Astragalus membranaceus improves therapeutic efficacy of asthmatic children by regulating the balance of Treg/Th17 cells / 中国天然药物

Astragalus membranaceus may be a potential therapy for childhood asthma but its driving mechanism remains elusive. The main components of A. membranaceus were identified by HPLC. The children with asthma remission were divided into two combination group (control group, the combination of budesonide and terbutaline) and A. membranaceus group (treatment group, the combination of budesonide, terbutaline and A. membranaceus). The therapeutic results were compared between two groups after 3-month therapy. Porcine peripheral blood mononuclear cells (PBMCs) were isolated from venous blood by using density gradient centrifugation on percoll. The levels of FoxP3, EGF-β, IL-17 and IL-23 from PBMCs and serum IgE were measured. The relative percentage of Treg/Th17 cells was determined using flow cytometry. The main components of A. membranaceus were calycosin-7-O-glucoside, isoquercitrin, ononin, calycosin, quercetin, genistein, kaempferol, isorhamnetin and formononetin, all of which may contribute to asthma therapy. Lung function was significantly improved in the treatment group when compared with a control group (P < 0.05). The efficacy in preventing the occurrence of childhood asthma was higher in the treatment group than the control group (P < 0.05). The levels of IgE, IL-17 and IL-23 were reduced significantly in the treatment group when compared with the control group, while the levels of FoxP3 and TGF-β were increased in the treatment group when compared with the control group (P < 0.05). A. membranaceus increased the percentage of Treg cells and reduced the percentage of Th17 cells. A. membranaceus is potential natural product for improving the therapeutic efficacy of combination therapy of budesonide and terbutaline for the children with asthma remission by modulating the balance of Treg/Th17 cells.

Atosiban efficacy and safety in pregnant women with threatened preterm delivery: systematic review of the literature with network meta-analysis / Eficacia y seguridad de atosiban en mujeres gestantes con diagnóstico de amenaza de parto pretérmino: revisión sistemática de la literatura con metaanálisis en red

ABSTRACT Objective: To assess the efficacy and safety of atosiban in pregnant women with risk of preterm delivery as compared to nifedipine, indomethacin, terbutaline, fenoterol and placebo. Materials and methods: A systematic literature review was carried out in eight electronic databases, including Medline, Central, and Embase, using free and standardized search terms. Outcomes assessment included time delay until delivery, neonatal mortality, ratio of adverse maternal events, and ratio of neonatal complications. The quality of the evidence was evaluated per study and for the body of evidence and, whenever feasible, the information was synthesized into a meta-analysis. Alternatively, a narrative summary was presented. Results: Eleven studies were included. Atosiban did not show any statistically significant differences in terms of delaying delivery versus other uterine contraction inhibitors. The neonatal mortality was lower compared to indomethacin (RR = 0.21; 95% CI: 0.05 to 0.92), and the percentage of total maternal adverse events was lower compared to fenoterol (RR = 0.16; 95% CI: 0.08 to 0.31), nifedipine (RR = 0.48; 95% CI: 0.3 to 0.78), and terbutaline (RR = 0.44; 95% CI: 0.28 to 0.71). Conclusions: Atosiban has similar efficacy for delivery delay in patients with risk of preterm delivery as compared to other agents (moderate certainty), showing some advantages regarding neonatal mortality (low certainty) versus indomethacin, and compared to fenoterol, nifedipine and terbutaline in terms of maternal adverse events (moderate certainty).

RESUMEN Objetivo: evaluar la eficacia y seguridad de atosiban en gestantes con amenaza de parto pretérmino comparado con nifedipino, indometacina, terbutalina, fenoterol y placebo. Materiales y métodos: se realizó una revisión sistemática de la literatura en ocho bases de datos electrónicas (Medline, Central, Embase, entre otras), mediante términos de búsqueda libres y estandarizados. Los desenlaces evaluados incluyeron tiempo de retardo del parto, mortalidad neonatal, proporción de eventos adversos maternos y proporción de complicaciones neonatales. Se evaluó la calidad de la evidencia por estudio y para el cuerpo de evidencia, y se sintetizó la información mediante metaanálisis, cuando fue posible; de lo contrario, se resumió de forma narrativa. Resultados: se incluyeron once estudios. Atosiban no mostró diferencias estadísticamente significativas en retardo del parto contra otros uteroinhibidores. Mostró menor mortalidad neonatal que la indometacina (RR = 0,21; IC 95 %: 0,05 a 0,92), y menor proporción de eventos adversos maternos totales que el fenoterol (RR = 0,16; IC 95 %: 0,08 a 0,31), el nifedipino (RR = 0,48; IC 95 %: 0,3 a 0,78) y la terbutalina (RR = 0,44; IC 95 %: 0,28 a 0,71). Conclusiones: atosiban tiene una eficacia similar para retardar el parto ante la amenaza de un parto pretérmino con otros comparadores (certeza moderada), con ventajas frente a indometacina en mortalidad neonatal (certeza baja) y frente a fenoterol, nifedipino y terbutalina en eventos adversos maternos (certeza moderada).

β₂-Adrenoceptor Blockade Deteriorates Systemic Anaphylaxis by Enhancing Hyperpermeability in Anesthetized Mice

PURPOSE: Patients treated with propranolol, a nonselective β-adrenoceptor antagonist, develop severe anaphylaxis, but the mechanism remains unknown. We determined effects of β₁- and β₂-adrenoceptor antagonists on the anaphylaxis-induced increase in vascular permeability in mice. METHODS: In anesthetized ovalbumin-sensitized C57BL mice, mean arterial blood pressure (MBP) was measured, and Evans blue dye extravasation and hematocrit (Hct) were assessed at 20 minutes after antigen injection. The following pretreatment groups (n=7/group) were studied: (1) sensitized control (non-pretreatment), (2) propranolol, (3) the selective β₂-adrenoceptor antagonist ICI 118,551, (4) the selective β₁-adrenoceptor antagonist atenolol, (5) adrenalectomy, (6) the selective β₂-adrenoceptor agonist terbutaline, and (7) non-sensitized groups. RESULTS: The antigen injection decreased MBP, and increased Hct and vascular permeability in the kidney, lung, mesentery, and intestine, but not in the liver or spleen. Pretreatment with ICI 118,551, propranolol and adrenalectomy, but not atenolol, reduced the survival rate and augmented the increases in Hct and vascular permeability in the kidney, intestine, and lung as compared with the sensitized control group. Pretreatment with terbutaline abolished the antigen-induced alterations. Plasma epinephrine levels were increased significantly in the sensitize control mice. CONCLUSIONS: Blockade of β₂-adrenoceptor can deteriorate systemic anaphylaxis by augmenting hyperpermeability-induced increase in plasma extravasation by inhibiting beneficial effects of epinephrine released from the adrenal glands in anesthetized mice.

Priapism as a rare presentation of chronic myelogenous leukemia

BACKGROUND: Priapism is a rare complication seen in one to five percent of adult leukemic patients. The word 'Priapism' is related to Priapus, the Greek and Roman God of procreation whose symbol was an erect phallus. CLINICAL PRESENTATION: The patient is a 22-year-old male with no known co-morbidities presenting with one month intermittent, unstimulated, painful penile erection with no other associated symptoms which resolves spontaneously, until nine hours prior to admission when symptoms recurred and persisted. Patient had no history of trauma and no drug intake. PHYSICAL FINDINGS: Patient was awake, in pain and tachycardic. There was note of pallor and splenomegaly. The penis was erect, firm, swollen and tender with superficial venous engorgement. The rest of the physical examination was unremarkable. LABORATORY WORK UP: Complete blood count showed anemia and leukocystosis. Peripheral blood smear revealed markedly increased white blood cells with predominance of mature and immature cells belonging to granulocytic series. There was splenomegaly on ultrasound. Genetic testing showed an abnormal male karyotype of 46 chromosomes including translocation (9;22). TREATMENT: Corpora cavernosa aspiration was done. Terbutaline was given. Patient was started and maintained on hydroxyurea and presently enrolled in Imitanib study. OUTCOME: There was resolution of priapism after the corpus cavernosa aspiration and initiation of hydroxyurea and the white blood cell count had decreased after initiation of hydroxyurea.

Efficacy and safety of tulobuterol patch versus oral salbutamol sulfate in children with mild or moderate acute attack of bronchial asthma: a comparative study / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To compare tulobuterol patch and oral salbutamol sulfate in terms of efficacy and safety in children with mild or moderate acute attack of bronchial asthma.</p><p><b>METHODS</b>A total of 92 children with mild and moderate acute asthmatic attack were randomly divided into salbutamol group (n=46) and tulobuterol group (n=46). Both groups received routine treatment with antihistamine, selective leukotriene receptor antagonist and glucocorticoid. In addition, the salbutamol group was given slow-release capsules of salbutamol sulfate, and the tulobuterol group was treated with tulobuterol patch. The two groups were compared with respect to symptom scores of cough, wheeze, respiratory rate, wheezing sound, three depression sign and peak expiratory flow, as well as adverse events.</p><p><b>RESULTS</b>As the treatment proceeded, symptom scores decreased in both groups; on the third day of treatment, all symptom scores except cough score showed a significant decrease in both groups (P<0.05), but the tulobuterol group had significantly lower symptom scores than the salbutamol group (P<0.05). On the fourteenth day of treatment, both groups had a significant decrease in cough score (P<0.05), but the tulobuterol group had a significantly lower cough score than the salbutamol group (P<0.05). One child developed hand trembling in the salbutamol group, while no adverse event occurred in the tulobuterol group.</p><p><b>CONCLUSIONS</b>Compared with oral salbutamol sulfate, tulobuterol patch has a better therapeutic efficacy and a higher safety in children with mild or moderate acute asthmatic attack.</p>

Efecto del salbutamol, terbutalina y oxígeno sobre la microdureza superficial del esmalte dentario / Effects of salbutamol, terbutaline and oxygen on microhardness of tooth enamel

Objetivo. Evaluar la microdureza superficial del esmalte dentario antes y después de ser sometido a la acción in vitro de las nebulizaciones con salbutamol, terbutalina y oxígeno. Material y métodos. Se realizó un estudio experimental, procediendo a la recolección de los datos antes y después de exponer la muestra a las nebulizaciones con antiasmáticos La muestra estuvo conformada por 30 piezas dentarias anterosuperiores divididas en tres grupos de diez. Se realizó la medición de la microdureza antes de la exposición de los especímenes, después éstos fueron colocados en tres cámaras y expuestos a la acción de los medicamentos, midiéndose su microdureza después de cinco y diez días de haber sido expuestos. Para la comparación entre la microdureza inicial y las otras dos mediciones se utilizó la prueba de Wilcoxon y para la comparación de cada momento entre los tres grupos se utilizó la técnica del análisis de varianza. El tratamiento de los datos se efectuó a un nivel de confianza de 95% y con un margen de error del 5%. Resultados. No se halló diferencia estadísticamente significativa entre la microdureza superficial del esmalte inicial y las mediciones a los cinco y diez días en los tres grupos de estudio (p<0,5). Conclusiones. La mayor disminución de la microdureza superficial del esmalte se observó en los especímenes que fueron sometidos al oxígeno.

Objective. To evaluate the enamel surface microhardness before and after being subjected to the action in vitro of nebulized salbutamol, terbutaline and oxygen. Material and methods. We conducted a pilot study, the process of data collection before and after exposing the sample to the nebulizer with asthma . The sample consisted of 30 anterior teeth divided into three groups of ten. It makes measuring the microhardness before exposure of the specimens, after they were placed into chambers and exposed to drug action, measuring their microhardness after five and ten days of being exposed. For comparison between the initial hardness and the other two measurements was used Wilcoxon test and for comparison of the moment among the three groups was used the technique of analysis of variance. The data processing was done at a confidence level of 95% and a margin of error of 5%. Results. No statistically significant difference was found between the initial enamel microhardness and measurements at five and ten days in the three study groups (p <0.5).Conclusions. The greater reduction in microhardness of enamel was observed in specimens that were subjected to oxygen.

Terbutaline versus salbutamol for suppression of preterm labor: a randomized clinical trial

Preterm labor [PTL] is a common medical problem during pregnancies and is associated with neonatal mortality and morbidity. Beta-adrenergic agonists are among the most commonly used tocolytic agents. The aim of this study was to compare the effectiveness, safety and adverse effects of terbutaline with those of salbutamol in the prolongation of pregnancy beyond 48 hours and until 37 weeks of gestation. Two hundred women with PTL were randomly assigned to receive subcutaneous terbutaline [250 micro g] or intravenous salbutamol [0.1 mg] followed by oral terbutaline [20 mg/d] or oral salbutamol [24 mg/d] as maintenance. The efficacy, side effects and complications after 48 hours and until 37 weeks of gestation were analyzed and compared. There was no significant difference between the two groups in success rate within 48 hours [P= .091]. Gestational age at delivery [P=.031] and the number of days for which the gestation was prolonged [P=.024] were significantly higher in those receiving terbutaline. Adverse effects, including tachycardia [P=.007] and anxiety [P=.006], were experienced more in the salbutamol group. Birth weight was significantly lower in the salbutamol group [P=.001]. Terbutaline provided more effective tocolysis with fewer adverse effects and a better neonatal outcome. However, terbutaline and salbutamol are equally effective in the first 48 hours

Effect of terbutaline on sodium transport in alveolar type I and type II cells / 南方医科大学学报

<p><b>OBJECTIVE</b>To explore the effect of terbutaline on sodium transport in rat alveolar type I (ATI) and type II (ATII) cells of rats.</p><p><b>METHODS</b>The whole cell currents were recorded from ATII cells isolated from rat lungs perfused with or without amiloride (inhibitor of epithelial sodium channel) and ZnCl(2) (inhibitor of cyclic nucleotide-gated cation channel) in the whole cell recording mode using the patch-clamp technique. The effect of terbutaline on the currents was examined.</p><p><b>RESULTS</b>The main currents recorded from ATII cells were amiloride-sensitive and Zn(2+)-sensitive. The amiloride-sensitive and Zn(2+)-sensitive current shared a similar proportion (P>0.05). Both currents could be significantly increased by terbutaline (P<0.05), and the proportion of amiloride-sensitive current was 1.7 times that of Zn(2+)-sensitive current (P<0.05).</p><p><b>CONCLUSION</b>There are functional epithelial sodium channels (ENaC) and cyclic nucleotide-gated cation channels (CNG) on freshly isolated ATII cells, both serving as the main channels for sodium transport. Terbutaline increases the absorption of alveolar fluid primarily by increasing sodium transport of ENaC and CNG on ATI and AT II cells.</p>

[ randomized, controlled trial of nebulized terbutaline in the first acute bronchiolitis in infant less than 12 months old]

Despite the common clinical practice, the available evidence on the efficacy of bronchodilators therapy for bronchiolitis is conflicting. The aim of this study is to evaluate the efficacy of nebulized terbutaline in bronchiolitis as measured by improvement in clinical score, oxygen saturation or reduction in duration of hospitalization. This prospective, double blind, placebo controlled, randomized clinical trial was performed at Children's Hospital of Tunis from December 2004 to April 2006. A total of 35 patients less than 12 months of age with diagnosis of moderately severe bronchiolitis were enrolled and assigned to receive nebulized terbutaline or normal saline placebo at admission [TO], at 30 minutes after admission [T30] and every four hours during a study period. Outcome measurements included: Respiratory Distress Assessment Instrument [RDAI] score, respiratory rate, oxygen saturation, heart rate and the duration of hospitalization. There were no significant difference between terbutaline and placebo at baseline, T30 min, T60 min, and T120 min after start study in RDAI score, oxygen saturation in room air, rate respiratory and heart rate. There was no difference in duration of hospitalization. Nebulized terbutaline therapy does not appear effective in treating moderately ill infants with the first acute bronchiolitis

Role of epithelial sodium channel alpha subunit in terbutaline-induced transient enhancement of pulmonary edema clearance in adult rats with acute lung injury / 南方医科大学学报

<p><b>OBJECTIVE</b>To explore the association of epithelial sodium channel alpha subunit (alphaENaC) with terbutaline-induced transient enhancement of pulmonary edema clearance in adult rats with acute lung injury (ALI).</p><p><b>METHODS</b>The effect of 1-h intratracheal terbutaline treatment on pulmonary edema clearance in adult rats with experimental ALI was observed by blood gas analysis, lung tissue HE staining, and extravascular lung water (EVLW) content measurement. The mRNA and protein expressions of alphaENaC in the lung tissues were detected by fluorescence quantitative real-time RT-PCR and Western blotting, respectively.</p><p><b>RESULT</b>Terbutaline treatment of the rats with ALI resulted in significant differences in PaO2, oxygenation index, and EVLW from those in ALI group without treatment. No significant differences in pulmonary alphaENaC mRNA and protein expressions were noted between the normal control, ALI, and terbutaline-treated ALI groups.</p><p><b>CONCLUSIONS</b>Intratracheal terbutaline administration for 1 h can significantly promote pulmonary edema clearance in adult rats with ALI, and this effect is not mediated by alphaENaC gene expression.</p>

An open, Multi center, Randomized, Parallel Group Study to Compare the Effectiveness and Safety of Fluticasone Plus Tulobuterol Versus Twice the Dose of Fluticasone Alone in Asthmatic Children / 소아알레르기및호흡기학회지

PURPOSE: We aim to compare the effectiveness and safety of fluticasone propionate (Flt) plus tulobuterol (Hk) versus high-dose Flt alone in controlling asthma in children. METHODS: Fifty three children aged 4 to 8 years, who were diagnosed with mild persistent asthma and underwent maintenance therapy with a low dose of inhaled corticosteroid (Flt) of 50-100 microgram/day were randomized to receive Flt plus Hk (Hokunalin(R) patch 1 mg, Abbott Japan, Tokyo, Japan), or Flt alone at twice the dosage. Patients underwent new treatment for 4 weeks. Asthma symptom scores, mean changes in morning and evening peak expiratory flow (PEF), the frequency of night awakenings, the use of reliever medication, caregiver's overall satisfaction and safety were evaluated and compared in each group. And they were followed-up again 4 week after treatment course for the evaluation of treatment-emergent adverse event (TEAE). RESULTS: No significant difference was found between the groups in terms of mean changes in the morning and evening PEF, the frequency of night awakening, the use of rescue medication and caregiver's overall satisfaction (P=0.83, P=0.83, P=0.17, P=0.32 and P=0.63). Furthermore, no statistically significant difference was observed between 2 groups in the incidence of any TEAE (P=1.00). CONCLUSION: This study demonstrated that a combination of Flt and Hk was as effective as a high-dose Flt therapy in the management of mild persistent asthma in children. The results of this study suggest that tulobuterol add-on therapy can be considered as a reasonable substitute to an increase in the dosage of steroid in the patients with steroid-phobia and it might be used to reduce the risk of high dose steroid therapy.

Efficacy and safety of nifedipine versus terbutaline in preterm labor: A meta-analysis / Philippine Journal of Obstetrics and Gynecology

BACKGROUND: Preterm birth is a major cause of perinatal morbidity and mortality. Tocolytic drugs are used to suppress uterine contractions. The most widely used tocolytics in the Philippines are betamimetics, such as Terbutaline, which are known to have high incidence of maternal adverse effects. Nifedipine, a calcium channel blocker, is an alternative tocolytic with potentially similar efficacy and fewer maternal side effects than terbutaline.CONCLUSION: Terbutaline and Nifedipine appeared to be equally effective tocolytic agents. However, nifedipine had tile advantage of lesser incidence of maternal adverse effects.

O atosibano como agente tocolítico: uma nova proposta de esquema terapêutico / Atosiban as a tocolytic agent: a new proposal of a therapeutic approach

OBJETIVO: avaliar um novo esquema terapêutico de emprego do atosibano quanto ao efeito tocolítico, eficácia e efeitos colaterais maternos e fetais. MÉTODOS: Estudo prospectivo com 80 gestantes em trabalho de parto prematuro admitidas para tocólise. Critérios de inclusão: gestação única, presença de contrações uterinas regulares, dilatação cervical >1 cm e <3 cm, esvaecimento cervical >50 por cento, idade gestacional entre 23 e 33 semanas e seis dias, membranas ovulares íntegras, índice de líquido amniótico >5 e <25 e ausência de doenças maternas, patologias feto-anexiais, restrição do crescimento fetal, sofrimento fetal e incompetência cervical. Critérios de exclusão: corioamnionite ou febre na vigência de tocólise. No grupo de estudo, utilizou-se atosibano com dose de ataque de 6,75 mg iv em bolus. Em seguida, infusão por três horas de 300 mcg/min e, após, 100 mcg/min durante três horas e 30 minutos. Se as contrações persistissem, mantinha-se infusão iv de 100 mcg/min durante 12 horas e 30 minutos e fazia-se nova avaliação, sucessivamente até completar 45 horas. No Grupo Controle, foi utilizado terbutalina; diluíram-se cinco ampolas de 2,5 mg de terbutalina em 500 mL de soro glicosado a 5 por cento e foi iniciada a infusão intravenosa contínua, 20 mL/h. Na persistência de contrações uterinas, aumentava-se a velocidade de infusão da solução em 20 mL/h até que se conseguisse a parada das contrações uterinas. Quando foi atingida a dose na qual a paciente não apresentava atividade uterina, esta foi mantida por 24 horas. RESULTADOS: a idade gestacional no parto variou de 29 semanas e cinco dias a 40 semanas e seis dias. Em 97,5 por cento dos casos foi possível postergar o parto em pelo menos 48 horas, com intervalo médio entre o início da tocólise e o parto de 28,2 dias. No Grupo Controle, em nove casos, o parto ocorreu em intervalo inferior a 48 horas após o início da tocólise (22,5 por cento); o intervalo médio entre o início da tocólise...

PURPOSE: to test a therapeutic approach using atosiban for tocolysis, evaluating its safety and maternal and fetal side effects. METHODS: prospective study with 80 pregnant women with preterm labor admitted for tocolysis. Inclusion criteria: singleton pregnancy, regular uterine activity, cervical dilatation between 1 to 3 cm, cervical enfacement greater than 50 percent, 23 to 33 weeks and six days of gestational age, intact membranes, amniotic fluid index between 5 and 25, no maternal, fetal or placental diseases, no fetal growth restriction, no cervical incompetence, no fever. Exclusion criteria: chorioamnionitis or fever during tocolysis. Atosiban group: women received 6.75 mg atosiban iv in bolus, 300 mcg/min for three hours, then 100 mcg/min for three hours and thirty minutes. If uterine activity persisted, it was maintained iv infusion of 100 mcg/min for 12.5 hand that so for as long as 45 hours. Control group: women received terbutaline (five ampoules, 500 mL crystalloid solution) iv infusion, 20 mL/h. If uterine activity persisted, infusion velocity was raised (20 mL/h) until uterine contractions were absent. The dose was maintained for 24 hours. RESULTS: gestational age at birth was 29 weeks and five days to 40 weeks and six days. In atosiban group, the proportion of women who had not delivered at 48 hours was 97.5 percent, mean interval between tocolysis and birth of 28.2 days. In control group, birth occurred before 48 hours in 22.5 percent of the cases; mean interval between tocolysis and birth of 5.3 days. Maternal side effects were observed in 27.5 percent of cases of the atosiban group, none with tachycardia, dyspnea or tachypnea. In the control group, 75 percent of the cases referred palpitations, tachycardia, tachypnea or headache (drug infusion was interrupted in four cases). Fetal tachycardia was observed in 22.5 percent of the cases (n=9). No early neonatal death was observed. CONCLUSIONS: the therapeutic approach used...

Alveolar fluid clearance and changes of alveolar type II cell cAMP and cGMP levels in rats with oleic acid-induced acute respiratory distress syndrome / 南方医科大学学报

<p><b>OBJECTIVE</b>To observe the changes of the levels of cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP) in acutely isolated alveolar type II (ATII) cells from rats with acute respiratory distress syndrome (ARDS), and test the effects of terbutaline on the cAMP and cGMP levels.</p><p><b>METHODS</b>SD rats were randomized into the control, ARDS, and terbutaline treatment groups, in which the cAMP and cGMP contents in the ATII cells were measured using radioimmunoassay, and the extravascular lung water (EVLW) content was quantified with gravimetric measurement.</p><p><b>RESULTS</b>The cAMP level in the ATII cells was significantly lowered whereas cGMP level and EVLW content increased in rats with oleic acid-induced ARDS. In terbutaline-treated rats with ARDS, the EVLW content were lower than that of non-treated rats, but still higher than that of the control rats. Terbutaline treatment also increased the content of cAMP but produced no significant effect on cGMP content in the ATII cells of the rats with ARDS.</p><p><b>CONCLUSION</b>Alveolar fluid clearance rate is decreased in rats with oleic acid-induced ARDS, and terbutaline can improve the capacity of alveolar fluid clearance, the mechanism of which may involve elevated cAMP content in the ATII cells. cAMP and cGMP in ATII cells might participate in the molecular pathogenesis of ARDS.</p>

Effect of ligustrazine injection on levels of interleukin-4 and interferon-gamma in patients with bronchial asthma / 中国结合医学杂志

<p><b>OBJECTIVE</b>To explore the effect of ligustrazine injection (LI) on serum levels of interleukin-4 (IL-4) and interferon-gamma (IFN-gamma) in patients with bronchial asthma and determine the mechanism of action of LI in preventing and treating asthma.</p><p><b>METHODS</b>Sixty-eight patients with mild or moderate bronchial asthma were assigned to two groups equally according to their sequence number, odd or even. The conventional treatment was administered to both groups, and LI was given to the treatment group by ultrasonic spray inhalation twice a day but not to the control group. The therapeutic course for all was 2 weeks. Further, 30 healthy subjects who had no history of smoking were enrolled as the normal control group. The clinical condition scores, frequency of attacks and dosage of Terbutaline inhaled were scored and recorded on the first day of hospitalization (before treatment) and after treatment. At the same time, the indexes of lung function, including forced expiratory volume in one second (FEV1), forced expiratory volume in one second to forced vital capacity ratio (FEV1%) and the peak expiratory flow (PEF) were determined before treatment. The levels of IL-4 and IFN-gamma in peripheral blood were detected by ELISA before and after treatment, and compared with that of the healthy control group.</p><p><b>RESULTS</b>After treatment, the clinical condition scores were found to be lower, indexes of lung function were elevated, but serum level of IL-4 and ratio of IL-4/IFN-gamma were reduced in both groups, showing significant differences as compared to those before treatment (P<0.05). However, the changes in all the indexes were more significant in the treatment group than in the control group, also showing statistical significance (P<0.05). No significant difference was revealed when IFN-gamma levels were compared before and after treatment in both groups, though a lowering trend could be seen, significant difference could not be found in the comparison of IFN-gamma levels between groups after treatment (P>0.05).</p><p><b>CONCLUSION</b>LI shows good clinical effect in treating bronchial asthma, and its mechanism might be related to the suppression of the synthesis of IL-4, thus leading to the inhibition of TH2 cell subset preponderant response and immune equilibrium regulation.</p>

Penile Erection during Transurethral Surgery : Case report and review of the literature

Imbalance between sympathetic and parasympathetic nervous systems is generally considered an underlying mechanism for intraoperative erection, although local stimulation before complete sensory blockade can contribute to the problem. With the onset of erection under regional anesthesia during an operative procedure, general inhalational anesthesia must be quickly initiated to enhance venous drainage of the engorged corpora cavernosa before prolonged venous stasis. Combination therapy including ketamine, glycopyrrolate, terbutaline, and alpha-adrenergics may be available, however, the benefit-risk ratio should be considered especially in the elderly patients with cardiovascular diseases. We present a case of intraoperative erection in an elderly patient, which was resolved by applying inhalational anesthesia with remifentanil after confirmation ineffectiveness of intravenous glycopyrrolate and ketamine. We also review and discuss the treatment strategies.

Safety and efficacy of oral nifedipine versus terbutaline injection in preterm labor.

OBJECTIVE: To compare the safety and tocolytic efficacy of oral nifedipine with intravenous terbutaline for the management of threatened preterm labor. MATERIAL AND METHOD: Pregnant women between 24 and 36 completed weeks of single gestation with preterm labor were randomized to either oral nifedipine (n=20) or intravenous terbutaline (n=20) treatment. Nifedipine (immediate released capsule) 10 mg was crushed and swallowed, 10 mg every 20 minutes was allowed if necessary with a maximum 40 mg in the first hour. After that 20 mg nifedipine every 4 hours was given, up to 72 hours. Terbutaline was initially infused with the rate 10 g/min with an increment 5 microg/min every 10 minutes if required, until 25 microg/min was reached. Once the contractions had stopped for 2-6 hours, the patients were switched to subcutaneous injection with 0.25 mg terbutaline every 4 hours for 24 hours. The main safety outcome was the changes in maternal diastolic blood pressure from baseline and 1 hour after starting the treatment (deltaDBP(1hr)). Secondary outcomes were the efficacy to delay delivery > or =48 hours and 7 days, the adverse events and the birth outcomes. RESULTS: deltaDBP(1hr) was greater in the terbutaline group than that in the nifedipine group with no statistically significant difference. Hypotension (defined as BP < or = 90/60 mmHg) was found in one patient of the nifedipine group and two patients of the terbutaline group. Seventeen and 14 patients in the nifedipine group and 15 and 12 patients in the terbutaline group had delayed delivery > or =48 hours and 7 days, respectively. Mothers in the nifedipine group experienced fewer side effects than those in the terbutaline group. Maternal heart rate, at I hour after starting the treatment, increased significantly higher in the terbutaline group than in the nifedipine group. Birth outcomes were measured in all nifedipine group patients, but in only 16 of the terbutaline group patients. Six mothers in each group delivered after 37 weeks. Intraventricular hemorrhage (IVH) occurred in three babies (gestational aged 25, 29 and 37 weeks) born to mothers treated with terbutaline. In one baby, IVH related to trauma resulted from the delivery procedure. CONCLUSION: The safety and efficacy of nifedipine compares with that of terbutaline for treatment of preterm labor.

The effect of polymorphism of the beta-2 adrenergic receptor on the response to beta-2 agonist in bronchial asthma patients.

AIM: To discover the role of beta2-adrenergic receptor (beta2-AR) polymorphism on the response to beta-2 agonist, particularly in coding amino acid at sequences 16 and 27 as well as adjacent nucleotides. METHODS: The study was conducted by nested case-control method with consecutive samples of asthma patients aged 15-60 years at the outpatient clinic, Department of Pulmonology in Dr. Wahidin Sudirohusodo General Hospital, Makassar. Twenty-eight patients were found irresponsive to terbutaline nebulation (increased FEV1 < 15%) and 56 patients were responsive (increased FEV1 > or =15%). DNA extraction and amplification were performed by PCR as well as polymorphism detection, which was done by automatic sequencing machine. RESULTS: The Arg 16 polymorphism did not have any effect on the response to terbutaline nebulation, but Gln 27 polymorphism did with OR 3.18. New polymorphism was found in nucleotide at 20th order before the start codon, it was T/C -20, which also has an effect on the response to terbutaline nebulation with OR 4.53. When the three polymorphisms were combined, the effect were greater with OR 11.11. It was found that age, gender, obesity, onset and ethnicity had no effect on the response to terbutaline nebulation. CONCLUSION: Polymorphism of the novel Gln 27 and T/C -20 (newly known) have an effect on the response to beta-2 agonist. Both combination and polymorphism of Arg 16 will bring greater effect on the response to beta-2 agonist.

The influence of terbutaline on VEGF gene expression in rat astrocytes after norepinephrine and burn serum induction / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the influence of adrenoreceptor beta-agonists terbutaline on gene expression of vascular endothelial growth factor (VEGF) in rat astrocyte after induction by norepinephrine (NE) and burn serum.</p><p><b>METHODS</b>The sera of normal and burn rats were separated for use. Primary astrocytes of brain tissue were isolated from neonatal 1-3 d rats and cultured and divided into following groups: (1) CONTROL GROUP: with 10% normal rat serum in the culture medium. (2) NEl, NE2, NE3 groups: with 10% burn rat serum and 10, 20, 50 micromol/L NE in the culture medium, respectively. (3) TBN1, TBN2, TBN3 groups: with 10% burn rat serum and 10, 20, 50 micromol/L NE and 10, 20, 50 micromol/L terbutaline in the culture medium, respectively. The mRNA and protein expression of VEGF in each group were determined with real-time PCR and Western blotting, respectively.</p><p><b>RESULTS</b>There was a low protein expression of VEGF in control group, but it increased slightly in NE1 group, and then increase gradually in NE2, NE3 groups, and it was obviously increased in TBN1, TBN2, TBN3 groups. The mRNA expression of VEGF in NE1, NE2, NE3 groups were [(13.26 +/- 0.03), (10.37 +/- 0.04), (14.87 +/- 0.55) copies/g], respectively, which were significantly higher than that of control [(5.72 +/- 0.12) copies/g, P < 0.01]. In addition, the expression of VEGF mRNA in TBN1, TBN2, TBN3 groups was higher than that in control group, and expression of VEGF mRNA [(13.39 +/- 0.19), (15.77 +/- 0.11), (16.00 +/- 0.07) copies/g] was gradually increased, which showed obvious difference between TBN2 and NE2, and also between TBN3 and NE3 groups (P < 0.01).</p><p><b>CONCLUSION</b>Terbutaline can increase gene expression of VEGF in rat astrocytes after induction by NE and burn serum.</p>