Search

Background and purpose Effective management of hypotension refractory to vasoconstrictors in severe sepsis is limited. A new strategy to ameliorate endotoxemic hypotension by inducing endothelium-dependent constriction of large arteries was assessed. Experimental approach Endotoxemia in rats was induced by injection of LPS (10 mg·kg(-1), i.v.). Haemodynamics were measured in vivo, reactivity of isolated mesenteric arteries by myography and expression of proteins and enzyme activities by immunohistochemistry, biochemistry and molecular biology. Key results Six hours after LPS, the hypotension was promptly reversed following injection (i.v. or i.p.) of oroxylin-A (OroA) . In isolated LPS-treated but not normal mesenteric arteries, OroA (1-10 μM) induced endothelium-dependent, sustained constriction, blocked by endothelin-1 (ET-1) receptor antagonists. OroA further enhanced LPS-induced expression of endothelin-converting enzyme, ET-1 mRNA and proteins and ET-1 release, OroA also enhanced phosphorylation of Rho-associated protein kinase (ROCK) and reversed LPS-induced suppression of RhoA activities in smooth muscle of arteries with endothelium. Activated- phosphorylation of smooth muscle ROCK was blocked by ET-1-receptor antagonists and ROCK inhibitors. Moreover, OroA post-treatment suppressed, via inhibiting NF-κB activation, inducible NOS expression and circulating NO. Conclusions and implications Reversal of endotoxemic hypotensive by OroA was due to release of endothelial ET-1, upregulated by LPS, from mesenteric arteries, inducing prompt and sustained vasoconstriction via activation of vascular smooth muscle RhoA/ROCK-pathway. In late endotoxemia, OroA-induced vasoconstriction was partly due to decreased circulating NO. Activation of endothelium-dependent constriction in large resistance arteries and suppression of systemic inflammation offer new strategies for acute management of endotoxemic hypotensive shock.

Background: The emergence of antimicrobial resistance reinforces the need for antimicrobial stewardship to promote the appropriate and judicious use of antimicrobials. Aim: To quantify restricted antimicrobial use among intensive care unit (ICU) discharges to general wards, and to review appropriateness of antimicrobial use. Method: A prospective clinical audit was conducted over a 2- week period. Medical records for ICU discharges were reviewed, with relevant data extracted (patient characteristics, antimicrobial therapy prescribed, treatment instructions). Appropriateness of restricted antimicrobials used was gauged in accordance with hospital policies and the Therapeutic Guidelines: Antibiotic. Results: 98 patients were discharged from the ICU - 74 (76%) discharged to general wards were on antimicrobials, 15 discharged to general wards were not on antimicrobials and 9 discharged out of the hospital. Of these 74 patients, 31 (42%) were prescribed a total of 57 restricted antimicrobials; only 11 of these 31 (36%) patients had documented approval (from microbiology/infectious diseases teams) for use of restricted antimicrobials. 46 restricted antimicrobials (n = 57; 81%) were deemed clinically appropriate and the remaining 11 were prescribed outside guideline-recommended indications. Conclusion: While most restricted antimicrobials were prescribed according to national guidelines, in only one-third of patients were the restricted antimicrobials 'approved' for use according to hospital policies. Better clinical documentation on treatment plans and review processes for restricted antimicrobial use is needed during the transition from ICU to general wards.

NiAl2O4,NiFe2O4, and their solid solution Ni(FezAl1−z)2O4 have been studied using high temperature oxide melt solution calorimetry in molten 2PbO·B2O3 at 973 K. X-ray absorption near edge structure (XANES) measurements and Mossbauer spectroscopy investigation of the cation distribution showed that the Ni fraction in octahedral sites increases with increasing iron content. Despite the zero heat of mixing, the solid solution is not thermodynamically ideal in the sense of Raoult's law. The entropies of mixing are similar to those for a solid solution of two inverse spinels and the activities are approximated as the square of the mole fractions. The stability of the solid solutions relative to oxide components (NiO,Al2O3,Fe2O3) increases with increasing iron content. The solid solution is a suitable waste form for nickel from industrial processing with higher iron content potentially beneficial to its stability.

Aim: β-amyloid peptides (Aβs) have been shown to block cerebral nitrergic neurogenic vasodilation by blocking sympathetic α7-nAChRs, and that oestrogen prevents Aβ-induced neurotoxicity. We examined whether Aβ-inhibition of α7-nAChR-mediated cerebral nitrergic vasodilation was prevented by oestrogen. Methods: Effects of Aβ and 17β-oestradiol on neurogenic nitrergic vasodilation in isolated porcine basilar arteries were examined using wire-myography. Drug effects on nicotine- and choline-induced calcium influx and inward currents in porcine cultured superior cervical ganglion (SCG) were investigated using confocal microscopy and patch-clamp techniques respectively. Results: Precontracted endothelium-denuded basilar arteries relaxed exclusively upon transmural nerve stimulation (TNS, 8 Hz), and applications of nicotine (100 μm) or choline (1 mm), which was sensitive to nitro-L-arginine (L-NNA, 30 μm) and tetrodotoxin (0.3 μm). The relaxation induced by nicotine and choline but not that by TNS was blocked reversibly by Aβ1-40 in a concentration-dependent manner. Aβ1-40 also reversibly blocked nicotine- and choline-induced increase of calcium influx and inward currents in the SCG neurons. Aβ inhibition of nicotine- and choline-induced α7-nAChR-mediated nitrergic vasodilation and inward currents was prevented by 17β-oestradiol (10 μm), but not by α-oestradiol (10 μm) or testosterone (10 μm). Conclusion: These results provide further evidence supporting that Aβ is an antagonist for the α7-nAChR found on post-ganglionic sympathetic adrenergic nerve terminals originating in the SCG. Aβ can cause constriction of cerebral arteries with possible decreased regional cerebral blood flow by blocking sympathetic nerve-mediated release of nitric oxide from the perivascular nitrergic nerves. This effect of Aβ can be prevented by endogenous oestrogen but not testosterone.

Noradrenaline (NE) and acetylcholine (ACh) released from the sympathetic and parasympathetic neurones in cerebral blood vessels were suggested initially to be the respective vasoconstricting and dilating transmitters. Both substances, however, are extremely weak post-synaptic transmitters. Compelling evidence indicates that nitric oxide (NO) which is co-released with ACh from same parasympathetic nerves is the major transmitter for cerebral vasodilation, and its release is inhibited by ACh. NE released from the sympathetic nerve, acting on presynaptic β2-adrenoceptors located on the neighbouring parasympathetic nitrergic nerves, however, facilitates NO release with enhanced vasodilation. This axo-axonal interaction mediating NE transmission is supported by close apposition between sympathetic and parasympathetic nerve terminals, and has been shown in vivo at the base of the brain and the cortical cerebral circulation. This result reveals the physiological need for increased regional cerebral blood flow in ‘fight-or-flight response’ during acute stress. Furthermore, α7- and α3β2-nicotinic ACh receptors (nAChRs) on sympathetic nerve terminals mediate release of NE, leading to cerebral nitrergic vasodilation. α7-nAChR-mediated but not α3β2-nAChR-mediated cerebral nitrergic vasodilation is blocked by β-amyloid peptides (Aβs). This may provide an explanation for cerebral hypoperfusion seen in patients with Alzheimer’s disease. α7- and α3β2-nAChR-mediated nitrergic vasodilation is blocked by cholinesterase inhibitors (ChEIs) which are widely used for treating Alzheimer’s disease, leading to possible cerebral hypoperfusion. This may contribute to the limitation of clinical use of ChEIs. ChEI blockade of nAChR-mediated dilation like that by Aβs is prevented by statins pretreatment, suggesting that efficacy of ChEIs may be improved by concurrent use of statins.

The magnetic and electronic properties of CeCo 2 bulk and nanoparticles have been investigated using element-specific techniques, X-ray absorption spectroscopy (XAS) and X-ray magnetic circular dichroism (XMCD). The results of Ce L 3 -edge XAS spectra shows a higher spectral weight of 4f l configuration in nanoparticles with respect to the bulk, which indicates that the valence of Ce is decreased in nanoparticles. In addition, spectroscopic results from the XMCD at Co L 2,3 -edges and Ce M 4,5 -edges indicate that CeCo 2 undergoes a nonmagnetic to magnetic transition with size reduction. The variations in electronic and magnetic properties of nanoparticles were attributed to the charge transfer related to the sample dimension.

Background and purpose: Actions of glutamate and serotonin on their respective receptors in the dorsal facial area (DFA) of the medulla are known to regulate common carotid arterial (CCA) blood flow in cats. Less is known about acetylcholine action on its nicotinic receptor (nAChR) subtypes in the DFA for regulation of CCA blood flow and this aspect was investigated. Experimental approach: Nicotinic and muscarinic agonists and antagonists were microinjected into the DFA through a three-barrel tubing in anesthetized cats. Results: CCA blood flow was dose-dependently increased by nicotine (a non-selective nAChR agonist) and choline (a selective α7-nAChR agonist). These effects of nicotine were attenuated by α-bungarotoxin (an α7-nAChR antagonist), methyllycaconitine (an α7-nAChR antagonist), mecamylamine (a relatively selective α3β4-nAChR antagonist) and dihydro-β-erythroidine (a relatively selective α4β2-nAChR antagonist). The choline-induced flow increase was attenuated by α-bungarotoxin and mecamylamine, but not by dihydro-β-erythroidine. Muscarinic agonists (muscarine and methacholine) and antagonist (atropine) affected neither the basal nor the nicotine-induced increase in the CCA blood flow. Conclusions and implications: Functional α7, α4β2, and α3β4 subunits of the nAChR appear to be present on the DFA neurons. Activations of these receptors increase the CCA blood flow. The present findings do not preclude the presence of other nAChRs subunits. Muscarinic receptors, if any, on the DFA are not involved in regulation of the CCA blood flow. Various subtypes of nAChRs in the DFA may mediate regulation of the CCA and cerebral blood flows. British Journal of Pharmacology (2006) 149, 206–214; doi:10.1038/sj.bjp.0706844

In Asia, ginseng is commonly included in herbals used for the treatment of sexual dysfunction. Recent studies in laboratory animals have shown that both Asian and American forms of ginseng enhance libido and copulatory performance. These effects of ginseng may not be due to changes in hormone secretion, but to direct effects of ginseng, or its ginsenoside components, on the central nervous system and gonadal tissues. Indeed, there is good evidence that ginsenosides can facilitate penile erection by directly inducing the vasodilatation and relaxation of penile corpus cavernosum. Moreover, the effects of ginseng on the corpus cavernosum appear to be mediated by the release and/or modification of release of nitric oxide from endothelial cells and perivascular nerves. Treatment with American ginseng also affects the central nervous system and has been shown to significantly alter the activity of hypothalamic catecholamines involved in the facilitation of copulatory behavior and hormone secretion. Recent findings that ginseng treatment decreased prolactin secretion also suggested a direct nitric oxide-mediated effect of ginseng at the level of the anterior pituitary. Thus, animal studies lend growing support for the use of ginseng in the treatment of sexual dysfunction and provide increasing evidence for a role of nitric oxide in the mechanism of ginsenoside action.

Recycle of L-citrulline to form L-arginine in cerebral perivascular nerves has been well described, providing direct evidence that nitric oxide (NO) is synthesized and released from these nerves to act as the transmitter for vasodilation. NO is also synthesized and released from cerebral endothelial cells, involving L-citrulline conversion to L-arginine. Evidence for the presence of enzymes involved in the conversion, however, has not been shown. The presence of nitric oxide synthase (NOS), argininosuccinate synthetase (ASS), and argininosuccinate lyase (ASL), and their coexistence with NADPH-diaphorase (NADPHd), a marker for NOS, in endothelial cells of middle cerebral arteries and the circle of Willis of the pig, therefore, were examined using combined immunohistochemical and histochemical techniques. NOS-, ASS-, and ASL-immunoreactivities were found in almost all endothelial cells of all cerebral arteries examined. All ASS-, ASL-, and NOS-immunoreactive (I) endothelial cells also stained positively for NADPHd, suggesting that ASS, ASL, and NOS were colocalized in endothelial cells of middle cerebral arteries and the circle of Willis. These results provide morphological evidence that cerebral vascular endothelial cells like cerebral perivascular nerves contain enzymes necessary for recycling L-citrulline to L-arginine to synthesize NO via an argininosuccinate (AS) pathway.

Oroxylin A, a flavonoid and an active component isolated from Scutellariae baicalensis, has been considered beneficial in preventing inflammation-induced microglia-mediated neurodegeneration. Its r...

Cerebral blood vessels from several species are innervated by vasodilator nerves. Acetylcholine (ACh) released from parasympathetic cholinergic nerves was first suggested to be the transmitter for vasodilation. Results from pharmacological studies in isolated cerebral arterial ring preparations, however, have demonstrated that nitric oxide (NO) but not ACh mediates the major component of neurogenic vasodilation. More recently, ACh and NO have been shown to co-release from the same cholinergic-nitrergic nerves, and that ACh acts as a presynaptic transmitter in modulating NO release. In this communication, evidence for the neuronal origin of NO and possible role of ACh in modulating NO release in large cerebral arteries at the base of the brain will be discussed.

The clinical stage at presentation of 280 women with histologically proven breast cancer is reviewed over a 25 year time span from 1962 to 1987. The data from 240 unscreened patients, including 87 women from the period 1962 to 1963, 103 women from 1981 to 1982, and 50 women from 1986 to 1987 demonstrate a chronologically based improvement in the stage of disease at presentation over the 25 years. Specifically, over that period, there was a fall in the mean tumour diameter, a reduction in the proportion of patients with involved axillary nodes, and a greater percentage of patients with Stages I and II disease. A reduction in the symptomatic period was also noted over this time, and a direct relationship was found between the duration of symptoms and tumour size, nodal status and overall stage of disease. A subsequent comparison with the staging data from 40 women with breast cancer detected at a breast screening clinic (1985-87) shows that significant further advances in the earlier diagnosis of breast cancer can be achieved. Mammographic breast screening centres represent the best-known means of early breast cancer detection, and thus may hold the key to reducing breast cancer mortality.

Acute appendicitis is a great masquerader in surgical practice; its diverse clinical presentation can sometimes lead to delay in diagnosis. Nonetheless, the underlying aetiology of acute appendicitis may not be apparent if the appendix is not sent for histological examination.