Daily life affective dynamics as transdiagnostic predictors of mental health symptoms: An ecological momentary assessment study

BACKGROUND

Affective dynamics have been identified as a correlate of a broad span of mental health issues, making them key candidate transdiagnostic factors. However, there remains a lack of knowledge about which aspects of affective dynamics - especially as they manifest in the course of daily life - relate to a general risk for mental health issues versus specific symptoms.

METHODS

We leverage an ecological momentary assessment (EMA) study design with four measures per day over a two-week period to explore how negative affect levels, inertia, lability, and reactivity to provocation and stress in the course of daily life relate to mental health symptoms in young adults (n = 256) in the domains of anxiety, depression, psychosis-like symptoms, behaviour problems, suicidality, and substance use.

RESULTS

Dynamic structural equation modelling (DSEM) suggested that negative affect levels in daily life were associated with depression, anxiety, indirect and proactive aggression, psychosis, anxiety, and self-injury; negative affective lability was associated with depression, physical aggression, reactive aggression, suicidal ideation, and ADHD symptoms; negative affective inertia was associated with depression, anxiety, physical aggression, and cannabis use; and emotional reactivity to provocation was related to physical aggression.

LIMITATIONS

The cross-sectional design, the limited span of mental health issues included, and the convenience nature and small size of the sample are limitations.

CONCLUSIONS

Findings suggest that a subset of mental health symptoms have shared negative affective dynamics patterns. Longitudinal research is needed to rigorously examine the directionality of the effects underlying the association between affective dynamics and mental health issues.

Adrenergic receptor system as a pharmacological target in the treatment of epilepsy (Review)

Epilepsy is a complex and common neurological disorder characterized by spontaneous and recurrent seizures, affecting ~75 million individuals worldwide. Numerous studies have been conducted to develop new pharmacological drugs for the effective treatment of epilepsy. In recent years, numerous experimental and clinical studies have focused on the role of the adrenergic receptor (AR) system in the regulation of epileptogenesis, seizure susceptibility and convulsions. α1-ARs (α1A, α1B and α1D), α2-ARs (α2A, α2B and α2C) and β-ARs (β1, β2 and β3), known to have convulsant or anticonvulsant effects, have been isolated. Norepinephrine (NE), the key endogenous agonist of ARs, is considered to play a crucial role in the pathophysiology of epileptic seizures. However, the effects of NE on different ARs have not been fully elucidated. Although the activation of some AR subtypes produces conflicting results, the activation of α1, α2 and β receptor subtypes, in particular, produces anticonvulsant effects. The present review focuses on NE and ARs involved in epileptic seizure formation and discusses therapeutic approaches.

Pathways from childhood trauma to aberrant salience: A structural equation approach to mentalization model

OBJECTIVE

The aim of this study was to explore the relationship between affective disturbances and aberrant salience in the context of childhood trauma, attachment, and mentalization in an analogue study.

METHODS

Using a cross-sectional design, an online community sample completed self-report measures of key variables. Structural equation modelling was used to test childhood trauma's influence on aberrant salience via a set of intermediate risk factors (depression, negative schizotypy, and insecure attachment). These intermediate risk factors were assumed to lead to the proximal risk factors of aberrant salience (i.e., disorganized schizotypy and disorganized attachment) depending on the vulnerability of mentalizing capacity to elevated stress.

RESULTS

The sample (N = 1263) was 78% female and aged between 18 and 35 years. The tested models closely fitted the observed data, revealing significant pathways from childhood trauma to aberrant salience via the hypothesized pathways. The direct effect of childhood trauma on aberrant salience was significant.

CONCLUSION

Findings suggest that the pathway to aberrant salience may be characterized by disorganization of self-state and intersubjectivity as a function of diminishment in mentalizing ability. This may relate to changes in attachment organization and socio-cognitive capacity, which could constitute possible risk factors signalling development of aberrant salience.

Aspirin attenuates morphine antinociceptive tolerance in rats with diabetic neuropathy by inhibiting apoptosis in the dorsal root ganglia

Morphine is a drug used in chronic pain such as diabetic neuropathy, but the development of tolerance to its antinociceptive effect is an important clinical problem. Aspirin is an analgesic and antiapoptotic drug used in combination with morphine as an adjuvant in diabetic neuropathy. Our aim in this study was to investigate the effects of aspirin on morphine-induced neuronal apoptosis and analgesic tolerance in rats with diabetic neuropathy. The antinociceptive effects of aspirin (50 mg/kg) and morphine (5 mg/kg) were evaluated by thermal pain tests. Streptozotocin (65 mg/kg) was injected intraperitoneally to induce diabetic neuropathy. To evaluate apoptosis, ELISA kits were used to measure caspase-3, Bax and Bcl-2 levels. Apoptotic cells were detected histologically by terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) method. Study results indicate that prior administration of aspirin to diabetic rats significantly increased the antinociceptive efficacy of morphine compared to morphine alone. Thermal pain tests showed that aspirin significantly reduced morphine tolerance in rats with diabetic neuropathy. Biochemical analysis revealed that aspirin significantly decreased the levels of pro-apoptotic proteins, caspase-3 and Bax, while increasing the anti-apoptotic Bcl-2 in DRG neurons. Semiquantitative scoring demonstrated that aspirin provided a significant reduction in apoptotic cell counts in diabetic rats. In conclusion, these data suggested that aspirin attenuated morphine antinociceptive tolerance through anti-apoptotic activity in diabetic rat DRG neurons.

Blockade of orexin receptor type-1 by SB-334867 and activation of orexin receptor type-2 attenuate morphine tolerance in rats

Purpose

The interaction of orexinergic neurons with the opioidergic system and their effects on morphine analgesia and tolerance have not been fully elucidated. The purpose of the study was to evaluate the effects of the orexin-1 and orexin-2 receptor (OX1R and OX2R) agonist and antagonist on morphine analgesia and tolerance in rats.

Material and methods

A total of 90 Wistar albino male rats weighing 180–220 g were used in the experiments. To induce morphine tolerance, rats were injected with a single dose of morphine (50 mg kg−1, s.c.) for 3 days. Morphine tolerance was assessed on day 4 in randomly selected rats by analgesia tests. In order to evaluate morphine tolerance situation, orexin-A, SB-334867, orexin-B and TCS OX2 29 were administered together with morphine for 3 days. The analgesic effects of orexin-A (10 μg kg−1), OXR1 antagonist SB-334867 (10 mg kg−1), OXR2 agonist orexin-B (15 μg kg−1), OXR2 antagonist TCS OX2 29 (0.5 mg kg−1) and morphine (5 mg kg−1) were measured at 15 or 30-min intervals by tail-flick and hot-plate antinociceptive tests.

Results

The results suggested that the combination of orexin-1 receptor antagonist SB-334867 and orexin-B with morphine significantly increased the analgesic effect compared to morphine-tolerant rats. In addition, administration of orexin-A and -B alone showed significant analgesic effects compared to the saline group. However, co-administration of orexin-A and -B with morphine did not increase the analgesic efficacy of morphine.

Conclusions

The results of this study demonstrated that co-administration of SB-334867 and orexin-B with morphine attenuated morphine tolerance. Further studies are needed to elucidate the details of the interaction between orexin receptors and the opioidergic system.

Independent risk factors affecting hemorrhage in percutaneous nephrolithotomy: Retrospective study

INTRODUCTION

The perioperative and postoperative concern in percutaneous nephrolithotomy (PNL) is bleeding. Disease-related conditions (such as stone size, stone HU, tract number, and diameter) affecting this situation were determined. To determine independent risk factors that may affect the amount of hemorrhage in PNL.

MATERIAL AND METHOD

A total of 308 adult patients (211 men, 97 women) undergoing the PNL procedure were included in the study. Renal anatomy and stone size were evaluated using non-contrast thin-section computed tomography (NCCT). NCCT was used to assess Hounsfield unit (HU) values of kidney stones, presence of atheroma plaque and obesity. The difference between preoperative hemoglobin (Hgb) values and postoperative 1st day Hgb values was recorded. This variation was evaluated for the effect of gender, age, atherosclerotic vein disease, urine pH and density, leukocyte count, lymphocyte count, neutrophil count (NEU), platelet count, mean platelet volume (MPV), neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), stone volume, HU, and obesity.

RESULTS

The mean Hgb variation was identified as 2.1 (standard deviation: 1.6). There were positive, significant, and weak correlations between the Hgb variation with NEU (P=0.019), MPV (P=0.000), NLR (P=0.005), stone volume (P=0.041) and HU (P=0.024) values. There was a negative significant and weak correlation between Hgb variation and PLT (P=0.022). No effects at significant levels were identified for gender (P=0.078), presence of atheroma plaque (P=0.949), obesity (P=0.869), age (P=0.686), urine pH (P=0.746), urine density (P=0.421), and PLR (P=0.855) on Hgb variations.

CONCLUSION

In addition to HU and stone volume, NEU count, MPV, NLR and PLT count may be used as independent risk factors to predict blood loss during PNL.

Metformin prevents morphine-induced apoptosis in rats with diabetic neuropathy: a possible mechanism for attenuating morphine tolerance

Morphine is a drug of choice for the treatment of severe and chronic pain, but tolerance to the antinociceptive effect limits its use. The development of tolerance to morphine has recently been associated with neuronal apoptosis. In this study, our aim was to investigate the effects of metformin on morphine-induced neuronal apoptosis and antinociceptive tolerance in diabetic rats. Three days of cumulative dosing were administered to establish morphine tolerance in rats. The antinociceptive effects of metformin (50 mg/kg) and test dose of morphine (5 mg/kg) were considered at 30-min intervals by thermal antinociceptive tests. To induce diabetic neuropathy, streptozotocin (STZ, 65 mg/kg) was injected intraperitoneally. ELISA kits were used to measure caspase-3, bax, and bcl-2 levels from dorsal root ganglion (DRG) tissue. Semi-quantitative scoring system was used to evaluate apoptotic cells with the the terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) method. The findings suggest that co-administration of metformin with morphine to diabetic rats showed a significant increase in antinociceptive effect compared to morphine alone. The antinociceptive tests indicated that metformin significantly attenuated morphine antinociceptive tolerance in diabetic rats. In addition, metformin decreased the levels of apoptotic proteins caspase 3 and Bax in DRG neurons, while significantly increased the levels of antiapoptotic Bcl-2. Semi-quantitative scoring showed that metformin provided a significant reduction in apoptotic cell counts in diabetic rats. These data revealed that metformin demonstrated antiapoptotic activity in diabetic rat DRG neurons and attenuated morphine tolerance. The antiapoptotic activity of metformin probably plays a significant role in reducing morphine tolerance.

Relationships between RDW, NLR, CAR, and APACHE II scores in the context of predicting the prognosis and mortality in ICU patients

OBJECTIVE

Intensive care units (ICU) are tasked with critical care and treatment with a view to improving prognosis. The Acute Physiology and Chronic Health Evaluation II (APACHE II) is one of the most commonly used scoring systems to predict prognosis. In this context, the objective of this study is to evaluate the prognostic value of Red Cell Distribution Width (RDW), Neutrophil-Lymphocyte ratio (NLR), and C-reactive protein to albumin ratio (CAR) in predicting the prognosis and mortality in patients admitted to the ICU.

PATIENTS AND METHODS

The RDW, NLR, and CAR values and APACHE II scores of patients admitted into an ICU, where heterogeneous groups of patients are usually treated, were recorded, categorized based on survival status, and investigated for any correlation between surviving patients' mortality and length of stay (LoS) in ICU and the said parameters.

RESULTS

The ICU mortality among the 2,147 patients included in the study was 43.2%. The most common diagnosis of the patients admitted to the ICU was sepsis. The RDW, NLR, and CAR values and APACHE II scores of the deceased patients were significantly higher than those of the survived patients. There was a significant correlation between LoS in ICU and the said parameters in the positive direction in the survived group only. The APACHE II score had the highest prognostic value in predicting mortality, followed by RDW, CAR, and NLR values in descending order.

CONCLUSIONS

Among the parameters investigated in this study, RDW had the highest prognostic value in predicting the prognosis and mortality. Hence, it may be incorporated into or used alongside the APACHE II scoring system to predict patient outcomes with higher accuracy. However, further randomized controlled studies are needed to determine the cut-off values in predicting the prognosis and mortality.

The impact of daily troponin-I and D-dimer serum levels on mortality of moderate-to-severe COVID-19 pneumonia patients

Introduction

Coronavirus Disease 2019 (COVID-19) caused by that infection resulted in a very high morbidity and mortality rates globally.

Purpose

The aim of this study is to analyses the daily Troponin-I and D-dimer levels and their impact on the need for intensive care and mortality of the COVID-19 infected patients.

Methods

206 patients who were hospitalized between 20.03.2020–05.05.2020 with a diagnosis of moderate-to-severe COVID-19 pneumonia were analyzed retrospectively. Serum Troponin-I and D-dimer levels were recorded at least 10 days.

Results

Average age was higher in mortality group compared to non-mortality group (respectively 67.79±14.9, 56.87±18.15, p:<0.001). Presence of hypertension, diabetes mellitus, previous coronary bypass surgery, heart failure, chronic renal failure and chronic obstructive pulmonary disease were statistically significant affecting mortality (respectively p:0.003, p:0.004, p:0.045, p:0.02, p:0.003, p:0.007). First 10 days measurements of Troponin-I and D-dimer values was associated with mortality and intensive care requirement (p<0.001). Both Troponin-I and D-dimer were higher in mortality group compared to the patients requiring intensive care. Troponin-I value on the 7th day ≥16.05 pg/ml was related with need for intensive care (AUC: 0.896, sensitivity: %78.6, specificity: %78.3, p<0.001). Troponin-I value ≥30.25 pg/ml on the 9th day was related with mortality (AUC: 0.920, sensitivity: %89.5, specificity: %89.3, p<0.001). D-dimer value ≥878 hg/ml on the 2nd day was associated with intensive care need (AUC: 0.896, sensitivity: %78.6, specificity %78.3, p<0.001). D-dimer value ≥1106 hg/ml on the 10th day was associated with mortality (AUC: 0.817, sensitivity: %68.4, specificity: %65.2, p<0.001). It was observed that hospitalization periods ≥9.5 days were associated with mortality (AUC: 0.738, sensitivity %68.4, specificity: %65.9, p<0.001).

Conclusion

We observed that hospitalizations ≥9.5 days increased mortality. Troponin-I and D-dimer follow-ups in serum are more effective than other inflammatory markers to show the need for intensive care and mortality. A high Troponin-I value should alert the clinician in terms of clinical deterioration.

Funding Acknowledgement

Type of funding sources: None.

Ghrelin receptor agonist hexarelin attenuates antinociceptive tolerance to morphine in rats

Ghrelin, a peptide hormone released from the gastric endocrine glands, shows analgesic activity apart from its various physiological effects. Nevertheless, the effects of ghrelin receptor (GHS-R) agonists on morphine analgesia and tolerance have not yet been elucidated. The purpose of this study was to evaluate the effects of the ghrelin receptor agonist hexarelin and antagonist [d-Lys3]-GHRP-6 on morphine antinociception and tolerance in rats. A total of 104 Wistar albino male adult rats (weighing approximately 220-240 g) were used in the experiments. To induce morphine tolerance, a three-day cumulative dose regimen was used in the rats. Then, randomly selected rats were evaluated for morphine tolerance on day 4. The analgesic effects of hexarelin (0.2 mg·kg-1), [d-Lys3]-GHRP-6 (10 mg·kg-1), and morphine (5 mg·kg-1) were measured at 30-min intervals (0, 30, 60, 90, and 120 min) by tail-flick and hot-plate analgesia tests. The findings suggest that hexarelin in combination with morphine attenuates analgesic tolerance to morphine. On the other hand, ghrelin receptor antagonist [d-Lys3]-GHRP-6 has no significant analgesic activity on the morphine tolerance in analgesia tests. Furthermore, co-administration of hexarelin and morphine increases the analgesic effect. In conclusion, these data indicate that administration of GHS-R agonist hexarelin with morphine enhances the antinociception and attenuates morphine tolerance.

The Effects of Proton Pump Inhibitors (Pantoprazole) on Pentylenetetrazole-Induced Epileptic Seizures in Rats and Neurotoxicity in the SH-SY5Y Human Neuroblastoma Cell Line

Recent studies have shown that proton pump inhibitors have positive effects on the nervous system. However, its effect on epileptic seizure and neuronal damage are still unclear. In this study, it was aimed to investigate the effect of pantoprazole on pentylenetetrazole-induced epileptic seizures in rats and neurotoxicity in the SH-SY5Y cell line. Animals were divided into three groups: control, saline (1 mL/kg serum physiologic), and pantoprazole (10 mg/kg). Pentylenetetrazole (45 mg/kg) was given to induce a seizure and a passive avoidance test trial was carried out to evaluate memory function. 8-hydroxy-2'-deoxyguanosine (8-OHdG), caspase-3, and brain-derived neurotrophic factor (BDNF) levels were measured in the brain by commercial kits. SH-SY5Y cells were treated with saline or pantoprazole for one hour, and then pentylenetetrazole (30 µm) was added to the medium to induce neurotoxicity. After 24 h, cell viability, total antioxidant, total oxidant status, and apoptosis were measured in SH-SY5Y cells. It was found that pantoprazole treatment postponed epileptic seizure onset, protected memory, reduced 8-OHdG, caspase-3, and also increased BDNF in the brain. In addition, it blocked pentylenetetrazole toxicity, apoptosis, increased antioxidant, and decreased oxidant status in SH-SY5Y cells. Pantoprazole significantly improved seizure, oxidative stress, and apoptosis. Thus, pantoprazole could be used as a supportive therapeutic agent in epilepsy.

AB1029 MYOCARDIAL DYSFUNCTION DETECTED BY USING SPECKLE TRACKING ECHOCARDIOGRAPHY IN FAMILIAL MEDITERRANEAN FEVER PATIENTS; IS THERE ANY DIFFERENCE REGARDING RESISTANT DISEASE?

Background:

Familial Mediterranean fever (FMF) is an auto-inflammatory disease commonly affects people from Mediterranean basin. It is characterized by acute self-limiting inflammatory attacks of serous membrane. Some recent studies showed diastolic dysfunction in patients with FMF however systolic function was rarely evaluated before.

Objectives:

To assess cardiac functions by using speckle tracking echocardiography (STE) in addition to routine measurements and to evaluate whether there is any difference between colchicine responsive patients and those with colchicine-resistant or severe disease.

Methods:

Seventy-four FMF patients (57 responsive [60% female and median age 35 [18-63] years], 17 resistant [53% female and median age 31 [20-49] years]) and 74 healthy controls ([53% female and median age 37 [22-55] years]) were included in the study. Patients with cardiac disease or risk factors affecting STE were excluded. Patients who had ≥1 attacks in three months despite ≥2 mg/day od colchicine or who were treated with IL-1 blocking agents were defined as colchicine resistant disease and who had amyloidosis (whom had proteinuria ≥500 mg/day in at least 2 occasion or biopsy-proven amyloidosis) defined as severe disease. Demographic and disease related characteristics were obtained by using a structured form. A detailed echocardiographic examination including the M-mode, Doppler, and STE was applied to whole study population.

Results:

There was no significant difference between groups in terms of age and sex. Disease duration was not different between colchine responsive and resistant patients (median duration in resistant diasease was 11 years (1-27), in responsive patients 6 years (0-33) and, p: 0.133). Although ejection fraction was similar among groups, global longitudinal peak systolic strain; a marker of systolic function, was significantly lower in FMF patients in comparison with healthy subjects and this difference was due to colchicine resistant FMF patients (p<0.05). There was no significant difference in echocardiographic parameters between non-resistive and resistive FMF patients (p>0.05) (Table).

Table.

Comparison of standard and speckle tracking echocardiographic findings among groups

Responsive FMF (n: 57)Resistant FMF (n: 17)Healthy Controls (n: 74)LA31 (23-41)30 (26-35)31 (22-44)LVD43 (35-86)41 (38-48)43 (20-50)LVS26 (20-32)24 (18-31)26 (19-34)EF62 (40-77)64 (46-73)60 (52-70)E95 (23-148)98 (9-130)93 (57-130)A83 (26-153)79 (8-134)81 (57-120)DT187 (100-303) *183 (100-296)161 (100-254)ELateral14 (8-29)13 (10-23)14 (8-23)ALateral11 (5-18)10 (7-18)10 (6-17)ESeptal11 (6-20)9 (5-16)11 (5-16)ASeptal10 (5-17)10 (5-17)9 (4-23)GLS20 (8-55) *20 (15-32)22 (16-33)GCS21 (10-29)20 (11-42)20 (13-30)

*Significant difference among groups, p<0,05. LA: Left atrium, LVD: left ventricular diastolic diameter, LVS: Left ventricular systolic diamater, EF: Ejection fraction, E: Early diastolic filling A: Atrial filling, DT: Deceleration time, GLS: Global Longitudinal strain GCS: Global circumflex strain

Conclusion:

This study shows that there is subclinical myocardial dysfunction in FMF patients. Those patients with severe or colchicine resistant disease has a numerical but statistically different trend toward systolic dysfunction.

Disclosure of Interests:

None declared

Response to Comment on "Dry reforming of methane by stable Ni-Mo nanocatalysts on single-crystalline MgO"

Hu and Ruckenstein state that our findings were overclaimed and not new, despite our presentation of evidence for the Nanocatalysts on Single Crystal Edges (NOSCE) mechanism. Their arguments do not take into account fundamental differences between our Ni-Mo/MgO catalyst and their NiO/MgO preparations.

Dry reforming of methane by stable Ni-Mo nanocatalysts on single-crystalline MgO

Large-scale carbon fixation requires high-volume chemicals production from carbon dioxide. Dry reforming of methane could provide an economically feasible route if coke- and sintering-resistant catalysts were developed. Here, we report a molybdenum-doped nickel nanocatalyst that is stabilized at the edges of a single-crystalline magnesium oxide (MgO) support and show quantitative production of synthesis gas from dry reforming of methane. The catalyst runs more than 850 hours of continuous operation under 60 liters per unit mass of catalyst per hour reactive gas flow with no detectable coking. Synchrotron studies also show no sintering and reveal that during activation, 2.9 nanometers as synthesized crystallites move to combine into stable 17-nanometer grains at the edges of MgO crystals above the Tammann temperature. Our findings enable an industrially and economically viable path for carbon reclamation, and the "Nanocatalysts On Single Crystal Edges" technique could lead to stable catalyst designs for many challenging reactions.

The effects of extremely low-frequency pulsed electromagnetic fields on analgesia in the nitric oxide pathway

There is growing interest in the effects of extremely low-frequency electromagnetic fields on mechanisms in biological organisms. This study's goal is to determine the role of the Nitiric Oxide (NO) pathway for thermal pain by intentionally interfering with it using a pulsed electromagnetic field generated by an extremely low-frequency alternating current (ELF-PEMF) in combination with BAY41-2272 (sGC activator), NOS inhibitor l-NAME, and NO donor l-arginine. This study included 72 adult male Wistar albino rats (mean weight of 230 ± 12 g). The rats were kept at room temperature (22 ± 2 °C) in a 12-h light/dark cycle and in a room with sound insulation. PEMF (50 Hz, 5 mT) were applied four times a day for 30 min and at 15-min intervals for 15 days. Analgesic effects were assessed with tail-flick and hot-plate tests. Before the tests, NO donor l-arginine (300 mg/kg), sGC activator BAY41-2272 (10 mg/kg), and NOS inhibitor l-name (40 mg/kg) were injected intraperitoneally into rats in six randomly-selected groups. The maximum analgesic effect of a 5 mT electromagnetic field was on day 7. PEMF significantly increased the analgesia effect when the functioning of the NO pathway was ensured with l-arginine, which is a NO donor, and BAY41-2271, which is the intracellular receptor and sGC activator. However, there was no difference between rats treated with PEMF and the NOS inhibitor l-NAME as compared to rats only treated with PEMF. In conclusion, PEMF generate analgesia by activating the NO pain pathway.

Effects of 5-HT1 and 5-HT 2 Receptor Agonists on Electromagnetic Field-Induced Analgesia in Rats

Much evidence demonstrates the antinociceptive effect of magnetic fields (MFs). However, the analgesic action mechanism of the electromagnetic field (EMF) is not exactly understood. The aim of the present study was to investigate the effects of 5-HT₁ and 5-HT₂ receptor agonists (serotonin HCl and 2,5-dimethoxy-4-iodoamphetamine [DOI] hydrochloride) on EMF-induced analgesia. In total, 66 adult male Wistar albino rats with an average body mass of 225 ± 13 g were used in this study. The animals were subjected to repeated exposures of alternating 50 Hz and 5 mT EMF for 2 h a day for 15 days. Prior to analgesia tests, serotonin HCl (5-HT₁ agonist) 4 mg/kg, WAY 100635 (5-HT₁ antagonist) 0.04 mg/kg, DOI hydrochloride (5-HT₂ receptor agonist) 4 mg/kg, and SB 204741 (5-HT₂ antagonist) 0.5 mg/kg doses were injected into rats. For statistical analysis of the data, analysis of variance was used and multiple comparisons were determined by Tukey's test. Administration of serotonin HCl MF (5 mT)-exposed rats produced a significant increase in percent maximal possible effect (% MPE) as compared with EMF group (P < 0.05). On the contrary, injection of WAY 100635 to MF-exposed rats produced a significant decrease in analgesic activity (P < 0.05). Similarly, the administration of DOI hydrochloride significantly increased % MPE values as compared with the EMF group while SB 204741 reduced it (P < 0.05). In conclusion, our results suggested that serotonin 5-HT₁ and 5-HT₂ receptors play an important role in EMF-induced analgesia; however, further research studies are necessary to understand the mechanism. Bioelectromagnetics. 2019;40:319-330. © 2019 Bioelectromagnetics Society.

Geographic Distribution of Multiple Arteries and Veins of 878 Kidney Donors From a Transplant Center in Turkey

AIM

The diagnosis and management of multiple renal arteries and veins have gained importance with the increasing number of kidney transplantations and improved techniques in interventional radiology and vascular reconstructions. The aim of this study is to define and to detect the rate of multiple renal arteries and veins in our living kidney transplant donors coming from all parts of our country.

METHODS

Abdominal computed tomography angiogram findings of 878 kidney transplant donors were analyzed. The presence and the distribution of multiple renal arteries and veins in donors coming from 7 geographic regions in Turkey were noted.

RESULTS

The presence of multiple renal arteries was observed in 34% (48/141) of patients in the Marmara Region, 36.7% (79/215) of patients in the Black Sea Region, 37.2% (64/172) of patients in the Central Anatolia Region and 36.1% (30/83) of patients in the Southeastern Anatolia Region. The highest incidences of multiple renal arteries were observed in the Mediterranean and Aegean regions, affecting 40% (32/80) and 41.9% (26/62) of patients, respectively, while East Anatolia was found to have the lowest incidence, affecting 28% (35/125) of patients. The incidence of multiple renal veins also varied across regions. The highest incidence was observed in the Central Anatolia Region, where 23.3% (40/172) of patients were affected; the lowest was seen in the Aegean Region, where 11.3% (7/62) of patients were affected. In Turkey as a whole, 35.8% (314/878) of patients presented with multiple renal arteries, while the rate of multiple renal veins was found to be 19% (167/878) among our donors.

CONCLUSIONS

As 80% of the kidney transplantations performed in Turkey involve living donors, we think it will be useful to have knowledge of not only the presence of multiple renal arteries and veins, but also the distribution of this feature throughout the different regions of the country.

Metacognitive interpersonal therapy in group: a feasibility study

Patients with personality disorders (PDs) other than borderline, with prominent features of social inhibition and over-regulation of emotions, are in need of specialized treatments. Individuals present with poor metacognition, that is the capacity to understand mental states and use psychological knowledge for the sake of purposeful problem solving; and are guided by maladaptive interpersonal schemas. We developed a short-term group intervention, Metacognitive Interpersonal Therapy in Groups (MIT-G), incorporating psychoeducational and experiential elements, to help these individuals become more aware of their drives when interacting with others; and to help them adopt more flexible behaviors via improvements in metacognition. We present results of an effectiveness study, evaluating whether we could replicate the initial positive results of our first pilot randomized controlled trial. Seventeen young adults outpatients with personality disorders were included in the 16 session program. Effect sizes were calculated for change from baseline to treatment end for the primary outcome, symptoms and functioning (Clinical Outcomes in Routine Evaluation Outcome Measure) and then for one putative mechanism of change - metacognition. Emotional dysregulation and alexithymia were also assessed. Qualitative evaluations of the acceptability and subjective impact of the treatment were also performed. MIT-G was acceptable to participants. There were medium to large magnitude changes from pre- to post- treatment on wellbeing, emotion dysregulation, alexithymia and metacognition. These gains were maintained at follow-up. There was evidence of clinically significant change on key variables. MITG appears acceptable to patients, as evidenced by the absence of drop-out from treatment. In light of the positive outcomes of this study and the expanding evidence base, MIT-G is a candidate for dissemination and investigations in larger trials as a possible effective intervention for PDs characterized by tendencies to overcontrol.

Direct Access to Primary Amines and Particle Morphology Control in Nanoporous CO2 Sorbents

Chemical tuning of nanoporous, solid sorbents for ideal CO₂ binding requires unhindered amine functional groups on the pore walls. Although common for soluble organics, post-synthetic reduction of nitriles in porous networks often fails due to insufficient and irreversible metal hydride penetration. In this study, a nanoporous network with pendant nitrile groups, microsphere morphology was synthesized in large scale. The hollow microspheres were easily decorated with primary amines through in situ reduction by widely available boranes. The CO₂ capture capacity of the modified sorbent was increased to up to four times that of the starting nanoporous network with a high heat of adsorption (98 kJ mol^-1 ). The surface area can be easily tuned between 1 and 354 m²  g^-1 . The average particle size (ca. 50 μm) is also quite suitable for CO₂ capture applications, such as those with fluidized beds requiring spheres of micron sizes.

The pathophysiological role of serotonin receptor systems in opioid analgesia and tolerance

Continuous treatment with opioid analgesics, such as morphine, leads to the development of ant nociceptive tolerance in patients. Although a lot of information about antinociceptive, the pathophysiological mechanisms of tolerance to opioid analgesia are not yet completely understood. Proposed mechanisms for opioid analgesic tolerance comprise down-regulation of opioid receptors, reduction of sensitivity G-proteins, altered intracellular signalling pathway including nitric oxide, adenyl cyclase, and protein kinase C. Numerous physiological and behavioural studies have shown an interaction of the serotonergic system and opioid antinociception. The serotonin (5-HT) receptor system is a necessary component of the spinal and midbrain pain modulation circuit mediating opioid analgesia. Various types of serotonin receptors demonstrate different effects on morphine analgesia. Systemic administration of opioids rise 5-HT levels in the spinal cord dorsal horn and contribute to opioid analgesia in the normal state but reduce that in neuropathic pain via spinal 5-HT3 receptors. Spinal and supraspinal serotonergic neurons may also play a pathophysiological role in the development of morphine analgesic tolerance. Serotonin receptor subtypes show different effects on opioid tolerance. This review paper focus on the current understanding of the role of serotonin receptor systems in opioid analgesia and tolerance.

The effects of endocannabinoid receptor agonist anandamide and antagonist rimonabant on opioid analgesia and tolerance in rats

The role of the cannabinoid (CB) system in the tolerance to analgesic effect of opioid remains obscure. The aim of the present study was to evaluate the effects of the endocannabinoid nonselective receptor agonist anandamide (AEA) and CB1 receptor antagonist rimonabant (SR141716) on morphine analgesia and tolerance in rats. Male Wistar albino rats weighing 215-230 g were used in these experiments. To constitute morphine analgesic tolerance, a 3-day cumulative dosing regimen was used. The analgesic effects of AEA (10 mg/kg), SR141716 (10 mg/kg), and morphine (5 mg/kg) were considered at 30-min intervals by tail flick (TF) and hot plate (HP) analgesia tests. The analgesic effects of the drugs were measured as TF and HP latencies in all groups for each rat and converted to %MPE. The data were analysed by analysis of variance followed by Tukey test. The findings suggested that AEA in combination with morphine produced a significant increase in expression of analgesic tolerance to morphine. Conversely, cannabinoid receptor antagonist SR141716 attenuated morphine analgesic tolerance. In addition, administration of AEA with morphine increased morphine analgesia. In conclusion, we observed that the cannabinoid receptor agonist anandamide and CB1 receptor antagonist SR141716 plays a significant role in the opioid analgesia and tolerance.

Aortic Elastic Properties and Myocardial Performance Index Are Impaired in Patients with Lichen Planus

OBJECTIVES

The aim of this study was to investigate the elastic properties of the aorta and the myocardial performance index of the left ventricle (LV) in patients with lichen planus (LP).

SUBJECTS AND METHODS

A total of 54 patients with LP and 50 controls were enrolled in the study. The 2 groups were well-matched regarding age, gender, body mass index, any smoking history, diabetes mellitus and systolic and diastolic blood pressure (SBP and DBP). The echocardiographic examination was performed on the study subjects and the controls. Aortic elasticity parameters and the myocardial performance index of the LV were calculated. The Student t test, the x03C7;2 test and multiple linear regression were used for the statistical analysis.

RESULTS

Aortic strain (AS, 4.77 ± 1.81 vs. 8.95 ± 2.22; p < 0.001) and aortic distensibility (AD, 0.25 ± 0.009 vs. 0.42 ± 0.120; p < 0.001) were significantly lower, and aortic stiffness index β (ASIβ, 3.65 ± 1.03 vs. 2.70 ± 0.91; p < 0.001) was significantly higher in the LP group than in the controls. The myocardial performance index (Tei index) was significantly higher in the LP group than in the control group (p = 0.001). The duration of the LP was negatively correlated with AS (r = -0.364, p < 0.001) and AD (r = -0.279, p = 0.006), and positively correlated with the Tei index (r = 0.324, p = 0.001) and ASIβ (r = 0.364, p < 0.001). After adjustment for relevant confounders (age, male gender, smoking, SBP, DBP, diabetes mellitus and low- and high-density lipoprotein cholesterol), LP and its duration were still associated with AS, AD and ASIβ.

CONCLUSION

In this study, AS and AD were lower and ASIβ and myocardial performance index higher in LP patients than in controls.

Attenuation of morphine antinociceptive tolerance by cannabinoid CB1 and CB2 receptor antagonists

Cannabinoid CB1 and CB2 receptor antagonists may be useful for their potential to increase or prolong opioid analgesia while attenuating the development of opioid tolerance. The aim of this study was to investigate the effects of AM251 (a selective CB1 antagonist) and JTE907 (a selective CB2 antagonist) on morphine analgesia and tolerance in rats. Adult male Wistar albino rats weighing 205-225 g were used in these experiments. To constitute morphine tolerance, we used a 3 day cumulative dosing regimen. After the last dose of morphine was injected on day 4, morphine tolerance was evaluated by analgesia tests. The analgesic effects of morphine (5 mg/kg), ACEA (a CB1 receptor agonist, 5 mg/kg), JWH-015 (a CB2 receptor agonist, 5 mg/kg), AM251 (1 mg/kg) and JTE907 (5 mg/kg) were considered at 30-min intervals (0, 30, 60, 90, and 120 min) by tail-flick and hot-plate analgesia tests. Our findings indicate that ACEA and JWH907 significantly increased morphine analgesia and morphine antinociceptive tolerance in the analgesia tests. In contrast, the data suggested that AM251 and JTE907 significantly attenuated the expression of morphine tolerance. In conclusion, we observed that co-injection of AM251 and JTE907 with morphine attenuated expression of tolerance to morphine analgesic effects and decreased the morphine analgesia.

A retrospective analysis of prognostic factors predictive of lymph-node metastasis and recurrence in thyroid papillary microcarcinoma

AIM

The literature is inconclusive concerning the prognostic factors and therapeutic management of papillary thyroid microcarcinoma (PTMC). Herein we report on our extensive experience with PTMC in relation to clinicopathological characteristics and prognostic factors.

METHODS

In all, 248 patients that were diagnosed and treated for PTMC between 2007 and 2012 were retrospectively analyzed. Demographic and tumor characteristics at presentation, and recurrence during follow-up were noted.

RESULTS

Total thyroidectomy and radioactive iodine (RAI) ablation treatment were performed in all patients. Bilateral involvement, vascular and capsular invasion, extra-thyroidal extension, and lymph node metastasis occurred significantly more frequently in patients with tumor size>5 mm (P<0.05). Multivariate statistical analysis showed that a clinically suspected diagnosis (OR:0.095; P=0.043) and elevated thyroglobulin (TG) level (OR: 1.083; P=0.011; cut-off value≥7.98 ngmL(-1)) were significant and independent risk factors for lymph node metastasis, with a sensitivity of 57% and specificity of 83%. After a median follow-up of 2 years (range:0.3-11 years), 10 (4%) of the 248 patients had recurrent disease. According to multivariate analysis, lymph node metastasis (OR: 51.4; P=0.003) was the only independent predictor of recurrence.

CONCLUSION

Our findings revealed that serum TG level and a clinically suspected diagnosis were risk factors for lymph node metastasis, while nodal metastasis was a predictor of recurrence.

Soluble guanylyl cyclase activators increase the expression of tolerance to morphine analgesic effect

OBJECTIVES

It is aimed to investigate the effects of guanylyl cyclase activation and inhibition on acute morphine antinociception and the development of tolerance to its effect.

BACKGROUND

Nitric oxide-soluble guanylyl cyclase signal transduction cascade suggested to play an important role in the development of tolerance to antinociceptive effects of morphine.

METHODS

Nociception was evaluated by tail flick and hot plate tests in male Wistar rats. The analgesic effects of intraperitoneal protoporphyrin IX (PPIX; an activator of soluble guanylyl cyclase), 3-morpholinosydnonimine hydrochloride (SIN-1; NO donor and activator of guanylyl cyclase), S-Nitroso-N-acetylpenicillamine (SNAP; an activator of guanylyl cyclase), 3,3-Bis (amino ethyl)-1-hydroxy-2-oxo-1-triazene (NOC-18; NO donor activating guanylyl cyclase) and 1H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one (ODQ; an inhibitor of guanylyl cyclase) alone or in combination with subcutaneous morphine injection were evaluated. Their effects on morphine tolerance development were evaluated by giving these agents 20 minutes prior to twice daily morphine injection during tolerance development for 5 days. On day 6, the expression of morphine tolerance was determined.

RESULTS

PPIX, SIN-1, SNAP and NOC-18 significantly increased expression of morphine tolerance while ODQ decreased.

CONCLUSION

These data suggested that sGC activators have a significant role in tolerance to the analgesic effect of morphine (Tab. 1, Fig. 4, Ref. 29).

Role of D₁/D₂ dopamin receptors antagonist perphenazine in morphine analgesia and tolerance in rats

While opioid receptors have been implicated in the development of tolerance, the subsequent mechanisms involved in these phenomena have not been completely understood. The purpose of this study was to investigate effects of D1/D2 dopamine receptors antagonist perphenazine on morphine analgesia and tolerance in rats. Male Wistar albino rats weighing 190-205 g were used in these experiments. To constitute of morphine tolerance, animals received morphine (50 mg/kg) once daily for 3 days. After last dose of morphine was injected on day 4, morphine tolerance was evaluated by the analgesia tests. The analgesic effects of perphenazine (1, 5, and 10 mg/kg ), D1-dopamine receptor antagonist SCH 23390 (1 mg/kg), D2-dopamine receptor antagonist eticlopride (1 mg/kg), and morphine were considered at 30-min intervals (0, 30, 60, 90, and 120 min) by tail-flick and hot-plate analgesia tests. Obtained data suggested that D1/D2 dopamine receptors antagonist perphenazine was capable of suppressing opioid tolerance, possibly by the mechanism of inhibiting D2-dopamine receptor. Because the data indicated that D2-dopamine receptor antagonist eticloride, but not D1-dopamine receptor antagonist SCH 23390, significantly decreased morphine tolerance in analgesia tests. In addition, administration of perphenazine with morphine increased morphine analgesia. Results from the present study suggested that dopamine receptors play a significant role in the morphine analgesic tolerance. In particular, D2-dopamine receptor has an important role rather than D1-dopamine receptor in development tolerance to morphine.

(18)F-FDG PET/CT findings in a case with HIV (-) Kaposi sarcoma

Although mucocutaneous sites are the most frequently encountered sites of involvement, Kaposi Sarcoma (KS) may also occasionally involve the breast and the skeletal, endocrine, urinary and nervous systems.. Various imaging modalities may be used to delineate the extent of the disease by detecting unexpected sites of involvement. Herein, we report a case of classical type KS, in whom staging with (18)F-FDG PET/CT imaging disclosed widespread disease and unexpected findings of bone and salivary gland involvement.

The impact of C4d staining as a humoral injury marker

PURPOSE

Acute and chronic humoral injuries in renal transplant recipients are the main reasons for graft rejection and failure. Histological and clinical characteristics of humoral rejection and symptoms are variable and not always helpful for differential diagnosis. Clinical monitoring of the allograft, an elevated serum panel-reactive antibody (PRA), and the presence of donor-specific antibody (DSA) during immune monitoring as well as C4d staining of biopsy material can establish the differential diagnosis. Even without a cellular component, humoral rejection reaction is serious because the target tissue is the graft endothelium. Because the kidney graft has a rich vascular structure this attack causes permanent injury to the kidney in the long term. Graft dysfunction in this setting is usually more severe, requiring dialysis therapy, compared with acute cellular reactions. Positive C4d staining of peritubular capillaries in biopsy material represent a hallmark of complement-dependent cytotoxicity, supporting the diagnosis of humoral rejection. We analyzed C4d staining as a hallmark of humoral rejection.

METHODS

From 2009 to 2011, we analyzed the relationship between pathological findings of C4d immunohistochemistry staining and the clinical outcomes of 45 kidney transplant recipients who underwent a kidney biopsy because of graft dysfunction due to possible humoral rejection.

RESULTS

Biopsy specimens of 15 patients stained C4d positive; the remaining 30 showed negative results. Intravenous steroids, PP + IVIG with or without antithymocyte globulin (ATG), was administered for treatment. Sixty six percent (n = 10) of patients were C4d positive with 16% (n = 5) of those showing C4d-negative biopsy results, losing their grafts, and returning to hemodialysis.

CONCLUSIONS

C4d staining refractory humoral rejection injury was related to poor graft outcomes.

Dual phase 18F-fluorodeoxyglucose positron emission tomography/computed tomography with forced diuresis in diagnostic imaging evaluation of bladder cancer

INTRODUCTION

(18)F-FDG PET has been regarded as a limited value in urooncology due to urinary excretion of the tracer. The purpose of this retrospective study was to investigate the clinical value of dual-phase FDG PET/CT with forced diuresis protocol (iv furosemide-voiding and oral hydration) in invasive or high grade bladder cancer.

METHODS

Fifty-one patients were included in this study. All patients underwent standard staging procedures and dual-phase FDG PET/CT before planned therapy. PET/CT findings before and after furosemide were compared with each other for pelvic region. Dual phase PET/CT findings were also compared with the results of prior imaging studies and all findings were correlated with final diagnosis (histopathology or clinical follow-up for at least 12 months).

RESULTS

Intravesical FDG activity significantly decreased in 90% of the patients with forced diuresis protocol. Eighty eight percent of the bladder findings and 20% of the local lymph node metastases, and other pelvic findings (local invasion and second primary malignancy of prostate) were detected only by the additional pelvic PET/CT images. As a result, dual phase PET/CT changed the staging and/or the therapy strategy in 16 patients (31%).

CONCLUSION

Dual phase FDG PET/CT contributes staging and decision of therapy strategy by detecting local disease and pelvic metastases with high accuracy when combined with forced diuresis protocol. Thus, we recommend dual phase imaging method with forced diuresis protocol in FDG PET/CT for bladder cancer and all other urogenital system malignities.

Fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) for the detection of skeletal muscle and skin metastases in uterine leiomyosarcoma: a case report

We report the clinical value of FDG PET/CT imaging in a 57-year-old woman who was diagnosed with uterine leimyosarcoma 6 years ago. In a staging procedure, whole body FDG PET/CT discloses the presence of both local recurrence and remote metastases at widespread musculocutaneous sites, liver and femur. With its advantage of scanning the whole body in a single procedure, we propose the use of PET/CT imaging for the evaluation of patients with uterine leimyosarcomas, a tumor with a propensity for widespread hematogenous spread to unusual sites.

Zimelidine attenuates the development of tolerance to morphine-induced antinociception

OBJECTIVES

The aim of this study was to investigate effect of zimelidine (a serotonin reuptake inhibitor) on morphine-induced tolerance in rats.

MATERIALS AND METHODS

Male Wistar albino rats weighing 160-180 g were used in these experiments (n=72). A 3-day cumulative dosing regimen was used for the induction of morphine tolerance. To constitute of morphine tolerance, animals received morphine twice daily for 3 days. After the last dose morphine was injected on the fourth day, morphine tolerance was evaluated. The analgesic effects of zimelidine (15 mg/kg; i.p.) and morphine (5 mg/kg) were considered at 30-min time intervals (0, 30, 60, 90 and 120 min) by tail-flick and hot-plate analgesiometer (n=6 in each experimental group).

RESULTS

The results showed that zimelidine significantly attenuated the development and expression of morphine tolerance. The maximal antinociceptive effect of zimelidine was obtained at the 60 minutes measurements in the zimelidine group and at the 30 minutes measurements in the morphine tolerant group by the tail-flick and hot-plate tests. Administration of zimelidine with morphine showed additive analgesic effect.

CONCLUSION

In conclusion, our results show that zimelidine reduces the development of tolerance to morphine-induced antinociception in rats.

The effects of serotonin/norepinephrine reuptake inhibitors and serotonin receptor agonist on morphine analgesia and tolerance in rats

Several studies have demonstrated that serotonergic and noradrenergic systems have important roles in morphine analgesia and tolerance. However, the exact mechanism underlying the development of morphine tolerance is not fully understood. The aim of this study was to investigate the possible role of serotonin/norepinephrine reuptake inhibitors (amitriptyline, venlafaxine) and serotonin receptor (5-HT(1A) and 5-HT(1B/1D)) agonist (dihydroergotamine) in morphine analgesia and tolerance in rats. To constitute morphine tolerance, animals received morphine (50 mg/kg; s.c.) once daily for 3 days. After the last dose of morphine was injected on day 4, morphine tolerance was evaluated. The analgesic effects of amitriptyline (20 mg/kg; i.p.), venlafaxine (20 mg/kg; s.c.), dihydroergotamine (100 μg/kg; i.v.) and morphine (5 mg/kg) were considered at 15- to 30-min intervals (0, 15, 30, 60, 90, and 120 min) by tail-flick and hot-plate analgesia tests. In this study, the data obtained suggested that amitriptyline and venlafaxine significantly increased the analgesic effect of morphine and attenuated the expression of morphine tolerance. However, dihydroergotamine significantly increased the analgesic effect of morphine but did not reduce the expression of morphine tolerance. In conclusion, we determined that co-administration of morphine with amitriptyline and venlafaxine increased the analgesic effects of morphine and attenuated the morphine analgesic tolerance.

Incisor trauma in a Turkish preschool population: prevalence and socio-economic risk factors

OBJECTIVE

This study aimed to assess the prevalence of traumatic injuries of the primary incisors in preschool children from 2 to 5 years old in South-Eastern Anatolia, Turkey. Additionally, the relationship between traumatic dental injuries, parents' education level, family income, size of incisal overjet and the presence of anterior open bite were examined.

BASIC RESEARCH DESIGN

A cross-sectional survey

CLINICAL SETTINGS

Data were collected through oral examinations and structured interviews, and included socio-economic indicators.

PARTICIPANTS

A total of 727 children of both genders were included in the study. 122 of these children were aged 2; 183 aged 3; 178 aged 4 and 186 aged 5.

RESULTS

The prevalence of dental injuries was 8.0% (n = 58). The highest frequency of trauma in the primary teeth was observed at the age of 4. Boys experienced more dental injuries than girls, 12.2% and 4.0%, respectively. The most common crown fracture was in enamel only (57%) followed by crown fracture of enamel and dentin (19%).

CONCLUSION

The prevalence of dental injuries in Turkish preschool children was very low. The children with incisal overjet greater than 5mm and anterior open bite experienced more dental injuries in primary teeth than their counterparts with normal occlusion. Socio-economic indicators were not statistically significantly associated with the occurrence of traumatic dental injuries.

Effects of alpha 2-adrenoceptor agonists dexmedetomidine and guanfacine on morphine analgesia and tolerance in rats

BACKGROUND

Alpha 2 (α(2))-adrenoceptor agonists may be useful for their potential to increase or prolong opioid analgesia while attenuating the development of opioid tolerance. The purpose of this study was to investigate the effects of dexmedetomidine and guanfacine (α(2)-adrenoceptor agonists) on morphine analgesia and tolerance in rats.

METHODS

Adult male Wistar albino rats weighing 195-205 g were used. To constitute morphine tolerance, animals received morphine (50 mg/kg) once daily for 3 days. After the last dose of morphine had been injected on day 4, morphine tolerance was evaluated by analgesia tests. The analgesic effects of dexmedetomidine (20 ug/kg), guanfacine (0.5 mg/kg), MK-467 (0.25 mg/kg), and morphine were estimated at 30-min intervals (0, 30, 60, 90, and 120 min) by tail-flick and hot-plate analgesia tests.

RESULTS

Our findings indicate that dexmedetomidine and guanfacine attenuated the expression of morphine tolerance. In addition, administration of dexmedetomidine with morphine increased morphine analgesia. On the contrary, data suggested that MK-467 (an α(2)-adrenoceptor antagonist) decreased morphine analgesia and increased morphine tolerance in analgesia tests.

CONCLUSION

In conclusion, we observed that co-injection of dexmedetomidine or guanfacine with morphine attenuated the expression of tolerance to the analgesic effect of morphine and that dexmedetomidine enhanced the morphine analgesia.

Secondary hematological malignancies after treatment of non-metastatic breast cancer

PURPOSE

To determine the frequency of secondary hematological malignancies in non-metastatic breast cancer (BC) patients who received adjuvant chemotherapy and radiotherapy.

METHODS

Data of BC patients followed at Hacettepe University Institute of Oncology, Department of Medical Oncology between 2004 and 2010 were retrospectively analysed.

RESULTS

There were 1,475 BC patients followed between 2004 and 2010 at our department; 1,319 (89.4%) of them had not metastatic disease. One thousand, one hundred eighty three (89.7%) early-stage BC patients received at least one treatment modality (radiotherapy and/or chemotherapy). The number of patients receiving only chemotherapy or only radiotherapy were 228 (17.3%) and 117 (8.9%), respectively. Eleven (1%) out of 1,066 BC patients receiving adjuvant/neoadjuvant chemotherapy were also treated with granulocyte colony stimulating factor (G-CSF). The frequency of secondary hematological malignancies among adjuvant or neoadjuvant chemotherapy BC patients was 0.56% (6/1,066); it was 0.59% (7/1,183) among radiotherapy and/or chemotherapy treated non-metastatic BC patients. Five patients developed acute myeloid leukemia (AML); 3 of them were AML-FAB M3 and 2 could not be subclassified. The 6th patient had multiple myeloma and the 7th had diffuse large B cell lymphoma (DLBCL). However, the latter did not receive cytotoxic chemotherapy for BC.

CONCLUSION

Treatment-associated secondary hematological malignancies, especially myeloid leukemias, are a growing problem due to high prevalence of BC and the dismal outcome of secondary leukemias. Further studies are needed to determine the risk for other hematological malignancies, possible responsible agents, and mechanisms.

The nitric oxide-cGMP signaling pathway plays a significant role in tolerance to the analgesic effect of morphine

Although the phenomenon of opioid tolerance has been widely investigated, neither opioid nor nonopioid mechanisms are completely understood. The aim of the present study was to investigate the role of the nitric oxide (NO)-cyclic guanosine monophosphate (cGMP) pathway in the development of morphine-induced analgesia tolerance. The study was carried out on male Wistar albino rats (weighing 180-210 g; n = 126). To develop morphine tolerance, animals were given morphine (50 mg/kg; s.c.) once daily for 3 days. After the last dose of morphine was injected on day 4, morphine tolerance was evaluated. The analgesic effects of 3-(5'-hydroxymethyl-2'-furyl)-1-benzylindazole (YC-1), BAY 41-2272, S-nitroso-N-acetylpenicillamine (SNAP), N(G)-nitro-L-arginine methyl ester (L-NAME), and morphine were considered at 15 or 30 min intervals (0, 15, 30, 60, 90, and 120 min) by tail-flick and hot-plate analgesia tests (n = 6 in each study group). The results showed that YC-1 and BAY 41-2272, a NO-independent activator of soluble guanylate cyclase (sGC), significantly increased the development and expression of morphine tolerance, and L-NAME, a NO synthase (NOS) inhibitor, significantly decreased the development of morphine tolerance. In conclusion, these data demonstrate that the nitric oxide-cGMP signal pathway plays a pivotal role in developing tolerance to the analgesic effect of morphine.