Response to Rimiterol and Salbutamol Aerosols Administered by Intermittent Positive-pressure Ventilation

The bronchodilator and cardiac effects produced by aerosols of 0·5% salbutamol and 0·5% and 1% rimiterol administered for three minutes in 40% oxygen by intermittent positive-pressure ventilation (I.P.P.V.) were compared in 15 asthmatic patients. Salbutamol and both the concentrations of rimiterol were equipotent in peak bronchodilator effect, but salbutamol had a significantly longer duration of bronchodilator action. There was significantly less increase in heart rate after rimiterol than after salbutamol. Aerosols of 0·5% rimiterol, 0·5% salbutamol, and saline were administered by I.P.P.V. to 10 normal volunteers. There was no difference between the mean heart rates after 0·5% rimiterol and saline but a highly significant increase in mean heart rate was observed after 0·5% salbutamol. It was concluded that 0·5% rimiterol was an effective short-acting bronchodilator drug with little or no cardiac beta₁-adrenergic activity when administered for three minutes by I.P.P.V. in 40% oxygen.     

Treatment of Tetanus Neonatorum with Muscle Relaxants and Intermittent Positive-pressure Ventilation

Intermittent positive-pressure ventilation and muscle relaxants were first used in Cape Town in 1958 in an attempt to reduce the mortality from tetanus neonatorum, which was then over 90%. Problems of effective ventilation, of tracheostomy, and of infection in the neonate were gradually overcome so that between 1967 and 1972 the mortality in 186 cases was 21%. In a consecutive series of 97 cases the mortality was 10%.     

Effects of Salbutamol and Isoprenaline Phenylephrine in Reversible Airways Obstruction

Ventolin (salbutamol) and Medihaler-Duo (isoprenaline/phenylephrine combination) standard pressurized inhalers were used to administer doses of two or six “puffs” to 16 patients with known reversible airways obstruction. The doses were administered in random order over two days. Both the Ventolin and Medihaler-Duo inhalers substantially increased FEV₁, but in the doses used salbutamol was more effective than isoprenaline/phenylephrine (P < 0·01). There was no significant difference between two and six puffs of salbutamol, though there seemed to be an advantage of six puffs of isoprenaline/phenylephrine over two puffs (P < 0·05). Adrenaline (1/1,000) 0·5 ml and atropine 0·6 mg produced similar increases in FEV₁ to those produced by salbutamol.The Pao₂ fell more than 5 mm Hg in three patients after salbutamol and in three after isoprenaline/phenylephrine. There was no significant fall in mean Pao₂ in any of the treatment groups. It is concluded that the Ventolin inhalant, administered in the conventional dose of two puffs, is as effective a bronchodilator as subcutaneous adrenaline and atropine, is more effective than the Medihaler-Duo, and is without detectable side effects.     

Bronchodilator Effect of Oral Salbutamol in Asthmatics Treated with Corticosteroids

In a double-blind trial the effect on ventilatory function of oral salbutamol (in two different doses) and a placebo were studied in 12 patients with chronic asthma receiving regular maintenance treatment with prednisolone. Salbutamol in a dose of 4 mg four times daily, given for a period of four weeks, produced a sustained and statistically significant increase in peak expiratory flow rate over the pretreatment recordings. This effect was not observed with a lower dose of salbutamol (2 mg four times daily) or with a placebo. Salbutamol in the higher dose would seem to be an effective and safe oral bronchodilator that can be recommended for the treatment of mild or moderate asthma. The duration of treatment in this study was, however, limited to four weeks, and it is not known whether effective bronchodilatation would be maintained if the drug were given for longer periods.     

Comparison of Cardiorespiratory Effects of Isoprenaline and Salbutamol in Patients with Bronchial Asthma

The effects of isoprenaline and salbutamol administered orally, by inhalation, or by intravenous infusion were compared in 13 asthmatic patients. Bronchodilator activity was assessed by serial measurement of specific airways conductance (SGaw). Log-dose response curves were obtained for both drugs and showed them to be equipotent as bronchodilators. Cardiovascular effects were variable, but in general, isopenaline caused greater rise in pulse rate and a greater change in blood pressure than the same dose of salbutamol.Cardiorespiratory measurements during continuous intravenous infusion of increasing doses of both drugs suggested a greater effect of isoprenaline than the same dose of salbutamol on metabolic rate, pulmonary ventilation, pulmonary gas exchange, cardiac output, and heart rate. The effect of salbutamol on the heart rate was about 10 times less than that of isoprenaline but lasted longer.     

Comparison of Effect of Salbutamol and Isoprenaline on Spirometry and Blood-gas Tensions in Bronchial Asthma

The effect of the aerosol inhalation of 200 μg. of salbutamol and 1,000 μg. of isoprenaline on spirometry and blood-gas tensions was compared in the same 11 asthmatic subjects. Both drugs significantly reduced airway obstruction, and the extent of the reduction did not differ for periods of up to 30 minutes. After isoprenaline tachycardia and a small significant fall in arterial oxygen tension occurred, whereas after salbutamol there was no change in pulse rate and the arterial oxygen tension did not fall.     

Immune Response of Mice to Orally Administered Lactic Acid Bacteria

In order to elucidate the interaction of lactic acid bacteria with the immune system, immune responses to the lactic acid bacteria, Bifidobacterium longum and Lactobacillus acidophilus, were examined in mice fed with each organism. In mice fed with B. longum for more than 8 weeks, an antibody response was detected to the cytoplasm of B. longum, but not to the cell wall. On the other hand, in mice fed with L. acidophilus for more than 6 weeks, an antibody response was detected to both the cytoplasm and cell wall of L. acidophilus. Moreover, feeding each organism for 2 weeks enhanced the proliferative response of Peyer’s patch (PP) cells to the cell fraction against which the serum antibody was detected. However, this was not found with spleen cells. These results suggest that mucosal stimulation by lactic acid bacteria may induce a systemic immune response to them.     

Response of Leucocyte Adenyl Cyclase to Isoprenaline and Effect of Alpha-blocking Drugs in Extrinsic Bronchial Asthma

The finding by several workers that biochemical responses to catecholamines are diminished in asthmatic patients during periods of active asthma as compared to normal subjects has led to the recognition of the beta-adrenergic blockade phenomenon, a common accompaniment of extrinsic bronchial asthma. Using an intact cell method to measure leucocyte adenyl cyclase activity, we have been able to show that there is a noticeably reduced responsiveness of this enzyme system (which is now identified with beta-receptor function) to isoprenaline in the leucocytes of patients suffering from acute bronchial asthma, but that asthmatic patients in remission could not be distinguished from normal persons in this respect. Evidently the defective beta-receptor function may be associated with overactivity of the alpha-receptors in acute bronchial asthma, since the responsiveness to isoprenaline stimulation could be restored towards normal by concomitant treatment of the leucocytes of these patients with alpha-receptor blocking drugs such as phentolamine or thymoxamine. Ouabain, though somewhat less potent, also enhanced responsiveness to isoprenaline stimulation. The relation of these results to the clinical observation of adrenaline resistance in active asthma suggests that alpha-receptor blocking drugs may be of value in restoring the sensitivity of beta-receptors to sympathomimetic amines.     

持续正压通气治疗阻塞性睡眠呼吸暂停综合征并发心房纤颤的临床研究

目的:研究持续正压通气治疗阻塞性睡眠呼吸暂停综合征(OSAHS)并发心房纤颤的临床疗效。方法:选取2013年1月到2014年1月我院收治的OSAHS并发心房纤颤患者60例,按照随机数字表法将患者分为实验组和对照组,每组30例。对照组给予常规治疗,实验组在对照组的基础上给予持续正压通气治疗,两组均治疗1年。分析治疗前、后两组心率(HR)、血氧饱和度(SPO2)、左心射血分数(LVEF)、脑钠肽(BNP),并比较两组心房纤颤转复率、复发率和不良反应。结果:治疗后实验组HR、SPO2、LVEF以及BNP显著优于对照组,两组比较差异具有统计学意义(P0.05);治疗后实验组心房纤颤转复率显著高于对照组,心房纤颤复发率显著低于对照组,两组比较差异具有统计学意义(P0.05);两组不良反应发生率比较无统计学意义(P0.05)。结论:持续正压通气治疗OSAHS并发心房纤颤具有较好的效果,有利于改善心功能,提高心房纤颤转复率降低房纤颤复发率。     

Acute Intermittent Porphyria: Response of Tachycardia and Hypertension to Propranolol

In four young adult patients with acute attacks of acute intermittent porphyria tachycardia and hypertension were prominent features of the illness. Urinary catecholamine excretion was increased in both patients in whom it was measured. The effect of the beta-adrenergic blocking drug propranolol was assessed in each case. The dose varied from 40 to 240 mg daily. A response in the form of a reduction in heart rate and blood pressure was noted in each case, and in one case a marked alleviation of abdominal pain followed administration of the drug.Propranolol, when given in high dosage to rats, did not induce an increase in hepatic delta-aminolaevulic acid synthetase, an enzyme which is raised in human and drug-induced animal porphyria. The use of propranolol is therefore unlikely to aggravate or precipitate an attack of acute intermittent porphyria.     

Effects of Isoprenaline Plus Phenylephrine by Pressurized Aerosol on Blood Gases,Ventilation, and Perfusion in Chronic Obstructive Lung Disease

The effects of a combined isoprenaline-phenylephrine inhalant in chronic obstructive lung disease were assessed in 23 patients. Significant changes occurred in blood gas tensions after inhalation, together with an overall improvement in ventilation/perfusion ratios. Cardiac output and physiological shunt were not significantly increased. Hence the addition of phenylephrine probably prevents the increase of hypoxaemia which may result from the disproportionate ventilation/perfusion ratio produced by sympathomimetics or xanthines used alone. The combination aerosol has a satisfactory bronchodilator effect, and is additionally safe if used by a severely hypoxic patient unaware of the seriousness of his condition.     

Inhibitory Effect of Nasal Intermittent Positive Pressure Ventilation on Gastroesophageal Reflux

Non-invasive intermittent positive pressure ventilation can lead to esophageal insufflations and in turn to gastric distension. The fact that the latter induces transient relaxation of the lower esophageal sphincter implies that it may increase gastroesophageal refluxes. We previously reported that nasal Pressure Support Ventilation (nPSV), contrary to nasal Neurally-Adjusted Ventilatory Assist (nNAVA), triggers active inspiratory laryngeal closure. This suggests that esophageal insufflations are more frequent in nPSV than in nNAVA. The objectives of the present study were to test the hypotheses that: i) gastroesophageal refluxes are increased during nPSV compared to both control condition and nNAVA; ii) esophageal insufflations occur more frequently during nPSV than nNAVA. Polysomnographic recordings and esophageal multichannel intraluminal impedance pHmetry were performed in nine chronically instrumented newborn lambs to study gastroesophageal refluxes, esophageal insufflations, states of alertness, laryngeal closure and respiration. Recordings were repeated without sedation in control condition, nPSV (15/4 cmH₂O) and nNAVA (~ 15/4 cmH₂O). The number of gastroesophageal refluxes recorded over six hours, expressed as median (interquartile range), decreased during both nPSV (1 (0, 3)) and nNAVA [1 (0, 3)] compared to control condition (5 (3, 10)), (p < 0.05). Meanwhile, the esophageal insufflation index did not differ between nPSV (40 (11, 61) h^-1) and nNAVA (10 (9, 56) h^-1) (p = 0.8). In conclusion, nPSV and nNAVA similarly inhibit gastroesophageal refluxes in healthy newborn lambs at pressures that do not lead to gastric distension. In addition, the occurrence of esophageal insufflations is not significantly different between nPSV and nNAVA. The strong inhibitory effect of nIPPV on gastroesophageal refluxes appears identical to that reported with nasal continuous positive airway pressure.     

Magnesium Deficiency Causes Loss of Response to Intermittent Hypoxia in Paraganglion Cells

Magnesium deficiency is suggested to contribute to many age-related diseases. Hypoxia-inducible factor 1α (HIF-1α) is known to be a master regulator of hypoxic response. Here we show that hypomagnesemia suppresses reactive oxygen species (ROS)-induced HIF-1α activity in paraganglion cells of the adrenal medulla and carotid body. In PC12 cells cultured in the low magnesium medium and treated with cobalt chloride (CoCl₂) or exposed to intermittent hypoxia, ROS-mediated HIF-1α activity was suppressed. This suppression was due to up-regulation of inhibitory PAS (Per/Arnt/Sim) domain protein (IPAS) that was caused by NF-κB activation, which resulted from ROS and calcium influx mainly through the T-type calcium channels. Induction of tyrosine hydroxylase, a target of HIF-1, by CoCl₂ injection was suppressed in the adrenal medulla of magnesium-deficient mice because of up-regulation of IPAS. Also in the carotid body of magnesium-deficient mice, CoCl₂ and chronic intermittent hypoxia failed to enhance the tyrosine hydroxylase expression. These results demonstrate that serum magnesium levels are a key determinant for ROS-induced hypoxic responses.Hypoxia-inducible factor 1α (HIF-1α)² and its family members are master regulators of hypoxic response (1–3). In hypoxia, the HIF-1, composed of HIF-1α and HIF-1β/Arnt, binds to hypoxia response element (HRE) to induce the gene expression of hypoxia-responsive proteins, such as erythropoietin and vascular endothelial growth factor. In addition to these proteins, tyrosine hydroxylase (TH), the rate-limiting enzyme for catecholamine biosynthesis, is induced in rat pheochromocytoma-derived PC12 cells and paraganglion cells in the adrenal medulla (AM) and carotid body (CB) in response to hypoxia (4). The CB acts as the primary peripheral chemoreceptor (5), and glomus cells of the CB are responsible for monitoring oxygen levels in arterial blood (5, 6). Through the release of neurotransmitters, including dopamine, the CB delivers information to the respiratory and cardiovascular networks in the brainstem, resulting in increases of ventilatory frequency and volume and also raising cardiac output.HIF-dependent hypoxic response is also caused by chronic intermittent hypoxia (CIH), which is a common feature of obstructive sleep apnea (OSA). There is accumulating evidence that CIH is associated with an increased oxidative stress (7, 8). Peng et al. (9) have shown that CIH induces reactive oxygen species (ROS) generation, thereby increasing HIF-1α expression, which is critical for eliciting CIH-induced cardiorespiratory responses by the CB. CIH also increases ROS generation and TH expression in the AM, although it is less sensitive than the CB (10).Recent studies have identified that IPAS, which is one of the alternatively spliced variants of HIF-3α, acts as a dominant negative inhibitor of HIF-1α by a direct interaction with HIF-1α and prevents its DNA binding (11). IPAS is predominantly expressed in the Purkinje cells of the cerebellum and corneal epithelium. In addition, because the IPAS gene has an HRE sequence in its promoter, IPAS can be induced by hypoxia in the heart and lung. Therefore, IPAS acts as a negative feedback inhibitor of HIF-1α (12).Magnesium deficiency is believed to be related to many diseases, such as hypertension, ischemic heart disease, and diabetes mellitus (13–16). However, the molecular mechanisms underlying the role of magnesium in the pathogenesis of these diseases have been largely undefined. Our analyses here demonstrate that magnesium deficiency causes a loss of ROS-induced HIF-1α activity by inducing IPAS gene expression.     

Effects of Adaptive Support Ventilation and Synchronized Intermittent Mandatory Ventilation on Peripheral Circulation and Blood Gas Markers of COPD Patients with Respiratory Failure

The objective of the study was to investigate the effects of adaptive support ventilation (ASV) and synchronized intermittent mandatory ventilation (SIMV) on peripheral circulation of chronic obstructive pulmonary disease (COPD) patients with respiratory failure. 86 COPD patients with respiratory failure were recruited in this study. Self-control method was used to compare the effect of ASV and SIMV on the parameters of ventilation machine, heart rate, blood pressure, central venous pressure (CVP), and blood gas markers. When the patients in ASV and SIMV groups were compared, respiratory rate, tidal volume, and peak airway pressure (PIP) showed significant difference. When minute ventilation (MV) was compared, no significant difference was shown. When peripheral circulation parameters were compared, peripheral circulation heart rate, SBP, DBP, and CVP showed significant difference. Compared with SIMV group, PaO₂, pH, and SaO₂ values were remarkably increased (P < 0.01) while no significant difference was found for partial pressure of carbon dioxide (pCO₂) when two groups were compared. In conclusion, when mechanical ventilation was used in COPD patients with respiratory failure, ASV can significantly improve clinical outcomes.     

Release of Free DNA by Membrane-Impaired Bacterial Aerosols Due to Aerosolization and Air Sampling

We report here that stress experienced by bacteria due to aerosolization and air sampling can result in severe membrane impairment, leading to the release of DNA as free molecules. Escherichia coli and Bacillus atrophaeus bacteria were aerosolized and then either collected directly into liquid or collected using other collection media and then transferred into liquid. The amount of DNA released was quantified as the cell membrane damage index (I_D), i.e., the number of 16S rRNA gene copies in the supernatant liquid relative to the total number in the bioaerosol sample. During aerosolization by a Collison nebulizer, the I_D of E. coli and B. atrophaeus in the nebulizer suspension gradually increased during 60 min of continuous aerosolization. We found that the I_D of bacteria during aerosolization was statistically significantly affected by the material of the Collison jar (glass > polycarbonate; P < 0.001) and by the bacterial species (E. coli > B. atrophaeus; P < 0.001). When E. coli was collected for 5 min by filtration, impaction, and impingement, its I_D values were within the following ranges: 0.051 to 0.085, 0.16 to 0.37, and 0.068 to 0.23, respectively; when it was collected by electrostatic precipitation, the I_D values (0.011 to 0.034) were significantly lower (P < 0.05) than those with other sampling methods. Air samples collected inside an equine facility for 2 h by filtration and impingement exhibited I_D values in the range of 0.30 to 0.54. The data indicate that the amount of cell damage during bioaerosol sampling and the resulting release of DNA can be substantial and that this should be taken into account when analyzing bioaerosol samples.