Mu-opioid receptors in the paraventricular nucleus regulate ejaculatory behaviors via the sympathetic nerve system in male rats / 中华男科学杂志

Objective@#To explore the effects of the mu-opioid receptor (MOR) in the paraventricular nucleus (PVN) on the ejaculatory behaviors of male rats and its potential mechanisms.@*METHODS@#Male SD rats with normal ejaculation ability were mated with female ones in hormone-induced estrus. After bilateral PVN microinjection of D-Ala-2-Me-Phe-4-Gly-ol enkephalin (DAGO) or D-Phe-Cys-Tyr-D-Trp-Arg-Thr-Pen-Thr-NH2 (CTAP) with an inserted catheter, the male animals were observed for mount latency (ML), mount frequency (MF), intromission latency (IL), intromission frequency (IF), ejaculation latency (EL), ejaculation frequency (EF), post-ejaculation interval (PEI), and intromission ratio (IR). The lumbar sympathetic nerve activity (LSNA) of the rats was recorded using the PowerLab data acquisition hardware device, and the levels of norepinephrine (NE) in the peripheral plasma were measured by ELISA following microinjection of saline or different doses of DAGO or CTAP.@*RESULTS@#Neither CTAP nor DGAO significantly affected the ML of the male rats (P > 0.05). DGAO remarkably increased IF (P < 0.01) and MF (P < 0.01), prolonged IL (P < 0.01), EL (P < 0.01) and PEI (P < 0.01), and reduced EF (P <0.01) and IR (P < 0.05). On the contrary, CTAP markedly decreased IF (P < 0.01) and MF (P < 0.01), shortened IL (P < 0.01), EL (P < 0.01) and PFI (P < 0.01), and elevated EF (P < 0.01) and IR (P < 0.01). Additionally, DAGO decreased LSNA in a dose-dependent manner and reduced the NE level in the peripheral plasma. CTAP, however, not only offset the effects of DAGO on LSNA, but also significantly increased LSNA.@*CONCLUSIONS@#MOR in PVN inhibits ejaculatory behaviors in male rats by weakening LSNA, which has provided some theoretical evidence for the use of highly selective opioids in the treatment of premature ejaculation.

β-adrenoceptor activation induces the apoptosis of human mesangial cells / 中华肾脏病杂志

Objective To investigate the effects of β-adrenoceptor (β-AR) activation on the apoptosis in human mesangial cells and it's mechanism.Methods Cultured HMC were used in experiments and were divied into four groups:the control group; β-AR activation (β-AR agonist NE/Pra) group; β-AR inhibitor (Prop) group; antioxidants group.The experiments technology including PCR,confocal scanning microscope,immunofluorescence and Tunel.Results The results of RTPCR and confocal scanning microscope showed that β1-AR and β2-AR were expressed in human HMC.β-AR activation induced reactive oxygen species (ROS) increase in human MCs,the relative levels of ROS were elevated as early as 0.5 h after β-AR activation,and gradually increased and peaked at 4 h on a concentration and time dependent manner.Tunel results demonstrated that β-AR activation induced apoptosis with ROS on a concentration and time dependent manner,β-AR blocking agent-propranolol significantly inhibited β-AR activation induced apoptosis.Antioxidants including vitamin C and NAC could inhibited β-AR activation induced apoptosis (all P ＜ 0.01).Conclusions β-AR is functionally expressed in human mesangial cell,furthermore β-AR activation-induced ROS increase mediate apoptosis.Antioxidants can inhibit β-AR activation induced apoptosis.

Posterior Reversible Encephalopathy Syndrome as a Simultaneous Manifestation of Guillain-Barre Syndrome in an Elderly Female Patient

We report a 62-year-old woman with a simultaneous occurrence of posterior reversible encephalopathy syndrome (PRES) and Guillain-Barre syndrome (GBS). The simultaneous presence of PRES in GBS is unusual and can easily escape recognition, with potentially serious consequences for the patient. Previous reports showed that the simultaneous or initial manifestation of PRES in GBS is more common in elderly female. The preponderance of female in older age may be due to age and gender related difference in sympathetic nerve activity.

Hypertension in Renal Diseases

Renal disease is closely associated with hypertension. Hypertension belongs to the clinical picture of chronic kidney disease (CKD). Hypertension associated with renal diseases occurs as a complication of various glomerular and interstitial diseases and may accelerate the decline of renal function if inadequately controlled. The pathophysiology through which the kidney raises blood pressure have been considerably clarified in recent years and it could be shown that "hypertension goes with the kidney" in experimental and clinical studies. The combined interactions of multiple independent mechanisms are thought to be involved in the development of hypertension. Impaired renal sodium handling leads to volume expansion. There is inappropriate activation of the renin-angiotensin system. As only recently documented in detail, renal injury raises the sympathetic tone, even when whole kidney glomerular filtration rate (GFR) is unchanged. This results from stimulating afferent signals coming from the kidney. There also is an evidence of impaired endothelial cell dependent vasodilatation even in very early stages of renal dysfunction. And other factors including uric acid, parathyoid hormone (PTH), and calcium may play a role in concert with other factors in the development of hypertension of renal diseases. Understanding these pathophysiologies is important for appropriate antihypertensive treatment.

Thoracoscopic T2 Sympathicotomy Effects on QT Interval / 대한마취과학회지

BACKGROUND: Thoracoscopic sympathicotomy was, at first, thought to be a simple and safe method for treatment of hyperhydrosis. However, few studies refer to the cardiac effects of this procedure, despite the fact that the T2 ganglia are in the direct pathway of the sympathetic innervation of the heart. An imbalance of right and left sympathetic efferent activity has been proposed as a mechanism for arrhythmia in patients with long QT syndrome. The aim of this study was to compare hemodynamic effect as well as ECG changes after right and left side sympathicotomy. METHODS: 42 patients with essential hyperhydrosis in ASA physical status class 1 undergoing thoracoscopic sympathicotomy were randomly divided into two groups: left side first operation group (group L, n = 22) and right side first operation group (group R, n = 20). Anesthesia was induced with thiopental sodium (5 mg/kg) and pancuronium (0.05 mg/Kg) and maintained with enflurane. During the procedure, we recorded blood pressure at both forearms and heart rate and ECG were recorded after anesthetic induction as baseline values, immediately after one side resectioned of sympathetic trunk, and after complete resectioning of both side. All operations were done with usual methods by experienced surgeons. All the records were coded and analysed singl blind by one author. RESULTS: After sympathicotomy, there was a significant decrease in heart rate but not in blood pressure. However, statistically there were no significant changes in QT interval during sympathicotomy either right side first operation or left side first operation. CONCLUSIONS: The main result of this study was that there were no significant changes in QT interval during sympathicotomy of either right or left side first operations. However, This does not mean that there was no possibility of prolongation of QT interval during thoracoscopic sympathicotomy. Careful observation of QT interval changes is needed during sympathicotomy.

Preoperative Heart Rate Affects the Degree of Heart Rate Variability during T2 Sympathicotomy / 대한마취과학회지

BACKGROUND: Thoracoscopic sympathicotomy was thought to be a simple and safe method for hyperhidrosis. There is a significant decrease in heart rate during the procedure. Also it has been suggested that the effect of the degree of sympathetic block on cardiac function was affected by the preoperative level of sympathetic activity. Our hypothesis was that the higher heart rate before sympathicotomy the more heart rate change during the procedure because heart rate is one of the indicators of sympathetic activity. METHODS: Sixty two patients with essential hyperhidrosis undergoing thoracoscopic sympathicotomy were studied. During the procedure, we recorded blood pressure at left arm and heart rate after anesthetic induction as baseline values, immediately after left side sympathicotomy, and after right side sympathicotomy. Patients were divided by median value of preoperative heart rate (83 beats/min) into group I (n = 32), preoperative heart rate below 83 beats/min, and group II (n = 30), above 83 beats/min. RESULTS: The preoperative mean heart rates of group I and II were 72 +/- 7.9 beats/min and 100 +/- 12.5 beats/min respectively. After sympathicotomy, the decrease of heart rate compared to the preoperative value in Group I was 6.6%, which was significantly lower than that of Group II, 17.6%. After left sympathicotomy, the number of cases of heart rate decreasing more than 10% was higher in Group II (20/30 cases) than Group I (13/32 cases). CONCLUSIONS: The main result of this study showed that the higher heart rate before sympathicotomy the more heart rate change during procedure.

The Effect of Acupuncture Stimulation on Sympathetic Skin Response, Sympathetic Flow Response, and Palmer Emotional Sweating Evoked by Electric Stimulation to the Forehead / 全日本鍼灸学会雑誌

The effect of acupuncture on the autonomic nervous system was analyzed by simultaneous measurement of sympathetic skin response (SSR), sympathetic flow response (SFR) and Palmer emotional sweating evoked with electric stimuli to the forehead at random interval and intensity. The mutual relation of measurements by those parameters was examined electrophysiologically.<BR>The subjects were ten healthy male volunteers. SSR at the left palm and SFR at the fingertip of the left forefinger were measured using laser doppler flowmetry, and emotional sweating at teh right palm was measured with the ventilated capsule method (hydrography). The measurements were performed in two sessions, with and without acupuncture stimulation that was given at L14 with the technique of sparrow picking (1Hz) for 1 minute and retaining the needle for 10 minutes. The amplitude of SSR, the reduction rate of SFR, and the sweat rate were measured before and after acupuncture stimulation, while those were measured before and after resting in the other session as a control study. As a result, habituation in each response was not seen and the correlation coefficient in each index was low, while SSR and Palmar sweating were inhibited significantly in the stimulation group only, and SFR was inhibited in both groups.<BR>These results suggested that acupuncture stimulation might inhibit the activity of the skin sympathetic nerve system.

The Effect of Hemodynamic Changes on the Regression of Sensory Analgesia after Epidural Block / 대한마취과학회지

BACKGROUND: The aim of this study was to compare the difference in regression of sensory analgesia on hemodynamic changes between bupivacaine and lidocaine in epidural blockade. METHODS: The thirty-six patients (ASA physical status Ior II) scheduled for elective cesarean section, we performed lumbar epidural blockade using 2% lidocaine (group I, II) or 0.5% bupivacaine (group III, IV). Eighty minutes after surgery, we divided the patients into 4 groups: The group I, III received normal saline, 20 ml, for 30 min; the group II, IV received normal saline, 20 ml, containing ephedrine, 2 mg ml, for 30 min. We compared the regression of sensory analgesia at 80 min with that at 140 min. RESULTS: The proximal extent of sensory analgesia at 140 min was significantly lower than that at 80 min in group II. However, no such significant changes occurred in group I, III, IV. CONCLUSIONS: The ephedrine-induced blood pressure increase accelerates regression of epidural blockade using lidocaine. We thought that even moderate and clinically insignificant cardiovascular activation by anxiety or pain can be a cause of reduction in the efficacy and duration of epidural blockade.

The Effect of the Intravenous Esmolol on Blood Pressure and Heart Rate during Electroconvulsive Therapy / 대한마취과학회지

BACKGROUND: Electroconvulsive therapy (ECT) that works by electrically inducing grand mal seizure is an effective therapy for patients with major psychosis and affective disorders. But ECT may produce intense stimulation of the central nervous system resulting in hypertension and tachycardia. Such an acute hyperdynamic state may be undesirable because of possible cardiovascular complications. We compared the ability of different bolus doses of esmolol to blunt the hemodynamic effects of ECT. METHODS: Twenty ASA physical status 1~2 patients were enrolled in a crossover design study to determine the effects of two standard esmolol bolus doses (0.5 mg/kg and 1.0 mg/kg) on the hemodynamic response and seizure duration during ECT. In each patients receiving esmolol or placebo, arterial pressure, heart rate, seizure duration and peripheral oxygen saturation (SpO2) were recorded. RESULTS: The seizure duration with placebo was 43 +/- 9 sec, esmolol 0.5 mg/kg bolus dose was 39 +/- 14 sec and esmolol 1.0 mg/kg bolus dose was 39 +/- 12 sec, but it was not significant. Compared with esmolol 0.5 mg/kg bolus dose, esmolol 1.0 mg/kg bolus dose decreased blood pressure and heart rate during ECT more effectively. CONCLUSIONS: Esmolol 1.0 mg/kg bolus dose was considered to be the better dose in blunting the hyperdynamic response during ECT without shortening of seizure duration.