Efeito da nitroglicerina no espasmo e na oclusão da artéria radial em cateterismos transradiais realizados em mulheres / Effect of nitroglycerin on radial artery spasm and occlusion in transradial catheterizations performed in women

Introdução: O benefício do cateterismo transradial já foi confirmado em pacientes do sexo feminino. Mulheres submetidas a exames por cateterismo transradial apresentam desafios únicos. A ocorrência de espasmo e oclusão da artéria radial após o procedimento é maior em mulheres. Objetivamos avaliar o benefício da nitroglicerina na redução de espasmo e oclusão da artéria radial em mulheres submetidas a cateterismo transradial. Métodos: Estudo multicêntrico, prospectivo, randomizado 2x2 fatorial, duplo-cego. Participantes foram randomizados para nitroglicerina 500mcg ou placebo em dois momentos: após colocação do introdutor hemostático e antes da retirada. A avaliação de espasmo da artéria radial foi clínica, por meio de escala dor. A avaliação da oclusão da artéria radial foi realizada com Doppler, nas primeiras 12 horas. Resultados: Foram incluídos 2.040 pacientes, sendo 774 (37,5%) mulheres. A média de idade foi similar entre os sexos (62,2 anos versus 61,5 anos; p=0,27). A incidência de espasmo da artéria radial foi maior nas mulheres (21,2% versus 6,6%; p<0,01), bem como a incidência de oclusão da artéria radial (3,4% versus 1,8%; p=0,03). O uso da nitroglicerina no início do procedimento não reduziu a incidência de espasmo da artéria radial em mulheres quando comparado com o placebo (19,7% versus 22,6%; p=0,34), tampouco as taxas de oclusão da artéria radial (4,3% versus 2,5%; p=0,17). O uso da nitroglicerina ao fim do procedimento não reduziu a incidência de oclusão da artéria em mulheres (2,8% versus 3,9%; p=0,37). Conclusões: O espasmo e a oclusão da artéria radial são mais frequentes em mulheres submetidas a cateterismo transradial quando comparadas aos homens. O uso da nitroglicerina não apresenta efeito benéfico na redução dessas incidências.

Background: The benefit of transradial catheterization is well established in female patients. Women undergoing transradial catheterization exams present with unique challenges. The occurrence of radial artery spasm and occlusion after the procedure is higher in women. The objective of this study was to evaluate the benefit of nitroglycerin in reducing radial artery spasm and occlusion in women undergoing transradial catheterization. Methods: This was a 2x2 factorial randomized, multicenter, prospective, double-blinded study. Participants were randomized to nitroglycerin 500mcg or placebo at two time points: after placement of the hemostatic introducer and before its removal. The evaluation of the radial artery spasm was clinical, using a pain scale The evaluation of the radial artery occlusion was performed with Doppler, in the first 12 hours. Results: A total of 2,040 patients were included, of which 774 (37.5%) were female. Mean age was similar between sexes (62.2 years versus 61.5 years; p=0.27). The incidence of radial artery spasm was higher in women (21.2% versus 6.6%; p<0.01), as well as the incidence of radial artery occlusion (3.4% versus 1.8%; p=0.03). The use of nitroglycerin at the beginning of the procedure did not reduce the incidence of radial artery spasm in women when compared with placebo (19.7% versus 22.6%; p=0.34), nor did the rates of radial artery occlusion (4.3% versus 2.5%; p=0.17). The use of nitroglycerin at the end of the procedure did not reduce the incidence of artery occlusion in women (2.8% versus 3.9%; p=0.37). Conclusions: Radial artery spasm and occlusion are more frequent in women undergoing transradial catheterization when compared to men. The use of nitroglycerin does not have a beneficial effect in reducing these incidences.

ANALYSIS AND COMPARATIVE STUDY OF TOPICAL CONSERVATIVEMEDICATION VERSUS OPERATIVE MANAGEMENT IN PATIENTS OFANAL FISSURE

Introduction:Anal fissures or anal ulcers are considered one of the commonest causes of severe analpain. Surgical techniques like manual anal(lords) dilatation or lateral internalsphincterotomy, effectively heal most fissures within a few weeks, but mayresult in permanently impaired anal continence. This has led to the research foralternative non-surgical treatmentAIMS AND OBJECTIVES:The present study comprises the comparative study of 2% Diltiazem gel,0.2% Glyceryl Nitrate,2%lignocaine jelly application and need of surgical intervention in the treatment of chronic fissure inano.MATERIALS AND METHODS: This is a prospective study of fissure in ano during the period from September 2020 to September2021 in Sheth Lallubhai Gordhandas Municipal General Hospital, Ahmedabad. Clinical Data ofadmitted patient were collected by their detail history after stabilizing the patient, clinicalexamination with appropriate investigations.OBSERVATION AND DISCUSSION:Anal fissure is a very common problem across the world. It causes considerablemorbidity and adversely affects the quality of life. Therefore appropriate treatment ismandatory.In this study the commonest age group affected was 31-40 years agegroup (40%) and least affected were 51-60 years age groupThe incidence of fissure in males was slightly greater than females with MaleFemale ratio being 2.2: 1 in our study.CONCLUSION:Propper clinical examination and appropriate investigations helps in management of patient eitheroperative or non-operative which leads successful treatment in these patients.

Nicardipine versus nitroglycerin for hypertensive acute heart failure syndrome: a single-center observational study / Journal of Rural Medicine

Objective: Nitroglycerin is a first-line treatment for hypertensive acute heart failure syndrome (AHFS). However, nicardipine is frequently used to treat hypertensive emergencies, including AHFS. In this study, we compared the effectiveness of nicardipine and nitroglycerin in patients with hypertensive AHFS.Patients and Methods: This single-center, retrospective, observational study was conducted at the intensive care unit of a Japanese hospital. Patients diagnosed with AHFS and systolic blood pressure 140 mmHg on arrival between April 2013 and March 2021 were included. The outcomes were the time to optimal blood pressure control, duration of continuous infusion of antihypertensive agents, duration of positive pressure ventilation, need for additional antihypertensive agents, length of hospital stay, and body weight changes. Outcomes were compared between the nicardipine and nitroglycerin groups. We also compared these outcomes between the groups after excluding patients who received renal replacement therapy.Results: Fifty-eight patients were enrolled (26 and 32 patients were treated with nitroglycerin and nicardipine, respectively). The nicardipine group had a shorter time to optimal blood pressure control (2.0 [interquartile range, 2.0–8.5] h vs. 1.0 [0.5–2.0] h), shorter duration of continuous anti-hypertensive agent infusion (3.0 [2.0–5.0] days vs. 2.0 [1.0–2.0] days), less frequent need for additional anti-hypertensive agents (1 patients [3.1%] vs. 11 patients [42.3%]), and shorter length of hospital stay (17.5 [10.0–33.0] days vs. 9.0 [5.0–15.0] days) than the nitroglycerin group. The duration of positive pressure ventilation and body weight changes were similar between the groups. The outcomes were similar after excluding patients who received renal replacement therapy.Conclusion: Nicardipine may be more effective than nitroglycerin for treating hypertensive AHFS.

The efficacy of esmolol, remifentanil and nitroglycerin in controlled hypotension for functional endoscopic sinus surgery / Eficácia do esmolol, remifentanil e nitroglicerina na hipotensão controlada para cirurgia sinusal endoscópica funcional

Abstract Introduction Controlled hypotension is a reversible procedure in which the patient's baseline mean arterial blood pressure is reduced by 30% and sustained at 60-70 mmHg during the procedure. It decreases blood loss and provides clear surgical field during the procedures. Objectives The purpose of this study was to compare the efficacy of controlled hypotension agents esmolol, remifentanil, and nitroglycerin in functional endoscopic sinus surgery, in terms of hemodynamic changes and impact on the surgical efficiency. Methods The research was carried out as a cohort study. Patients who underwent functional endoscopic sinus surgery were randomized into 3 groups. Controlled hypotension was achieved with remifentanil (Group R), esmolol (Group E) and nitroglycerin (Group N). The efficacy of the drugs was tested by comparing the length of time with the targeted mean arterial pressure, the amount of anesthetics used, surgical field bleeding score and surgeon's satisfaction. Results Between May to December 2015, 60 patients were included and randomized equally into 3 different study groups. The median of the length of time with the targeted mean arterial pressure was shorter in the Group R when compared with Group E (p = 0.01) and Group N (p = 0.14). The amount of volatile anesthetics used was 25.0 mL (15-51), 43.0 mL (21-105) and 40.0 mL (26-97) in Groups R, E and N, respectively (p < 0.001). While there was more bleeding with nitroglycerin, surgical field bleeding scores were lower in Group R when compared with esmolol (p = 0.001) and nitroglycerin (p < 0.001). The analysis of surgeon's satisfaction scores concluded that surgeons were more satisfied with the group R (100%), when compared with group E (60%) and group N (30%) (p < 0.001). Conclusion Less volatile agent, short time to achieve controlled hypotension, stable blood pressure, lower surgical field bleeding scores and larger length of time with the targeted mean arterial pressure were found as the advantages of Remifentanil. Less costly, efficiency of achieving the targeted median arterial pressure and less postoperative complications were the advantages of nitroglycerin. In functional endoscopic sinus surgery procedures, appropriate controlled hypotensive agents should be selected according to the patients' characteristics and advantages/disadvantages of the drugs.

Resumo Introdução Hipotensão controlada é um procedimento reversível no qual a pressão arterial média basal do paciente é reduzida em 30% e mantida em 60-70 mmHg durante o procedimento. Isso diminui a perda de sangue e propicia um campo cirúrgico limpo durante os procedimentos. Objetivo Comparar agentes usados para hipotensão controlada: esmolol, remifentanil e nitroglicerina em cirurgia sinusal endoscópica funcional, em termos de alterações hemodinâmicas e impactos na eficácia cirúrgica. Método O estudo foi feito como de coorte. Pacientes submetidos à cirurgia sinusal endoscópica funcional foram randomizados em 3 grupos. A hipotensão controlada foi feita com remifentanil (Grupo R), esmolol (Grupo E) e nitroglicerina (Grupo R). A eficácia dos medicamentos foi testada com a comparação do período de tempo com a pressão arterial média desejada, a quantidade de anestésicos usados, o escore de sangramento no campo cirúrgico e a satisfação do cirurgião. Resultados Entre maio e dezembro de 2015, 60 pacientes foram incluídos e randomizados igualmente nos três grupos de estudo. A mediana do período com a pressão arterial desejada foi menor no Grupo R quando comparado ao Grupo E (p = 0,01) e Grupo N (p = 0,14). A quantidade de anestésicos voláteis usados foi de 25,0 mL (15 ± 51), 43,0 mL (21 ± 105) e 40,0 mL (26 ± 97) nos Grupos R, E e N, respectivamente (p < 0,001). Houve mais sangramento com nitroglicerina e escores de sangramento no campo cirúrgico foram menores no Grupo R quando comparados com esmolol (p = 0,001) e nitroglicerina (p < 0,001). A análise dos escores da satisfação do cirurgião concluiu que os cirurgiões estavam mais satisfeitos com o grupo R (100%) quando comparados ao grupo E (60%) e o grupo N (30%) (p < 0,001). Conclusão Agente menos volátil, pouco tempo para obter a hipotensão controlada, pressão arterial estável, menor escore de sangramento no campo cirúrgico e período de pressão arterial desejada curto foram considerados como vantagens do remifentanil. Menor custo, eficácia de obtenção da pressão arterial média desejada e menos complicações pós-operatórias foram as vantagens da nitroglicerina. Nos procedimentos de cirurgia sinusal endoscópica funcional, os agentes apropriados para obtenção de hipotensão controlada devem ser selecionados de acordo com as características dos pacientes e as vantagens/desvantagens dos fármacos.

Therapeutic effect of Toutongning Dropping Pills on migraine / 中草药

Objective: To evaluate the therapeutic effect of Toutongning Dropping Pills in the treatment of migraine in various experimental models. Methods: The experimental model of nitroglycerin-induced migraine in rats was used to observe the preventive effect of Toutongning Dropping Pills. The analgesic effect of Toutongning Dropping Pills was observed by chemical stimulation, thermal stimulation in mice, mechanical stimulation and formalin stimulation in rats. The sedative effect of Toutongning Dropping Pills was observed by using the mice convulsion model induced by strychnine nitrate and the model of spontaneous activity in normal mice. The blood-activating effects of Toutongning Dropping Pills were observed in rats with hyperviscosity and mice with microcirculation disorder. Results: Five days after Toutongning Dropping Pills were given, compared with the model group, 1 g/kg and 2 g/kg drug dose group significantly reduced the number of climbing cage and scratching head in migraine rats, and shortened the fading time of pink ears. Toutongning Dropping Pills 1.5 g/kg and 3 g/kg dose group significantly reduced the number of writhing induced by acetic acid in mice; While it had no obvious effect on the thermal stimulation model. Toutongning Dropping Pills 1 g/kg and 2 g/kg dose group could significantly improve pain threshold of the mechanical stimulation of rats, and shorten the phase II time of formalin pain in rats; 1.5 g/kg and 3 g/kg drug dose group could significantly prolong the incubation period of convulsion and reduce the number of spontaneous activities in mice; 0.5 g/kg and 1 g/kg and 2 g /kg drug dose group significantly inhibited the increase of whole blood viscosity in rats; 1.5 g/kg and 3 g/kg drug dose group significantly improved the blood flow pattern in mice, reduced erythrocyte aggregation, and increased the number of capillary intersection points. Conclusion: Toutongning Dropping Pills have obvious analgesic, sedative, blood-activating functions, and have therapeutic effects on experimental migraine.

Consistency Evaluation of in vitro Quality of Nitroglycerin Tablet Reference Preparation and Imitative Preparation / 中国药房

OBJECTIVE：To investigate the in vitro quality consistency of domestic Nitroglycerin table t imitative preparation and reference preparation （original drug ）. METHODS ：The contents of nitroglycerin and related substances in 1 batch of Nitroglycerin tablet reference preparation （manufacturer A ）and 4 batches of imitative preparation （manufacturer B ，C，D，E） were determined according to Nitroglycerin Tablet Import Drugs Registration Standard JX 20010267. The paddle method of dissolution determination method was adopted ，with the rotating speed of 50 r/min. HPLC method was adopted to determine the dissolution amount of 5 batches of above preparations in 4 kinds of dissolution mediums （pH 1.2 hydrochloric acid solution ，pH 4.0 acetate buffer solution ，pH 6.8 phosphate buffer solution ，water） within 10 min.The accumulative dissolution rate was calculated，and dissolution curves of samples were drawn.The similarity of the dissolution curves was evaluated by calculating similarity factor （f2）of 2，5，8 min accumulative dissolution rate. RESULTS ：The contents of nitroglycerin in the preparations from manufacturer A ，B，C，D，E were 99.8％，98.3％，94.0％，93.3％，96.7％，respectively（n＝2）；the contents of related substance were 0.46％，0.55％，0.63％，0.72％，0.49％，respectively（n＝2）. Using reference preparation of manufacturer A as control，f2 of imitative preparation from manufacturer B ，C，D，E were 74，28，25，67 in pH 1.2 hydrochloric acid solution ；76， 26，28，84 in pH 4.0 acetate buffer solution ；79，39，35，71 in pH 6.8 phosphate buffer solution ；69，32，37，62 in water ， respectively. CONCLUSIONS ：The method is suitable for in vitro quality consistency evaluation of Nitroglycerin table timitative preparation. Compared with reference preparation ，the contents of main components in the imitative preparations from manufacturer C，D are lower ；in vitro dissolution curves of those imitative preparation are not similar to reference preparation .

Efficacy and Safety of Kuanxiong Aerosol in the Treatment of Coronary Heart Disease Angina ：A Meta-analysis / 中国药房

OBJECTIVE：To systematically evaluate the efficacy and safety of Kuanxiong aerosol in the treatment of coronary heart disease angina ，and to provide evidence-based reference for climical drug use . METHODS ：Retrieved from Cochrane Library，PubMed，Embase，CKNI，Wanfang data ，VIP，and CBM ，randomized controlled trials （RCTs）about Kuanxiong aerosol （trial group ）versus nitroglycerin （control group ）in the treatment of coronary heart disease angina were collected during the inception to Mar. 20th，2020. After literature screening and data extraction ，quality assessment was performed using the bias risk assessment tool recommended by the Cochrane System Evaluator Manual 5.1.0. Meta-analysis was performed by using Rev Man 5.3 statistical software. Sensitivity analysis was conducted for the stability of the result ，and trial sequential analysis （TSA）was performed by using TSA 0.9 software. RESULTS ：A total of 11 RCTs were included ，with a total of 1 847 cases. Meta-analysis showed that improvement rate of angina pectoris （within 3 min）[RR＝1.11，95％CI（1.02，1.22），P＝0.02] and total response rate of angina pectoris （within 5 min）[RR＝1.04，95％ CI（1.01，1.07），P＝0.01] in trial group were significantly higher than control group；the incidence of ADR [RR＝0.44，95％CI（0.35，0.57），P＜0.000 01] in trial group was significantly lower than control group. There was no statistical significance in total response rate of ECG [RR＝1.02，95％CI（0.97，1.09），P＝0.42] or the level of NO after treatment [SMD ＝－0.08，95％CI（－0.61，0.45），P＝0.76] between 2 groups. The results of sensitiv ity analysis and TSA showed that the efficacy evidence of Kuanxiong aerosol in the treatment of coronary heart disease pectoris was not accurate ，but the evidence of safety was accurate. CONCLUSIONS ：Kuanxiong aerosol can improve the efficacy in patients with coronary heart disease angina ，and the safety is better ，but the conclusions of efficacy needs to be further confirmed by enlarging sample size.

Coronary Computed Tomography Angiography for the Diagnosis of Vasospastic Angina: Comparison with Invasive Coronary Angiography and Ergonovine Provocation Test

OBJECTIVE: To investigate the diagnostic validity of coronary computed tomography angiography (cCTA) in vasospastic angina (VA) and factors associated with discrepant results between invasive coronary angiography with the ergonovine provocation test (iCAG-EPT) and cCTA. MATERIALS AND METHODS: Of the 1397 patients diagnosed with VA from 2006 to 2016, 33 patients (75 lesions) with available cCTA data from within 6 months before iCAG-EPT were included. The severity of spasm (% diameter stenosis [%DS]) on iCAG-EPT and cCTA was assessed, and the difference in %DS (Δ%DS) was calculated. Δ%DS was compared after classifying the lesions according to pre-cCTA-administered sublingual nitroglycerin (SL-NG) or beta-blockers. The lesions were further categorized with %DS ≥ 50% on iCAG-EPT or cCTA defined as a significant spasm, and the diagnostic performance of cCTA on identifying significant spasm relative to iCAG-EPT was assessed. RESULTS: Compared to lesions without SL-NG treatment, those with SL-NG treatment showed a higher Δ%DS (39.2% vs. 22.1%, p = 0.002). However, there was no difference in Δ%DS with or without beta-blocker treatment (35.1% vs. 32.6%, p = 0.643). The significant difference in Δ%DS associated with SL-NG was more prominent in patients who were aged < 60 years, were male, had body mass index < 25 kg/m2, and had no history of hypertension, diabetes, or dyslipidemia. Based on iCAG-EPT as the reference, the per-lesion-based sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of cCTA for VA diagnosis were 7.5%, 94.0%, 60.0%, 47.1%, and 48.0%, respectively. CONCLUSION: For patients with clinically suspected VA, confirmation with iCAG-EPT needs to be considered without completely excluding the diagnosis of VA simply based on cCTA results, although further prospective studies are required for confirmation.

Clinical effect of Shiquan Dabu Decoction combined with nitroglycerin on acute heart failure after myocardial infarction / 中国基层医药

Objective@#To summarize and discuss the clinical effect of Shiquan Dabu Decoction combined with nitroglycerin in the treatment of heart failure after acute myocardial infarction.@*Methods@#From January 2016 to June 2017, 110 patients with heart failure after acute myocardial infarction admitted to the Department of Cardiology of Lishui Hospital of Traditional Chinese Medicine were selected as study objects.The patients were randomly divided into observation group and control group according to the digital table, with 55 cases in each group.The control group was treated with routine nitroglycerin therapy, while the observation group was treated with routine nitroglycerin therapy combined with Shiquan Dabu Decoction.The therapeutic effect of the two groups after one week of treatment was observed.@*Results@#The total effective rate in the observation group was 92.73%, which was significantly higher than that of the control group(78.18%), and the difference between the two groups was statistically significant(χ2=4.681, P<0.05). The HR level of the observation group[(82.5±6.5)times/min] was significantly lower than that of the control group[(102.6±3.9)times/min](t=19.655, P<0.01). The levels of SBP[(116.5±6.4)mmHg]and SpO2[(95.2±1.6)%] in the observation group were significantly higher than those in the control group[(108.8±5.2)mmHg, (92.5±1.2)%], there were statistically significant differences between the two groups(t=6.925, 10.012, all P<0.01). The incidence of adverse reaction in the observation group was 10.91%, which was higher than that in the control group(3.64%), but there was no statistically significant difference (χ2=2.157, P>0.05).@*Conclusion@#For patients with heart failure after acute myocardial infarction, the combination of traditional Chinese medicine Shiquan Dabu Decoction in clinical routine treatment has better effect and is worthy of popularizing.

Clinical effect of Shiquan Dabu Decoction combined with nitroglycerin on acute heart failure after myocardial infarction / 中国基层医药

Objective To summarize and discuss the clinical effect of Shiquan Dabu Decoction combined with nitroglycerin in the treatment of heart failure after acute myocardial infarction .Methods From January 2016 to June 2017,110 patients with heart failure after acute myocardial infarction admitted to the Department of Cardiology of Lishui Hospital of Traditional Chinese Medicine were selected as study objects .The patients were randomly divided into observation group and control group according to the digital table ,with 55 cases in each group.The control group was treated with routine nitroglycerin therapy ,while the observation group was treated with routine nitroglycerin therapy combined with Shiquan Dabu Decoction.The therapeutic effect of the two groups after one week of treatment was observed.Results The total effective rate in the observation group was 92.73%,which was significantly higher than that of the control group (78.18%),and the difference between the two groups was statistically significant ( χ2 ＝4.681,P＜0.05).The HR level of the observation group [(82.5 ±6.5)times／min] was significantly lower than that of the control group[(102.6 ±3.9)times／min](t＝19.655,P＜0.01).The levels of SBP[(116.5 ±6.4)mmHg] and SpO2[(95.2 ±1.6)%] in the observation group were significantly higher than those in the control group [(108.8 ± 5.2)mmHg,(92.5 ±1.2)%],there were statistically significant differences between the two groups ( t ＝6.925, 10.012,all P＜0.01).The incidence of adverse reaction in the observation group was 10.91%,which was higher than that in the control group (3.64%),but there was no statistically significant difference (χ2 ＝2.157,P＞0.05). Conclusion For patients with heart failure after acute myocardial infarction ,the combination of traditional Chinese medicine Shiquan Dabu Decoction in clinical routine treatment has better effect and is worthy of popularizing .

Metabolomics in the Nitroglycerin-Induced Migraine Rats Intervened by Flunarizine / 中国药学杂志

OBJECTIVE: To study the mechanism of flunarizine in the nitroglycerin-induced migraine model rats by metabonomics. METHODS: The nitroglycerin-induced migraine rat model was used and the brain samples and serum samples were obtained at 30, 60, and 90 min after model establishment or drug administration. After the isolation of TCC sites was performed,GC-TOF-MS was used to analyze the metabolic status of rat serum and TCC sites in different groups. RESULTS: The metabolic status of the model group and the flunarizine group differed from that of the control group at the same time point.The metabolic state that compared with the model group or the flunarizine group at different time points changes continuously with time. Compared with those in the model group, L-asparagine, 5-methoxytryptamine, α-lactose, ribitol, arachidonic acid, and glycerol in the serum samples and the phosphoglycolic acid, erythrose, inosine, glyceric acid, and D-glucose in the TCC samples were changed in the flunarizine group, indicating that the energy metabolism pathways and amino acid metabolic pathways were involved in the mechanism of flunarizine intervening migraine. CONCLUSION: Flunarizine may improve metabolic disorders in nitroglycerin-induced migraine model rats by affecting energy metabolism and amino acid metabolism.

Effect of Tongbi decoction on endothelial function and hemorheology in patients with coronary heart disease with angina pectoris / 国际中医中药杂志

Objective To observe the effect of Tongbi decoctionon for the changes of the endothelial function and hemorheology in patients with coronary heart disease. Methods A total of 90 patients with angina pectoris were divided into the observation group and the control group according to the random number table method, with 45 in each group. The control group was given routine clinical treatment, and the observation group was treated with Tongbi decoction on the basis of the control group. After treated for 4 weeks, the pain severity of angina pectoris was observed before and after treatment, and the frequency and duration of angina pectoris were recorded. The levels of serum vascular endothelin (ET) and endothelin (VEGF) were measured by ELISA. The serum NO was measured by nitrate reductase method, and whole blood viscosity and plasma viscosity were measured by blood viscometer. The hematocrit was measured by hematocrit analyzer and optical density method. The erythrocyte aggregation index was measured, and the fibrinogen level was measured by heating precipitation method. And the clinical efficacy was evaluated. Results After treatment, the total effective rate was 93.3％ (42/45) in the observation group and 77.8％ (35/45) in the control group, and there was significant difference between the two groups (Z=-3.164, P=0.002). After treatment, the score of angina pain (0.62 ± 0.05 vs. 1.17 ± 0.14, t=5.733) , the frequency of angina attack (3.62 ± 0.43 times/week vs. 5.02 ± 0.64 times/week, t=5.042), the duration of angina attack (3.17 ± 0.42 minutes/time vs. 4.06 ± 0.51 minutes/time, t=4.781) in the observation group were significantly lower than those in the control group (P<0.05). After treatment, the levels of VEGF and NO in the observation group were significantly higher than those in the control group (t value was 5.892, 5.347, all Ps<0.05), and ET was significantly lower than that in the control group (t=4.926, P=0.037). After treatment, the whole blood viscosity, plasma viscosity, hematocrit, aggregation index and fibrinogen levels in the observation group were significantly lower than those in the control group (t values were 4.832, 4.233, 5.031, 4.136, 4.531, all Ps<0.05). Conclusions The application of Tongbi decoction can improve the endothelial function of patients with angina pectoris, adjust the hemorheological indexes and relieve the symptoms related to angina pectoris.

Preventive effects of total coumarin and essential oil of Angelicae Dahuricae Radix on migraine rats and their mechanisms / 吉林大学学报(医学版)

Objective: To observe the preventive effects of combined application of total coumarin and essential oil of Angelicae Dahuricae Radix on the migraine rats induced by nitroglycerin, and to explore their mechanisms. Methods: A total of 56 Wistar rats were randomly divided into normal control group (saline 0. 1 mL · 10 g 1), migraine model group (saline 0. 1 mL · 10 g 1), total coumarin of Angelicae Dahuricae Radix group (100 mg · kg-1), essential oil of Angelicae Dahuricae Radix group (100 mg · kg-1), and low dose (25 mg · kg-1), middle dose (50 mg · kg-1) and high dose (100 mg · kg-1) of total coumarin and essential oil composition of Angelicae Dahuricae Radix groups (composition groups) (n=8). After continuously intragastric adminstration for 7 d, the rats were injected subcutaneously with nitroglycerin (10 mg · kg-1) for establishing the migraine models. The behavior of the rats were observed, the levels of nitric oxide (NO) in serum and brain tissue of rats, the levels of calcitonin gene related peptide (CGRP) and endothelin (ET) in plasma of the rats in various groups were detected. Results: Compared with normal control group, the frequencies of head shaking, the face shoting times of posterior legs and the scratching times of anterior limbs of the rats in migraine model group were increased (P<0. 05 or P<0. 01), and the levels of NO in serum and brain tissue of the rats were increased (P< 0. 01). Compared with migraine model group, the frequencies of head shaking, the face shoting times of posterior legs and scratching times of anterior limbs of the rats in total coumarin group, essential oil group, and composition groups were decreased (P<0. 05 or P<0. 01), and the levels of NO in serum and brain tissue of the rats were decreased (P<0. 05 or P<0. 01). Compared with migraine model group, the levels of CGRP and ET in plasma of the rats in essential oil group, total coumarin group and middle and high doses of composition groups were decreased (P<0. 05). Conclusion: The composition of two active ingredients of Angelicae Dahuricae Radix, total coumarin and essential oil, has preventive effects in the migraine rats induced by nitroglycerin, and their mechanisms may be related to regulation of the levels and function of vasoactive substances.

The clinical efficacy and safety of nitroglycerin combined with atenolol in the treatment of coronary heart disease / 中国生化药物杂志

Objective To study the clinical efficacy and safety of nitroglycerin combined with atenolol in the treatment of coronary heart disease.Methods From February 2014 to November 2016, 114 cases of coronary heart disease patients treated in Zhongshan hospital were selected, all patients were randomly divided into experimental group and control group, the patients in experimental group were treated with nitroglycerin combined with atenolol, and the patients in control group were treated with nitroglycerin, the therapeutic effects of two groups were observed, the adverse reactions of the two groups were compared.Results After treatment, the total effective rate of the treatment group was 93% higher than that of the control group(78.9%), the difference was statistically significant(P< 0.05);The total effective rate of ECG in the experimental group was 89.5% higher than that in the control group(73.7%), the difference was statistically significant(P<0.05);There were 2 cases(3.5%)of adverse reactions in the experimental group and there were 11 cases(19.3%)of adverse reactions in the control group, which was significantly lower in the experimental group than that in the control group, the difference was statistically significant(P<0.05).Conclusion Phenyl bromide Malone and colchicine had good clinical curative effect in the treatment of chronic gout.

Effects of the bioactive parts of Xiongma Decoction on CGRP-CRLR/RAMP1 pathway in TCC of rats with nitroglycerin-induced migraine / 西安交通大学学报(医学版)

Objective To explore the effects of bioactive parts of Xiongma Decoction (parts of ethyl acetate and n-butanol extract) on the CGRP-CRLR/RAMP1 signal pathway so as to clarify its therapeutic mechanism on migraine.Methods We randomly divided 36 male SD rats into 6 groups with 6 in each:blank group,model group,groups of low-,medium-and high-dose Xiongma Decoction bioactive parts,and Sumatriptan group.By giving hypodermic injection of 10 mg/kg nitroglycerin,the migraine rat model was copied;Only 18 rats were found to have positive expressions of CGRP,CRLR,and RAMP1 in TCC with immunohistochemistry staining after heart perfusion.For the remaining 18 rats,TCC was stripped directly from the whole brain and divided into two parts,one part used to detect CGRP,CRLR,RAMP1 mRNA expressions by qPCR,and the other part to detect CGRP,CRLR,RAMP1 protein expressions by Western blot.Results The number of CGRP,CRLR and RAMP1 immunoreactive cells,the mRNA and protein expressions on TCC in model group were effectively increased,compared with those in the blank group (P＜0.05),indicating that the model copying was successful.Compared with those in the model group,the number of CGRP,CRLR and RAMP1 immunoreactive cells in Xiongma Decoction bioactive parts was significantlv decreased,and the expressions of CGRP,CRLR and RAMP1 mRNA and protein were reduced (P＜0.05).Conclusion The bioactive parts of Xiongma Decoction can reduce the activity of CGRP-CRLR/RAMP1 signal pathway in TCC of migraine rats.

Influence of Intravenous Injection Urapidil and Nitroglycerin Micro Pump on Blood Pressure and Heart Rate of Hypertension Patients Undergoing Tooth Extraction / 现代生物医学进展

Objective:To study influence of intravenous injection urapidil and nitroglycerin micro pump on blood pressure and heart rate (HR) of hypertension patients undergoing tooth extraction.Methods:116 hypertension patients underwent electrocardiographic monitoring tooth extraction in our hospital from January 2015 to October 2016 were enrolled in this study.According to the random number table method,the patients were divided into observation group and control group with 58 cases,the control group was given nitroglycerin plus pump static point to maintain,the observation group was given intravenous urapidil and pump maintenance,compared the changes of systolic blood pressure (SBP),diastolic blood pressure (DBP) and HR in two groups before operation,at anesthesia,10min after anesthesia,in operation,10 min after operation,and compared the adverse reactions condition of the two groups.Results:The levels of SBP and DBP in two groups in operation and 10 min after operation were significantly lower than that before operation,and the SBP and DBP levels in the observation group in operation were significantly lower than control group,the differences were statistically significant (all P＜0.05).The HR in control group in operation,10 min after operation were significantly higher than before operation,while the observation group were significantly lower control group,the differences were statistically significant (P＜0.05).The total incidence of adverse reactions in the observation group was 6.90％(4/58),which has no significant difference than 10.34％ (6/58) in control group (P＞0.05).Conclusion:Intravenous injection urapidil has little effect on blood pressure and HR in hypertension patients undergoing tooth extraction,and with good safety,which is worthy of promotion.

Pharmacological effects of drugs mediated by calcitonin gene-related peptide:a review / 中国药理学与毒理学杂志

Calcitonin gene-related peptide (CGRP), a predominant neurotransmitter in sensory nerves, is widely distributed in central and peripheral tissues. In the cardiovascular system, besides relaxing vascular smooth muscle, CGRP protects against ischemic myocardium while inhibiting cardiac remodeling. The pharmacological effects of nitroglycerin and rutaecarpine have proved to be associated with the increase in the synthesis and release of CGRP. In gastrointestinal tissues, CGRP participates in the regulation of gastrointestinal function and has protective effects on the gastric mucosa. Rutaecar?pine, capsaicin and its derivatives can reduce gastric mucosa damage induced by a variety of factors by increasing synthesis and release of CGRP.

Effects and mechanisms of Liujing Toutong Tablets on migraine of rats / 中草药

Objective To investigate effect and mechanisms of Liujing Toutong Tablets (LTT) on migraine model rats. Methods Rats were sc injected with nitroglycerin to establish migraine model, effect of LTT on scratching latency and frequency of migraine model rats was investigated; 5-hydroxytryptamine (5-HT), norepinephrine (NE), and dopamine (DA) in brain tissue were detected; And β-endorphin (β-EP), calcitonin gene related pepitde (CGRP), and endothelin (ET) in serum were examined by ELISA; The content of nitric oxide (NO) and activity of nitric oxide synthase (NOS) in serum were examined. Results After sc injected with nitroglycerin in 1 to 3 min, the rats in model group began to scratch its head frequently, scratching latency of rats in high- and low- dose (1.4 and 0.7 g/kg) of LTT group was extended (P < 0.01) and scratching frequency was decreased (P < 0.001); The content of β-EP and ET in serum and DA in brain tissue of rats in high- and low-dose (1.4 and 0.7 g/kg) of LTT group were increased (P < 0.05, 0.01, 0.001), and the content of CGRP and the activity of NOS in serum were decreased (P < 0.05). The content of 5-HT and NE in brain tissue of rats in high- and low- dose (1.4 and 0.7 g/kg) of LTT group had no significant change. Conclusion LTT has a significant therapeutic effect on migraine, and could inhibit contractile response of vascular. The mechanisms may be connected with increasing content of β-EP, ET, DA and decreasing content of CGRP and the activity of NOS.

Determination of Nitroglycerin Ointment by HPLC / 中国药师

Objective:To optimize and improve the content determination method for nitroglycerin ointment. Methods:An HPLC method was used,the column was Hypersil ODS(150 mm × 4. 6 mm,5 μm),the mobile phase was acetonitrile ∶water(50 ∶50),the detection wavelength was set at 220 nm,the flow rate was 1 ml·min-1 ,the column temperature was 30℃,and the injection volume was 20 μl. Results: The results showed a good linear relationship within the concentration range of 0. 020 3-0. 203 3 mg · ml-1 ( r =0. 999 9),and the average recovery was 99. 51%(RSD=1. 06%,n=9). Conclusion: The method is rapid,accurate and reproduci-ble,and can be used to determine the content of nitroglycerin in nitroglycerin ointment.

Successful Management of Severe Peripheral Tissue Ischemia after Arterial Catheterization in Micro Preemies using Humidification & Topical Nitroglycerin

Micro preemies usually undergo arterial catheterization for frequent blood pressure monitoring and blood sampling. Peripheral tissue injury associated arterial catheterization is a well-described morbidity observed in neonates. Despite the potential permanent disability associated with this complication, the currently available therapeutic options remain limited. We report a unique case of a preterm infant who developed severe tissue ischemia after arterial catheterization of the radial artery and was successfully treated using extensive humidification and topical nitroglycerin ointment application over an extended period (36 days) until complete clinical recovery.