口服美托洛尔引起浮肿1例

美托洛尔为第2代选择性肾上腺素β受体(β受体)阻滞剂,临床上用于治疗高血压、心绞痛、心肌梗死及各种室上性或室性心动过速[1-4].对某些无临床意义、非器质性心脏病病人出现的房性、室性期前收缩等,若伴有心悸症状,也可酌情使用β受体阻滞剂,改善症状.我院1例室性期前收缩病人应用美托洛尔改善心悸症状,出现了颜面及双下肢浮肿,现报道如下.     

β1肾上腺素能受体反义寡核苷酸对肾性高血压大鼠血流动力学及心肌肥厚的影响

目的 :观察阳离子脂质体 (DOTAP DOPE)介导的 β1肾上腺素能受体mRNA反义寡核苷酸 (β1 AS ODN)对肾性高血压大鼠血流动力学及心肌肥厚的影响。方法 :建立二肾一夹 (2K1C)肾性高血压大鼠模型 ,随机分为假手术组、模型组、反向寡核苷酸组、反义寡核苷酸组和卡维地洛 (carvedilol)组。ODN与DOTAP DOPE以 1 2摩尔比混合 ,4周末尾静脉注射 0 .5mg·kg-1,卡维地洛 10mg·kg-1·d-1灌胃 4周。定期测血压 ,8周末测血流动力学参数 ,左室重量指数 (LVWI)及血浆内皮素 1(ET 1)浓度 ,并对LVWI与ET 1进行线性相关分析。结果 :与反向寡核苷酸组比 ,β1 AS ODN能降低血压最高达39mmHg并持续 2 7d(30 .4 4± 6 .5 0 ,P <0 .0 1) ,降低左室收缩压 (LVSP) (P <0 .0 5 )、左室舒张末压 (LV EDP) (P <0 .0 1) ,升高左室最大收缩和舒张速率 (±dp dtmax) (P <0 .0 1) ,降低LVWI(P <0 .0 5 )及血浆ET 1(P <0 .0 1) ;与卡维地洛组比 ,各指标均无显著性差异。LVWI与ET 1显著正相关 (r =0 .74 9,P <0 .0 1)。结论 :DOTAP DOPE介导的 β1 AS ODN单剂量静脉注射能持续降压 ,改善血流动力学 ,预防心肌肥厚 ,可能与其降低血浆ET 1有关。     

52例α1受体阻滞剂在输尿管上段结石体外冲击波碎石术后的应用

目的探讨α1受体阻滞剂对输尿管上段结石体外冲击波碎石术(ESWL)术后辅助排石的初步经验。方法分析2006年1月至2010年5月108例输尿管上段结石ESWL患者的临床资料,患者随机分成两组:A组52例,B组56例。所有患者ESWL术后予司帕沙星0.2g,每天1次,A组接受上述治疗的同时,另加用坦索罗辛0.4mg,每日1次,所有患者日均饮水2L以上,进行日常活动。结果 A组与B组结石平均排出时间分别为4.10、6.91d,肾绞痛发生率为8%和29%,差异有统计学意义(P<0.05);结石排出率分别为82.7%、58.9%,一次ESWL后结石排净率分别为75.0%、44.6%,差异无统计学意义(P>0.05)。结论坦索罗辛可明显缩短输尿管上段结石患者的排石时间,减少肾绞痛发生次数,使用安全、痛苦少、恢复快。     

Cholinergic basal forebrain structures are involved in the mediation of the arousal effect of noradrenaline

Cholinergic basal forebrain structures are implicated in cortical arousal and regulation of the sleep–wake cycle. Cholinergic neurones are innervated by noradrenergic terminals, noradrenaline excites them via alpha‐1 receptors and microinjection of noradrenaline into the basal forebrain enhances wakefulness. However, it is not known to what extent the cholinergic versus non‐cholinergic basal forebrain projection neurones contribute to the arousing effects of noradrenaline. To elucidate the roles of cholinergic basal forebrain structures we administered methoxamine, an alpha‐1‐adrenergic agonist into the basal forebrain, in intact animals and again after selective destruction of the basal forebrain cholinergic cells by 192 IgG‐saporin. In eight male Han–Wistar rats implanted with electroencephalogram/electromyogram electrodes, a microdialysis probe targeted into the basal forebrain was perfused with artificial cerebrospinal fluid for 6 h on a baseline day, and with cerebrospinal fluid in the first and with methoxamine in the second 3‐h period of the subsequent day. The sleep–wake activity was recorded for 24 h on both days. Saporin was then injected into the basal forebrain and 2 weeks later the same experimental schedule (with cerebrospinal fluid and methoxamine) was repeated. In the intact animals, methoxamine exhibited a robust arousing effect and non‐rapid eye movement (NREM) and REM sleep was suppressed. Lesioning of the basal forebrain cholinergic neurones abolished almost completely the NREM sleep‐suppressing effect of methoxamine, whereas the REM sleep‐suppressing effect remained intact. Thus, the basal forebrain cholinergic neurones mediate, at least in part, cortical arousal and non‐REM sleep‐suppression, but they are not involved in the REM sleep‐suppressing effects of noradrenaline.     

The Road to Eleusis: Unveiling the Secret of the Mysteries

Abstract

Vivid imagery and hallucinations are occasionally reported by patients on beta-adrenergic blocking agents. The authors document this side effect with drawings by a well-known commercial artist.     

Demonstration of intrathecal and systemic morphine and ST-91 effects on fed canine upper gut motility

We studied the effects of opioid and adrenergic agonists and antagonists given systemically intravenously and intrathecally on postprandial antral and small bowel motility in a chronic conscious dog model. We studied eight dogs with a surgically implanted thoracic spinal intrathecal injection catheter, and six gastrointestinal manometric perfusion catheters. Morphine given intrathecally or intravenously induced propagated clusters of intestinal pressure activity in the fed dogs. The minimal effective dose for morphine was 150 g/kg by the intrathecal route and 450 g/kg by the intravenous route. ST-91 (an ₂-adrenergic agonist) profoundly inhibited antral and small intestinal pressure activity with similar minimal effective dose (100 g/kg) and duration of effect for both intravenous and intrathecal routes. Neither naloxone (3000 g/kg) nor combined phentolamine (1500 g/kg) with propranolol (300 g/kg) altered postprandial antral or small intestinal motility. The capacity of pharmacologic agents to block morphine-induced activity fronts when administered in the same compartment (intravenously or intrathecally) was investigated. The minimally effective morphine-antagonist dose for naloxone was similar intrathecally and intravenously (36 g/kg for both routes). ST-91 (100 g/kg) when given intrathecally or intravenously blocked morphine-induced clustered phasic pressure activity while simultaneously abolishing postprandial small intestine phasic pressure activity. These data suggest the presence of opioid and ₂-adrenergic receptors in the spinal cord that can modulate gastrointestinal motility in the postprandial state. Pharmacological interactions between these systems occur at spinal and target organ levels.     

交感神经递质及其受体在小鼠血吸虫肝纤维化中的作用

目的 研究交感神经递质及其受体在正常小鼠及血吸虫病肝纤维化小鼠体内的变化情况.方法 应用腹部敷贴尾蚴法制备血吸虫病小鼠模型.30只昆明小鼠随机分为正常对照组和肝纤维化模型组.采用HE和Van Gieson染色,光镜观察肝组织病理学改变及纤维化程度,免疫荧光组织化学染色结合激光共聚焦扫描检测肝组织中α1A、β2肾上腺素能受体表达情况,同时用高效液相色谱-电化学法检测血浆中去甲肾上腺素和多巴胺的水平. 结果 正常组α1A、β2肾上腺素能受体散在表达于肝细胞胞质和肝窦内,模型组在门静脉和虫卵结节周围肝细胞胞质中阳性表达明显增加(α1A受体的平均灰度值分别为18.28±7.56、30.53±8.88,β2受体的平均灰度值分别为28.67±6.42、42.29±4.56,t值分别为-2.888和-6.648,P值均＜0.05);血吸虫肝纤维化小鼠和正常小鼠去甲肾上腺素含量分别为(7.83±4.36)、(2.72±0.94)ng/ml,多巴胺的含量分别为(6.97±4.33)、(0.74±0.34)ng/ml,t值分别为-3.372和-4.428,P值均＜0.05.结论 交感神经递质及其受体表达的上调可能是血吸虫肝纤维化发展的作用机制之一.     

β肾上腺素能受体激动剂对离体大鼠肺泡液体清除率的作用

目的探讨β1肾上腺素能受体激动剂地诺帕明、β2肾上腺素能受体激动剂特布他林、β3肾上腺素能受体激动剂BRL37344对离体大鼠肺泡液体清除率(AFC)的作用及机制。方法5%白蛋白等渗生理盐水溶液和不同药物混合后灌注到离体大鼠的肺泡腔内,根据灌注前及其孵育1h后白蛋白浓度的变化来计算大鼠AFC。结果基础AFC为6.9%±2.2%,地诺帕明、特布他林、BRL37344可显著提高AFC(分别为17.1%±2.4%、19.5%±1.2%、19.9%±2.5%)。β1肾上腺素能受体阻滞剂Atenolol可完全抑制地诺帕明提高AFC(6.1%±0.9%)的作用,但不能阻滞特布他林和BRL37344的作用。β2肾上腺素能受体阻滞剂ICI118551完全抑制了特布他林和BRL37344提高AFC(分别为5.7%±0.6%和7.8%±2.6%)的作用,部分抑制了地诺帕明的作用(AFC为12.7%±1.8%)。β3肾上腺素能受体阻滞剂SR59230A部分抑制了BRL37344和特布他林的作用(AFC分别为13.8%±3.1%和14.5%±3.4%),但不能阻滞地诺帕明的作用。结论地诺帕明、特布他林、BRL37344可以显著提高大鼠的AFC。但地诺帕明和特布他林是分别通过β1、β2肾上腺素能受体起作用;而BRL37344可能是通过β2肾上腺素能受体调节的。ICI118551和SR59230A可能分别具有抑制β1或β2肾上腺素能受体的作用。     

基于FAERS的α1受体拮抗剂相关性功能障碍不良事件数据挖掘研究

目的：基于美国FDA不良事件报告系统（FAERS）大数据,对肾上腺素能α₁受体拮抗剂（α₁RA）相关性功能障碍不良事件进行数据挖掘,为临床安全使用α₁RA提供参考。方法：下载2004Q1至2018Q4共60个季度的FAERS数据,经过MedEx药品名称标准化、MedDRA不良事件系统分类等数据清洗后,提取α₁RA相关性功能障碍不良事件,采用比例报告比值法（PRR）和报告比值比法（ROR）进行信号检测。结果：共提取到α₁RA相关性功能障碍不良事件报告记录1651条,其中坦索罗辛1075条（1.76%）、特拉唑嗪164条（1.47%）、赛洛多辛158条（5.16%）、阿呋唑嗪134条（1.57%）和多沙唑嗪120条（0.72%）。6个HLTs检索到ADEs报告,5种α₁RAs在"勃起和射精状态和障碍"均提示信号,坦索罗辛和赛洛多辛在"性欲障碍类"提示信号,特拉唑嗪在"性功能障碍"提示信号,坦索罗辛、赛洛多辛和阿呋唑嗪在"性高潮障碍和失调"提示信号,坦索罗辛和赛洛多辛在"精子发生和精液疾病"提示信号。报告超过100例的不良事件有："勃起功能障碍" 722例（0.72%）、"射精障碍"596例（0.59%）、"性欲障碍"295例（0.29%）、"勃起增强"211例（0.21%）、"性功能障碍"200例（0.20%）,均以坦索罗辛报告数最多。结论：应警惕α₁RA相关性功能障碍不良事件风险。     

Pseudoephedrine and circadian rhythm interaction on neuromuscular performance

This study analyzed the effects of pseudoephedrine (PSE) provided at different time of day on neuromuscular performance, side effects, and violation of the current doping cut‐off threshold [World Anti‐Doping Agency (WADA)]. Nine resistance‐trained males carried out bench press and full squat exercises against four incremental loads (25%, 50%, 75%, and 90% one repetition maximum [1RM]), in a randomized, double‐blind, cross‐over design. Participants ingested either 180 mg of PSE (supra‐therapeutic dose) or placebo in the morning (7:00 h; AM_PLAC and AM_PSE) and in the afternoon (17:00 h; PM_PLAC and PM_PSE). PSE enhanced muscle contraction velocity against 25% and 50% 1RM loads, only when it was ingested in the mornings, and only in the full squat exercise (4.4–8.7%; P < 0.05). PSE ingestion raised urine and plasma PSE concentrations (P < 0.05) regardless of time of day; however, cathine only increased in the urine samples. PSE ingestion resulted in positive tests occurring in 11% of samples, and it rose some adverse side effects such us tachycardia and heart palpitations. Ingestion of a single dose of 180 mg of PSE results in enhanced lower body muscle contraction velocity against low and moderate loads only in the mornings. These mild performance improvements are accompanied by undesirable side effects and an 11% risk of surpassing the doping threshold.