cases met the criteria of adrenal crisis. The authors categorized four cases as “suggestive of adrenal crisis” and two cases as “consistent with adrenal crisis.” Risk factors were significant adrenal insufficiency, pain, infection, having undergone an invasive procedure, having received a barbiturate general anesthetic, and poor health status and stability at the time of presentation. The authors estimated risk to be less than one in 650,000 in patients with adrenal insufficiency.ConclusionsAdrenal crisis is rare in dental patients, with only six reports of it having been published in the past 66 years. Risk is associated with unrecognized adrenal insufficiency, poor health status and stability at the time of treatment, pain, infection, having undergone an invasive procedure and having received a barbiturate general anesthetic.Clinical ImplicationsRisk of adrenal crisis is reduced through proper evaluation of the patient, identification of risk factors and following appropriate preventive measures.     

Appearance of antidepressant-like effect by sildenafil in rats after central muscarinic receptor blockade: evidence from behavioural and neuro-receptor studies

Summary. The phosphodiesterase (PDE) 5 inhibitor sildenafil has been shown to display psychotropic actions in humans and animals, and has been used for the treatment of antidepressant-associated erectile dysfunction. However, its effects on the neurobiology of depression are unknown. Nitric oxide (NO)-cyclic guanosine monophosphate (cGMP) inhibition is anti-depressant in animals, and increasing cGMP with sildenafil is anxiogenic in rodents. Substantial cholinergic-nitrergic interaction exists in the brain, while sildenafil shows modulatory actions on cholinergic transmission. Depression is also associated with increased cholinergic drive. Here we report that sildenafil increases muscarinic acetylcholine receptor (mAChR) signaling in human neuroblastoma cells. We also show that fluoxetine (20 mg/kg/day × 7 days), as well as a combination of sildenafil (10 mg/kg/day × 7 days) plus the antimuscarinic atropine (1 mg/kg/day × 7 days) demonstrates significant, comparable antidepressant-like effects in the rat forced swim test (FST) and also reduces cortical β-adrenergic receptor (β-AR) density, while sildenafil or atropine alone did not. Importantly, sildenafil did not modify fluoxetine’s response. Sildenafil thus demonstrates antidepressant-like effects but only after central muscarinic receptor blockade, providing evidence for cholinergic-nitrergic interactions in the neurobiology of depression. Correspondence: Christiaan B. Brink, Division of Pharmacology, North-West University (PUK), Internal Box 16, Potchefstroom 2520, South Africa     

Expressions and possible roles of GDNF receptors in the developing dopaminergic neurons

Glial cell line-derived neurotrophic factor (GDNF) has an essential role in the survival and maturation of the dopaminergic (DA) neurons in the substantia nigra (SN) of mammalian embryonic brain. In addition to Ret, cell adhesion molecules (CAMs) were also proposed to function as transmembrane signaling receptors of GDNF. The present study was to investigate whether these transmembrane receptors of GDNF were correlated with the tyrosine hydroxylase (TH) expression of SN DA neurons during early developmental stage. RT-PCR and Western blot were performed to detect TH expression in SN of perinatal rats at mRNA and protein level respectively; meanwhile, Western blot was performed to detect the expressions of the transmembrane proteins including Ret, neural cell adhesion molecule-140 (NCAM-140), integrin β1 and N-cadherin. The results showed that TH mRNA expression was positively correlated with both Ret and N-cadherin protein, while there was no correlation with NCAM-140 and integrin β1; TH protein expression was correlated with all of these transmembrane molecules. These data suggested that the expression of either TH mRNA or TH protein was subject to the mediation of different transmembrane receptor combinations of GDNF.     

Heterogeneity in epithelium-dependent responses

The airway epithelium exerts a profound influence on the responsiveness of bronchial smooth muscle to both contracting and relaxing agents. This may be due to the release of an epithelium-derived factor or factors. There is a considerable heterogeneity in the effects of the epithelium between orders of bronchi, between species, and between pharmacologic agents. Such heterogeneity may reflect variations in the release and/or effect of the epithelium-derived relaxing factor(s). This report demonstrates that: (1) there is a basal and a stimulated release of the factor, (2) the prominence of different types of release varies between species, (3) the effect of the epithelium on relaxation of bronchial smooth muscle is greatest in the presence of high degrees of cholinergic tone, (4) the effects of the epithelium are not mediated via cyclic GMP, and (5) the epithelium-derived relaxing factor is not nitric oxide.     

软骨前体细胞及微小 RNA-140 在骨关节炎软骨损伤修复中的作用

目的总结软骨前体细胞（cartilage progenitor cells，CPCs）及微小 RNA-140（microRNA-140，miR-140）在骨关节炎（osteoarthritis，OA）软骨损伤修复中的作用及应用前景。方法查阅国内外近年有关 CPCs、miR-140 及 OA 软骨损伤修复的相关研究，归纳总结后进行综述。结果CPCs 具有良好的自我增殖性、干细胞表面抗原表达特性及多向分化潜能等特点，其成软骨分化能力优于其他组织来源 MSCs。CPCs 与 OA 发生发展密切相关，但其在 OA 软骨损伤部位自主活化及成软骨分化能力方面并不能达到软骨完全修复的要求。miR-140 具有软骨特异性，参与 OA 发病机制，具有抑制 Notch 信号通路、诱导活化 CPCs 并增强其增殖及成软骨分化的能力，从而促进 OA 软骨损伤修复的潜能。关节腔局部给药是目前治疗 OA 的主要方式之一，关节腔注射 miR-140 虽然对大鼠软骨退变具有显著抑制作用，但也存在非靶向聚集、生物利用度低及清除快等问题，基于关节软骨特性构建具有良好安全性、软骨靶向性且能高效递送 miR-140 的载体材料具有良好应用前景。此外，CPCs 主要分散在软骨表层，而 OA 软骨损伤也开始于该层，因此强调 OA 早期干预至关重要。结论miR-140 具有诱导活化 CPCs、促进 OA 早期软骨损伤修复的潜能，进一步探索 miR-140 在 OA 发生机制中的作用及研发基于 miR-140 的新的 OA 治疗策略具有重要临床意义。     

淫羊藿次苷Ⅱ对大鼠阴茎海绵体压力、平均动脉血压的影响及其作用机制的研究

目的 淫羊藿次苷Ⅱ是淫羊藿中提取分离的单体,为了解淫羊藿次苷Ⅱ对阴茎性功能障碍(ED)的疗效,通过体内试验观察其对阴茎海绵体压力和平均动脉血压的影响及作用机制.方法 麻醉下游离大鼠左侧颈总动脉和左侧阴茎海绵体,允别插管与电生理仪连接;游离左侧海绵体神经(CN),采用电生理仪刺激器连接双极电极刺激;检测不同浓度的淫羊藿次苷Ⅱ在刺激CN后对阴茎海绵体压力(ICP)和平均动脉血压(MAP)影响,淫羊藿苷、西地那非、罂粟碱作为对照组.同时观察可溶性环鸟苷酸(sGC)抑制剂H-[1,2,4]噁二唑[4,3.A]喹喔啉(ODQ)、一氧化氮合酶(NOS)抑制剂N~ω硝基-L-精氨酸(LNNA)及一氧化氮生成抑制剂亚甲蓝(methylene blue,MB)对淫羊藿次苷Ⅱ(10~(-4)mol/L)诱发ICP/MAP变化的影响.结果 4组药物均剂量依赖性显著提高ICP(P<0.01),淫羊藿次苷Ⅱ、淫羊藿苷和西地那非对MAP无显著影响(P>0.05),而罂粟碱浓度达10~(-4)mol/L后,即可显著降低MAP(P<0.01).在受试浓度下,LNNA、MB和ODQ可显著抑制淫羊藿次苷Ⅱ诱发的ICP变化(P<0.01),对两地那非诱发的ICP变化无影响(P>0.05).结论 淫羊藿次苷Ⅱ和淫羊藿苷呈剂量依赖性地提高大鼠阴茎勃起功能(ICP),淫羊藿次苷Ⅱ效价强度为淫羊藿苷的2.44倍,对平均动脉血压没有显著影响,其机制可能与增强阴茎海绵体NO-cGMP通路的活性有关.     

电针对神经病理性痛大鼠脊髓NO/cGMP信号转导通路的影响

目的 探讨电针对神经病理性痛大鼠脊髓一氧化氮/环鸟苷酸(NO/cGMP)信号转导通路的影响.方法 清洁级雄性SD大鼠48只,体重190～210 g,随机分为3组(n=16):假手术组(S组)仅分离坐骨神经,不结扎;神经病理性痛组(NP组)采用坐骨神经慢性压迫性损伤(CCI)法制备神经病理性痛模型;电针组(E组)于CCI后11～17 d时采用穴位神经刺激仪进行电针刺激,刺激大鼠术侧委中穴与环跳穴,刺激频率2 Hz,波宽0.6 ms,起始电流强度1 mA,每10 min递增1 mA,刺激时间30 min,1次/d.于CCI前(基础状态)、CCI后10、16 d时测定机械痛阈和热痛阈.CCI后10 d时痛阈低于基础痛阈的30%为模型制备成功.CCI后17 d时处死大鼠,取脊髓组织,采用分光光度法测定脊髓总一氧化氮合酶(tNOS)、诱导型一氧化氮合酶(iNOS)和神经元型一氧化氮合酶(nNOS)的活性,免疫组化法测定脊髓背角nNOS和iNOS的表达,采用硝酸还原酶法测定脊髓NO含量,采用放射免疫分析法测定脊髓cGMP含量.结果 与基础值比较,NP组和E组CCI后机械痛阈和热痛阈降低(P＜0.01);与CCI后10 d时比较,E组CCI后16 d时机械痛阈和热痛阈均升高(P＜0.01);与S组比较,NP组机械痛阈和热痛阈降低,脊髓tNOS、nNOS活性、NO和cGMP含量升高,nNOS表达上调,E组机械痛阈和热痛阈降低(P＜0.05或0.01),其余指标差异无统计学意义(P＞0.05);与NP组比较,E组机械痛阈和热痛阈升高,脊髓tNOS和nNOS活性、NO和cGMP含量降低,nNOS表达下调(P＜0.05或0.01).3组脊髓iNOS活性和表达比较差异无统计学意义(P＞0.05).结论 电针减轻大鼠神经病理性痛的机制与抑制脊髓NO/cGMP信号转导通路有关.     

血小板中cAMP与cGMP及血清LDL-ch对犬下腔静脉移植物内膜增生的影响

为探讨静脉系移植物通畅率的影响因素，对自体静脉碎片种植Ｄａｃｒｏｎ后植入下腔静脉（ＩＶＣ）的１３只犬及全血预凝Ｄａｃｒｏｎ后植入ＩＶＣ作对照的８只犬血清脂蛋白胆固醇、血小板环－磷酸腺苷（ｃＡＭＰ）、环－磷酸鸟苷（ｃＧＭＰ）及移植物内膜厚度进行了测定。结果：种植组通畅率（６１．５％）高于对照组（２５．０％），Ｄａｃｒｏｎ腔面术后２周完全内皮化；对照阻塞组与种植阻塞组血小板ｃＡＭＰ低于对照通畅组与种植通畅组，血清低密度脂蛋白胆固醇（ＬＤＬ－ｃｈ）高于对照通畅组与种植通畅组，前二组内膜厚度大于后二组。结果提示：内皮层不完整所致腔面前列环素及血小板ｃＡＭＰ减少，可能是静脉系移植物内膜增生的主要原因，高ＬＤＬ－ｃｈ血症可能对其有促进作用；人工血管内皮化，抗血小板与降血脂处理对预防内膜增生及提高通畅率可能有帮助。     

药穴结合治疗对溃疡性结肠炎患者血小板功能状态影响的临床观察

目的：观察药穴结合对溃疡性结肠炎（UC）患者血小板功能状态（CMP-140、TXB2）的影响。方法：将262例UC患者随机分为4组。中药组45例口服中药方【黄芪、蒲黄（包）、党参、茯苓、厚朴、荔枝核、白术、川芎、木香、三七粉（冲）】。耳穴组48例取脾、大肠、内分泌、交感、皮质下，以王不留行籽贴在耳穴上。药穴组89例在口服中药同时加耳穴贴压。对照组80例口服柳氮磺胺吡啶2．0g。分别测定治疗前后CMP一140、TXB：的含量。结果：药穴组CMP-140、TXB：治疗后显著降低，与治疗前比较，差异有非常显著性意义（P〈0．01）；治疗后药穴组与对照组、中药组比较，差异有显著性意义（P〈0．05）。提示药穴组能明显降低CMP-140、TXB2含量。总有效率药穴组与中药组、耳穴组、对照组比较，差异均有显著性意义（P〈0．05）；中药组、耳穴组、对照组3组比较，差异无显著性意义（P〉0．05）。提示药穴组疗效明显优于其他3组。结论：药穴结合能明显降低CMP-140、TXB：的含量，对UC有较好治疗作用。     

带钩软体Cu140宫内节育器的研制和试用

带钩软体Ｃｕ１４０ＩＵＤ的设计构思为：１．带钩的ＩＵＤ可固定在宫底肌层内；２ＩＵＤ体部柔软，能适应不同大小形态的宫腔和收缩时变形；３．铜套面积１４０ｍｍ２在环的体部分布合理，铜面积减少可获得同样满意的避孕效果。放置３９４例经一年随访按生命表法统计一年净累计带器妊娠率１．０３％，因症取出率１．０４％，脱落率３．３６％，副反应小。脱落与ＩＵＤ的质量和放置技术有关。未掌握放置技术时脱落率达１０．６９％，正确放置到位者脱落率低。提高ＩＵＤ质量和放置技术，钩铜１４０将成为一种理想的新颖ＩＵＤ。