Activity of the hypothalamic-pituitary-adrenal axis in mice selected for left- or right-handedness

Asymmetry in brain modulation of the immune system has been previously described. In mice, paw preference has been shown to be associated with immune reactivity but the mechanisms involved in such an association are not yet known. The autonomic nervous system and the neuroendocrine system are considered as major candidates for neural influences on the immune system. In the present study, the activity of the hypothalamic-pituitary-adrenal (HPA) axis of adult female mice selected for paw preference (left-handers vs. right-handers) was assessed by measuring both adrenocorticotropic hormone (ACTH) and corticosterone plasma levels, as well as the in vitro responses of hypothalamus and adrenocortical cells to various hormone releasing stimuli. The results reported here showed no difference in the activity of the HPA axis between left- and right-handed mice, suggesting that this neuroendocrine axis is not implicated in the association between functional brain asymmetry and immune reactivity. However, our results do not exclude the possibility that the HPA axis could play a role in such an association under other circumstances, such as during development or stressful situations.     

白松片对慢性应激抑郁模型大鼠行为学及血浆CORT、ACTH的影响

目的：观察白松片对慢性应激抑郁大鼠模型行为学和血浆CORT、ACTH含量的影响。方法：SD雄性大鼠28只随机分为空白对照组、模型对照组、氟西汀对照组及白松片试验组，选用慢性轻度不可预见性应激加孤养造模，观察各组大鼠敞箱实验和液体消耗等行为学指标变化，采用放射免疫方法检测大鼠血浆皮质醇(CORT)和促肾上腺皮质激素(ACTH)含量。结果：慢性应激抑郁大鼠体重增加缓慢，敞箱实验中的水平运动、垂直运动得分、清洁动作次数显著减少，中央格停留时间显著延长；糖水消耗明显下降，纯水消耗显著增多，而且其血浆皮质醇和促肾上腺皮质激素含量增加。氟西汀和白松片均显著改善慢性应激抑郁大鼠模型的行为学和神经内分泌变化。结论：慢性轻度不可预见性应激可使大鼠行为及神经内分泌发生异常改变，引起抑郁状态，白松片对此具有一定拮抗作用。     

一例促皮质素静脉外渗至局部皮肤坏死的案例解析与改进

对1例癫痫性痉挛患儿采用促皮质素静脉给药时发生静脉外渗至局部皮肤坏死的案例进行解析。针对事件发生原因,制定并采取措施:静脉穿刺难度事前评估,优化临床监护,加强相关知识培训,以肌肉注射代替静脉滴注等,避免了此类事件的再次发生,提升了临床合理用药水平,确保了患者安全。     

Active transport of polypeptides in rabbit nasal mucosa: Possible role in the sampling of potential antigens

Transepithelial pathways of macromolecule transport have been studied in vitro in rabbit nasal respiratory mucosa, maintained at 27° C. Transepithelial electrical potential difference, short-circuit current and resistance were 3.4±0.5mV (submucosa positive), 65.0±6.7 A cm^–2 and 52.1±5.6 cm^–2 respectively (n=15). These electrical characteristics are those of a leaky epithelium allowing macromolecules to permeate paracellularly. A detailed permeation study of a polypeptide (elcatonin, M _w=3362) was also undertaken. Elcatonin mucosa-submucosa (J _ms) and submucosa-mucosa (J _sm) fluxes were measured by radioimmunoassay. With 10 g/ml elcatonin, J _ms was significantly larger than J _sm for the whole 120-min period of observation; net flux showed a maximum in the first 30 min (J _ms=13.6±1.0 ng cm^–2 h^–1, J _sm=1.4±0.1 ng cm^–2 h^–1, n=10). J _ms fell towards the value of J _sm if the temperature was reduced to 4°C or if the mucosa was simultaneously treated with 0.1 mM dinitrophenol and 3 mM monoiodoacetate. J _ms and J _net followed saturation kinetics with increasing elcatonin concentrations. Adrenocorticotropic hormone (M _r=4500) produced a similar pattern to elcatonin. However, J _ms and J _sm were not significantly different from each other at any time either for [³H]sucrose (M _w=342) or for [¹⁴C]polyethyleneglycol-4000 (M _w=4000) when present in the bathing medium at 500 M concentration. The results show active transport of polypeptides in parallel with passive permeation (possibly through leaky intercellular junctions). Active transport does not appear to be related to nonspecific pinocytosis but to receptor-mediated endocytosis. The latter may be important for the sampling of potential antigens from the nasal lumen.     

Safety,tolerability, and effectiveness of oral zonisamide therapy in comparison with intramuscular adrenocorticotropic hormone therapy in infants with West syndrome

West syndrome is a distinct, infantile onset, epileptic encephalopathy, associated with poor neurodevelopmental outcome. The present study was designed as a randomized, open-label, pilot study to evaluate the safety, feasibility, and effectiveness of oral zonisamide therapy in comparison with adrenocorticotropic hormone therapy in infants with West syndrome. Thirty infants with West syndrome were randomized to receive treatment with either synthetic, intramuscular adrenocorticotropic hormone (30–60 IU) or oral zonisamide (4–25 mg/kg/day). The study participants had a long treatment lag and preponderance of male sex (90%). The primary effectiveness outcome measure was the cessation of epileptic spasms at 2 weeks of initiation of therapy and persistent till 6 weeks as per West Delphi consensus statement recommendations. Comparison of efficacies of zonisamide versus adrenocorticotropic hormone was as following: the cessation of epileptic spasms (27% vs. 40%, p = 0.70), resolution of hypsarrhythmia at 14 days (20% vs. 33%, p = 0.68) and resolution of hypsarrhythmia at 6 weeks (36% vs. 71%, p = 0.14). Overall, the study observed a poor efficacy of both adrenocorticotropic hormone and zonisamide therapy, which is probably due to long treatment lag and a high proportion of structural aetiology. However, oral zonisamide appeared to be safe and tolerable in the study.     

Adrenocorticotropic hormone-dependent hypercortisolism caused by pancreatic neuroendocrine carcinoma: A thought-provoking but remorseful case of delayed diagnosis

Introduction and importanceDefinitive diagnosis of functioning neuroendocrine neoplasms (NENs) in the pancreas is challenging. Adrenocorticotropic hormone (ACTH) regulates adrenal cortisol production. Ectopic ACTH secretion by functioning NENs may cause hypercortisolism.Presentation of caseA 62-year-old woman who was receiving medications for hypertension and hyperlipidemia was referred to our hospital because of abnormal blood tests. Diabetes mellitus was initially diagnosed. Dynamic computed tomography and endoscopic ultrasound revealed a 35-mm diameter hypovascular tumor in the distal pancreas and multiple liver metastases. Endoscopic ultrasound-guided fine-needle aspiration resulted in a diagnosis of neuroendocrine carcinoma. The patient developed pancreatic leakage progressing to peritonitis, abscess formation, pleural effusion, and ascites after the fine-needle aspiration biopsy. Her clinical condition deteriorated to a septic state, necessitating emergency surgery comprising distal pancreatectomy, intraperitoneal lavage, and drainage. Wound healing was protracted and accompanied by ongoing high white blood cell counts and neutrophilia. She also developed a gastric ulcer postoperatively. Systematic endocrine investigations were performed because hypercortisolism caused by a functioning NEN was suspected. Eventually, a definitive diagnosis of an ACTH-producing NEN in the pancreas was made. Systemic chemotherapy was proposed; however, the patient and her family opted for palliative treatment only. She died 42 days after the initial diagnosis.Clinical discussionWe here present a patient with ACTH-dependent hypercortisolism attributable to a pancreatic NEN who died of progressive cancer after a delay in definitive diagnosis.ConclusionDetailed investigation, including systematic endocrine examination and functional imaging studies, are important for precise diagnosis of, and appropriate treatment for, NENs.     

海洛因戒断及复吸对大鼠肾上腺髓质细胞β-内啡肽和促肾上腺皮质激素表达及血清皮质醇的影响

目的 探讨海洛因戒断、脱毒及复吸对大鼠肾上腺髓质细胞β-内啡肽（β-EP）和促肾上腺皮质激素（ACTH）表达及血清皮质醇（COR）的影响。方法 成年雄性SD大鼠63只,随机分为实验组（21只）、盐水对照组（21只）和正常对照组（21只）,实验组又分为戒断组、脱毒组和复吸组,采用免疫组织化学、图像分析法及放射免疫测定法进行研究。结果 与正常及盐水对照组比较,海洛因戒断组β-EP免疫反应（β-EP-IR）细胞染色变浅,平均灰度值升高（P <0.05）;经美沙酮脱毒治疗,β-EP-IR细胞染色较正常及盐水对照组加深,平均灰度值降低（ P <0.05）;海洛因复吸组β-EP-IR细胞表达再次减弱,但与正常及盐水组比较,平均灰度值差异无显著性。与正常及盐水对照组比较,实验各组大鼠肾上腺髓质ACTH免疫反应（ACTH-IR）细胞染色均变浅,平均灰度值增高,有显著差异（P <0.05）。放射免疫测定结果表明,实验各组大鼠血清COR均显著高于正常对照组（P <0.05）。结论 海洛因戒断、脱毒、复吸影响了大鼠肾上腺髓质细胞表达β-EP、ACTH以及血清COR的分泌。     

宫内生长发育受限患儿血清糖皮质激素变化

目的探讨宫内生长发育受限患儿是否存在下丘脑一垂体一’肾上腺轴功能紊乱。方法收集2012-1-1至2013-6-1在北京友谊医院儿科住院的宫内生长发育受限（inttauterine growth re8triction,IUGR）患儿和适于胎龄儿（appropriate for gestational age,AGA）血清,采用ELISA方法检测血清促肾上腺皮质激素（ACTH）、皮质醇、醛固酮激素水平变化。结果IU6R48例,AGA50例,两组性别比无差异。IUGR血清ACTH、皮质醇浓度（均数±标准差）浓度均比AGA组明显升高,且差异有统计学意义（P〈0．05）;IUGR血清醛固酮浓度与AGA组相比,血清水平下降,但差异无统计学意义,P〉0．05。结论宫内生长发育受限患儿血清ACTH、皮质醇浓度均明显高于适于胎龄儿,提示宫内生长发育受限患儿存在下丘脑-垂体-肾上腺轴的功能紊乱。     

肾上腺嗜铬细胞瘤致异位ACTH综合征的临诊应对

肾上腺嗜铬细胞瘤引起的异位ACTH综合征非常罕见.本文详细介绍1例肾上腺嗜铬细胞瘤引起异位ACTH综合征临床特点并结合国内外研究进展,讨论其诊治.提出正确的诊断应结合临床、生化、激素分泌、影像学、病理学、肿瘤免疫组化染色进行最终的综合判断.