Doses Of Dopamine Research Articles

Role of Phospholipase C in the Dopamine D2 Signaling Pathway in the Control of Lateral Cilia in Gill of Crassostrea virginica

Lateral cell cilia of gill of Crassostrea virginica are controlled by serotonergic‐dopaminergic innervations from their ganglia. Dopamine is the neurotransmitter causing cilio‐inhibition, serotonin cilio‐excitation. Previous work of our lab showed the post‐synaptic dopamine receptors present in lateral cells are D2‐type. Dopamine D2 receptors (D2R) are G protein‐coupled metabotropic receptors. Ligand binding to D2R splits its Gi/o protein into the Gβγ and Gαi/o subunits. Gαi/o inhibits adenylyl cyclase; while Gβγ opens GIRK channels, closes L‐type Ca2+ channels and activates phospholipase C (PLC). The inhibition of adenylyl cyclase and subsequent lowering of cAMP is known to slow lateral cilia; however, the role of PLC in the signaling pathway has not been well studied with respect to control of lateral cilia. Using immunohistofluorescence, our lab visualized PLC in lateral cell. In this study we hypothesized that the PLC component of the D2 pathway also plays a role in the cilio‐inhibition. To test this we utilized PLC activators and inhibitors on excised gill to determine their effects on lateral cilia. Cilia beating rates were measured using stroboscopic microscopy. In control gill, applying a dose response of dopamine (10−6 – 10−3M) is cilio‐inhibitory, decreasing beating rates of lateral cilia to 0. Applying m‐3M3FBS (10−5 – 10−4M), a PLC activator, caused a moderate decrease in cilia beating rates. Applying U73122 (10−4M), a phosphatidylinositol 4,5‐bisphosphate specific PLC inhibitor, did not alter cilia beating rates by itself, but did effect the dose response to dopamine (10−5 – 10−3M). In the presence of the inhibitor, while the 10−5M dose of dopamine caused the expected decrease in cilia beating rates, the addition of higher doses of dopamine was unable to reduce beating rates any further. As expected, the drug D609, a PLC inhibitor but specific for phosphatidylcholine, had no effects on cilia beating rates or the actions of dopamine. The results of this study supports our hypothesis that the PLC component of the D2R signal transduction pathway plays a role in the inhibitory control of gill lateral cilia. The results show that both components of the D2R pathway, the adenylyl cyclase component and the PLC component are involved in controlling lateral cilia beating. In humans the D2R signal transduction pathway is significantly involved in the actions of antidepressants, neuroleptics, and drugs of abuse, as well as implicated in neuropsychiatric and neurodegenerative disorders. This physiology study is helpful in furthering the understanding of the pathway and should help to generate further investigations.Support or Funding InformationThis work was supported in part by grant 2R25GM06003 of the Bridge Program of NIGMS, NIH grant K12GM093854‐07A1 IRACDA Program of Rutgers University and 604060048 of PSC‐CUNY.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Clinical progress of vasopressin in the treatment of septic shock

Septic shock is a serious stage of sepsis with a hospital mortality rate of more than 40%. The pathophysiology of septic shock is vasodilation and increased permeability. Fluid resuscitation, vasopressor drugs are usually used to maintain the perfusion pressure of the main organs. However, infectious patients usually have the irresponsive vessel to catecholamines and may lead to obvious side effects using high doses of norepinephrine or dopamine. Recent studies have shown that vasopressin (AVP) improves hemodynamics, increases tissue perfusion, and synergizes with norepinephrine in patients with septic shock, showing extent application prospects in the treatment of septic shock. The practice of AVP in septic shock is reviewed in this article in order to provide a reference for clinicians.

Effects of different doses of dopamine on organ function of rats at early stage of severe scald

Objective: To explore the effects of different doses of dopamine on organ function of rats at early stage of severe scald. Methods: Thirty-two male Wistar rats aged 8 to 12 weeks were divided into sham injury (SI) group, simple resuscitation (SR) group, small dose (SD) group, and moderate dose (MD) group according to the random number table, with 8 rats in each group. After rats in the 4 groups were performed cardiac catheterization, rats in group SI were sham injured on the back by immersing in 37 ℃ warm water for 18 s, and rats in the other 3 groups were inflicted with 30% total body surface area (TBSA) full-thickness scald on the back by immersing in 97 ℃ hot water for 18 s. Rats in group SI were not treated after the injury, while rats in the other 3 groups were performed fluid resuscitation for 24 h through jugular vein catheter with micro syringe pump according to the Parkland formula. They were given 4.0 mL·kg(-1)·% TBSA(-1) normal saline during the first 24 h, of which they were given half of the total amount for the first 8 h, and they were given half of the total amount for the second and third 8 h. Rats in group SR were infused normal saline only, while rats in group SD and group MD were infused normal saline+ 1.25 μg·kg(-1)·min(-1)dopamine and normal saline+ 6.00 μg·kg(-1)·min(-1) dopamine respectively. Volume of 0.5 mL venous blood of all rats were taken through the cardiac catheter with serum separated at post injury hour (PIH) 1, 3, 6, 12, and 24. Serum content of cardiac troponin I (cTnI) was determined by enzyme-linked immunosorbent assay; serum content of diamine oxidase (DAO) was detected by ultraviolet spectrophotometer; serum content of β(2)-microglobulin (β(2)-MG) was determined by latex-enhanced immunoturbidimetric assay; serum content of total bile acid (TBA) was determined by enzyme colorimetry; serum content of lactic acid, malondialdehyde, and myeloperoxidase (MPO) was determined by ultraviolet spectrophotometer. Data were processed with analysis of variance for repeated measurement, one-way analysis of variance, least significant difference test, and Bonferroni correction. Results: (1) At PIH 1, 3, 6, 12, and 24, serum content of cTnI of rats in group SR, group SD, and group MD [(2.69±0.19), (3.04±0.19), (4.96±0.25), (6.88±0.28), (4.75±0.31) μg/L, (2.70±0.14), (3.08±0.13), (5.06±0.19), (7.11±0.21), (4.89±0.16) μg/L, (2.18±0.14), (2.54±0.09), (3.97±0.14), (5.46±0.34), (3.32±0.33) μg/L] were higher than that in group SI [(1.70±0.08), (1.70±0.08), (1.69±0.11), (1.69±0.08), (1.70±0.08) μg/L, P<0.05], serum content of cTnI of rats in group SR and group SD was similar (P>0.05), and serum content of cTnI of rats in group MD was lower than that in group SR and group SD (P<0.05). (2) At PIH 1 to 24, serum content of DAO of rats in group SR, group SD, and group MD was higher than that in group SI (P<0.05), serum content of DAO of rats in group SR and group MD was similar (P>0.05), and serum content of DAO of rats in group SD was lower than that in group SR and group MD (P<0.05). (3) At PIH 1 to 24, serum content of β(2)-MG of rats in group SR, group SD, and group MD was higher than that in group SI (P<0.05), serum content of β(2)-MG of rats in group SR and group MD was similar (P>0.05), and serum content of β(2)-MG of rats in group SD was lower than that in group SR and group MD (P<0.05). (4) At PIH 1 to 24, serum content of TBA of rats in group SR, group SD, and group MD was similar (P>0.05) and higher than that in group SI (P<0.05). (5) At PIH 1 to 24, serum content of lactic acid of rats in group SR, group SD, and group MD was higher than that in group SI (P<0.05), serum content of lactic acid of rats in group SR and group MD was similar (P>0.05), and serum content of lactic acid of rats in group SD was lower than that in group SR and group MD (P<0.05). (6) At PIH 1 to 24, serum content of malondialdehyde and MPO of rats in group SR, group SD, and group MD was higher than that in group SI (P<0.05), serum content of malondialdehyde and MPO of rats in group SR and group MD was similar (P>0.05), and serum content of malondialdehyde and MPO of rats in group SD was significantly lower than that in group SR and group MD (P<0.05). Conclusions: With effective liquid recovery, dopamine of MD can improve early cardiac function of rats with severe scald, while dopamine of SD can alleviate tissue ischemia and hypoxia, reduce oxygen free radical damage in internal organs, and improve functions of intestine and kidney.

Effect of administration of neurotransmitters: Serotonin and dopamine on testicular maturation in the freshwater crab Travancoriana schirnerae Bott, 1969 (Crustacea: Gecarcinucidae)

The current investigation aimed at the effect of administration of the neurotransmitters, serotonin and dopamine, on testicular maturation in the freshwater crab Travancoriana schirnerae Bott, 1969 (Crustacea: Gecarcinucidae). Adult males in active, inactive and revival phases of spermatogenesis were injected with serotonin and dopamine in multiple doses and their dissected testes were submitted to histomorphological examinations. Though serotonin treatment during active phase showed increased values for testicular index, acinar diameter and proportion of mature spermatozoa, only the testicular index values differed statistically from that of controls. Serotonin administration during inactive phase caused an increase in testicular index and acinar diameter, reduction in intra and interacinar spaces and pycnosis of germ cells and detection of division stages. A notable increase in the testicular index, acinar diameter and fresh batches of spermatozoa was perceptible in crabs injected with serotonin during revival phase. In contrast, dopamine injection showed a decline in testicular activity irrespective of the phase of spermatogenesis, as evinced from low testicular index, acinar diameter, presence of small, irregularly shaped acini with indistinct acinar boundaries, reduction in the number of mature spermatozoa and absence of division stages. To conclude, the stimulatory neurotransmittant, serotonin can be used to induce testicular maturation in species of aquaculture potential.

Assessment of adrenal reserve and secretion of cortisol in patients over 60 years of age undergoing cardiac surgery.

IntroductionCortisol level affects the prognosis of patients after cardiac surgery. Meanwhile, there are no clear guidelines for steroid supplementation after a cardiac operation. The relationship between age and blood cortisol levels has not been finally clarified.AimAssessment of adrenal reserve and secretion of cortisol in patients over 60 years of age undergoing cardiac surgery.Material and methodsThe study included 20 patients of both sexes referred for cardiac surgery. A short ACTH synthetic stimulation test was carried out. Assessment of cortisol secretion was carried out in the morning on the day of surgery and the 1st, 2nd and 4th days after surgery in blood samples.ResultsA result within the normal range for the adrenal reserve was found in 19 of the 20 patients enrolled in the study. The short Synacthen test predicted postoperative secretion of cortisol (p = 0.04, r = 0.047). A relationship between secretion of cortisol and patients’ age was observed (p = 0.03, r = 0.48). The concentration of cortisol on the 1st postoperative day was correlated with the total dose of dopamine (p = 0.006, r = 0.58) and adrenaline (p = 0.04, r = 0.47). The concentration of cortisol on the day of the surgery correlated with the lactate concentration on day 2 (p = 0.04, r = 0.45). The concentration of lactates on day 1 correlated with total dose of dopamine (p = 0.01, r = 0.54).ConclusionsA short Synacthen test allows one to predict secretion of cortisol after cardiac surgery. Greater secretion of cortisol after cardiac surgery may be associated with a more difficult postoperative course. There was no decrease in cortisol secretion with age.

Dopamine in critically ill patients with cardiac dysfunction: A systematic review with meta-analysis and trial sequential analysis.

BackgroundDopamine has been used in patients with cardiac dysfunction for more than five decades. Yet, no systematic review has assessed the effects of dopamine in critically ill patients with cardiac dysfunction.MethodsThis systematic review was conducted following The Cochrane Handbook for Systematic Reviews of Interventions. We searched for trials including patients with observed cardiac dysfunction published until 19 April 2018. Risk of bias was evaluated and Trial Sequential Analyses were conducted. The primary outcome was all‐cause mortality at longest follow‐up. Secondary outcomes were serious adverse events, myocardial infarction, arrhythmias, and renal replacement therapy. We used GRADE to assess the certainty of the evidence.ResultsWe identified 17 trials randomising 1218 participants. All trials were at high risk of bias and only one trial used placebo. Dopamine compared with any control treatment was not significantly associated with relative risk of mortality (60/457 [13%] vs 90/581 [15%]; RR 0.91; 95% confidence interval 0.68‐1.21) or any other patient‐centred outcomes. Trial Sequential Analyses of all outcomes showed that there was insufficient information to confirm or reject our anticipated intervention effects. There were also no statistically significant associations for any of the outcomes in subgroup analyses by type of comparator (inactive compared to potentially active), dopamine dose (low compared to moderate dose), or setting (cardiac surgery compared to heart failure).ConclusionEvidence for dopamine in critically ill patients with cardiac dysfunction is sparse, of low quality, and inconclusive. The use of dopamine for cardiac dysfunction can neither be recommended nor refuted.

Sensory attenuation in Parkinson\u2019s disease is related to disease severity and dopamine dose

Abnormal initiation and control of voluntary movements are among the principal manifestations of Parkinson’s disease (PD). However, the processes underlying these abnormalities and their potential remediation by dopamine treatment remain poorly understood. Normally, movements depend on the integration of sensory information with the predicted consequences of action. This integration leads to a suppression in the intensity of predicted sensations, reflected in a ‘sensory attenuation’. We examined this integration process and its relation to dopamine in PD, by measuring sensory attenuation. Patients with idiopathic PD (n = 18) and population-derived controls (n = 175) matched a set of target forces applied to their left index finger by a torque motor. To match the force, participants either pressed with their right index finger (‘Direct’ condition) or moved a knob that controlled a motor through a linear potentiometer (‘Slider’ condition). We found that despite changes in sensitivity to different forces, overall sensory attenuation did not differ between medicated PD patients and controls. Importantly, the degree of attenuation was negatively related to PD motor severity but positively related to individual patient dopamine dose, as measured by levodopa dose equivalent. The results suggest that dopamine could regulate the integration of sensorimotor prediction with sensory information to facilitate the control of voluntary movements.

Clinical Outcomes of Minimized Hydrocortisone Dosage of 100 Mg/Day on Lower Occurrence of Hyperglycemia in Septic Shock Patients.

The current international guideline recommended 200 mg/day of hydrocortisone intravenously to treat septic shock. However, a subsequent study on cortisol metabolism actually showed an increase in cortisol level during sepsis. Hence, the smaller hydrocortisone dose of 100 mg/day might be sufficient and reduce steroid-associated complications. We aimed to compare the clinical outcomes of minimized hydrocortisone dose of 100 mg to the currently recommended dose in the treatment of septic shock patients. A double-blinded randomized controlled trial included 80 septic shock patients with hemodynamic instability despite fluid and vasopressive therapy. Participants were divided equally into two groups to treat with 100 mg/day or 200 mg/day of hydrocortisone, then stepwise down titrated and discontinued on day 8. The outcome of interest was the hyperglycemic rate. Vital status, time to shock reversal, superinfection and gastrointestinal bleeding rates were also compared. Patients with 100 mg hydrocortisone had significantly lower hyperglycemic rate compared with 200 mg, 63.9% versus 86.5% (the adjusted hazard ratio [HR], 0.08; 95% confidence interval [CI], 0.02-0.41, P = 0.002). Time to shock reversal was shorter in patients with 100 mg hydrocortisone, 2 days vs. 4 days, P = 0.031. The 28-day mortality rate when adjusted for Simplified Acute Physiology Score II showed no significant difference (HR, 0.68; 95% CI, 0.37-1.24, P = 0.209). The reinfection and gastrointestinal bleeding rates were comparable between groups. Minimized daily hydrocortisone dosage of 100 mg could lower the occurrence of hyperglycemia without increasing mortality in septic shock, compared with the currently recommended dosage of 200 mg/day.

Methylene Blue for Refractory Shock in Polytraumatized Patient: A Case Report

BackgroundMethylene blue (MB) has been advocated for the treatment of shock refractory to standard measures. MB is proposed to increase blood pressure in shock by interfering with guanylate cyclase and nitric oxide synthase (NOS) activity. Several studies have evaluated the vasoconstrictive and positive inotropic effects of MB in septic shock patients. However, there is a paucity of studies involving trauma patients. Case ReportA 4-year-old boy was hit by a truck while riding his bicycle and was treated with fluid resuscitation at the emergency department and then taken to the operating room for damage-control surgery. He had liver, diaphragm, rectal, and thoracic injuries. At the pediatric intensive care unit (PICU), he remained hypotensive despite volume, dopamine, epinephrine, and norepinephrine infusion. A dose of 0.5 mg/kg of i.v. MB was administered. During the next 2 h after MB administration, we were able to wean him off norepinephrine, and doses of epinephrine and dopamine were reduced. Ultimately, he was discharged from the PICU 13 days later in good condition. Why Should an Emergency Physician Be Aware of This?Trauma patients who have experienced bleeding and survived the initial insult are still at risk of dying from continuing systemic hypoperfusion and the resultant multiple organ dysfunctions. Use of a low dose of MB as an adjuvant to treat shock might improve survival of these patients.

Survey on sleep disorders in patients with Parkinson disease

Objective To survey the prevalence and distribution of sleep disorders in patients with Parkinson disease (PD) and to analyze the influencing factors. Methods The prevalence and distribution of sleep disorders were surveyed with Parkinson Disease Sleep Scale (PDSS) among 206 PD patients. The association of sleep disorders with age, course of disease, cognitive function, motor function, depression, and the equivalent dose of levodopa (LED) was analyzed. Results The overall PDSS score in 206 patients was (116.9±21.4). The three most frequent items of sleep disorders were the overall sleep quality(181/206, 87.9%), difficulty in maintaining sleep(160/206, 77.7%)and nocturnal enuresis(151/206, 73.3%); the three least frequent items were early awaking(87/206, 42.2%), urinary incontinence(56/206, 27.2%)and hallucination(44/206, 21.4%). The three items with the lowest average scores were nocturnal enuresis(6.9±3.1), difficulty in maintaining of sleep(7.1±2.7)and overall sleep quality(7.1±2.0); three items with the highest average scores were audiovisual illusion(9.3±1.8), incontinence caused by motion disability(9.0±2.1) and early awaking with upper and lower limb pain(8.7±2.1). PD patients were divided into group 1 [Hoehn-Yahr(HY F=3.27, P=0.04) between group 1 and group 3. The linear regression analysis showed that the HAMD and the LED scores had the greatest influence on PDSS score (R2=0.142, 0.196). Conclusion PD patients have a variety of sleep symptoms. The treatment of large doses of dopamine and depression contribute to the occurrence of PD sleep disorders. Key words: Parkinson disease; Sleep disorders; Depression; Questionnaires

Hypotension Aggravated by Dopamine in a Dog Under Isoflurane Anesthesia

Background: Hypotension (MAP &lt; 60 mmHg) is the most common complication in anesthetic practice and has been identified in 38% of canine patients undergoing general anesthesia for variety of procedures. Normalization of arterial pressure can usually be achieved by decreases in inhalant anesthetic concentrations, fluid administration, and use of inotropes/vasopressors in healthy animals (ASA I) or animals with mild systemic disease (ASA anesthetic risk II). The present report shows an ASA II dog with severe hypotensive crisis [mean arterial pressure (MAP) &lt; 50 mmHg] during general anesthesia, in which the procedure was aborted because hypotension was aggravated by dopamine.Case: A 7-year-old male Bull Terrier was anesthetized for magnetic resonance imaging (MRI) of a tumor in the face. After intramuscular acepromazine (0.01 mg/kg) and meperidine (3 mg/kg), anesthesia was induced with intravenous (IV) ketamine (1 mg/kg) and propofol (2.3 mg/kg) and maintained with isoflurane in oxygen. Ten min after induction of anesthesia MAP was 45 mmHg, while end-tidal isoflurane (ETISO) concentration was 0.5%. End-tidal isoflurane was decreased to 0.3% and an IV bolus of Lactated Ringer’s was initiated (15 mL/kg over 10 min), followed by two ephedrine boluses (0.1mg/kg, IV) administered 5 min apart. MAP remained low (&lt; 50 mmHg) and dopamine constant rate infusion (CRI) was initiated (7.5 μg/kg/min). Ten minutes after dopamine CRI was commenced, MAP was further decreased to 25-22 mmHg. Dopamine CRI was increased to 10 μg/kg/min, but MAP remained &lt; 25 mmHg. Infusion drugs and isoflurane anesthesia were stopped. After the animal was extubated MAP returned 60-70 mmHg.Discussion: Among the drugs used, isoflurane is known for decreasing blood pressure in a dose-related manner because of its vasodilating properties. Hypotension is rarely associated with low end-tidal isoflurane concentrations (0.3-0.5%) in animals that do not present previous evidence of circulatory dysfunction. Acepromazine may have contributed to the hypotensive actions of isoflurane in the case reported here because of its vasodilating effects. Acepromazine has prolonged plasma half-life (7 h) and might also have contributed to the lack efficacy of ephedrine to treat hypotension. Aggravation of hypotension (MAP decreased from 45-50 mmHg to approximately 25 mmHg) by dopamine was unexpected. Aggravation of hypotension during administration of vasopressor doses of dopamine could be related to the activation of the cardiopulmonarychemoreflex (CCR), previously known with the eponym Bezold-Jarisch reflex or due to a prevalence of dopamine´s vasodilatory effects (dopaminergic receptor stimulation) and failure of this drug in promiting increased CO and SVR at the dose ranges used (7.5 to 10 μg/kg/min).. The CCR involves activation of mechano and baroreceptors in the heart, by inotropes such as dopamine and dobutamine. This activation originates vagal afferent impulses to the nucleus tractus solitarii of the spinal cord, which in turn originates parasympathetic afferent impulses to the heart. The consequence is an increase in parasympathetic outflow and decreased sympathetic activity, ultimately producing bradycardia, hypotension, or both.Keywords: acepromazine, Bezold-Jarish reflex, cardiopulmonary chemoreflex, canine, inotropes.

Retinal changes in Parkinson's disease and glaucoma

BackgroundThe topic of retinal neurodegeneration in PD is controversial, therefore the objective was to compare macular ganglion cell complex (mGCC) and peripapillary retinal nerve fiber layer (pRNFL) thickness in PD using 2 Spectral-Domain (SD) Optical Coherence Tomography (OCT) devices. MethodsIn total, 146 eyes of 130 age-similar patients were included, of these 46 eyes of 30 PD patients, 60 eyes of 60 glaucoma patients and 40 eyes of 40 healthy controls. Peripapillary RNFL and mGCC were measured. Correlation analyses were performed for evaluation of association between pRNFL or mGCC and PD severity using the Movement Disorder Society (MDS)-Unified Parkinson Disease Rating Scale (UPDRS). Scatterplots were used to evaluate relationships between disease duration, dopamine dose, olfactory assessment and retinal thickness. ResultsNo significant difference was found for both eyes of PD patients compared to healthy subjects neither for overall mGCC nor each sector. However, the ipsilateral eye to the most-affected body side with bradykinesia in PD patients had a statistically significant thinner superior pRNFL compared to healthy controls (P = 0.03). There was no significant correlation between pRNFL or mGCC and disease severity; also, the scatterplots did not indicate a correlation between disease duration, dopamine dose, olfactory testing and OCT results. ConclusionsImaging of the retina revealed thinning of some retinal layers of the ipsilateral eye to the most-affected body side in PD patients compared to healthy controls. Peripapillary RNFL and mGCC did not correlate to disease severity; however, this was a fairly small and heterogeneous group of PD patients.

The effects of continuous blood purification in patients with septic shock during perioperative period

Objective To evaluate the effects of continuous blood purification in patients with septic shock during perioperative period. Methods Forty-seven patients with infectious shock during perioperative period were enrolled and randomly divided into experimental group(group D, n=23) and control group(group F, n=24). Patients in group D received continuous venous hemofiltration starting before surgery till 72 hours after surgery. Patients in group F were treated with blood purification for 72 hours postoperatively. The blood oxygenation index, pH, HCO, base excess(BE), BUN, serum creatinine(SCr), SBP, DBP and HR were recorded in the two groups before surgery (T0), by the end of operation (T1), and 24 h (T2), and 48 h (T3), and 72 h (T4) after operation. The duration of operation, the perioperative doses of dopamine and metaraminol, and the recovery rate of patients were recorded, as well. Results Doses of dopamine and alamin in group D were significantly lower than those in group F (P 0.05), there was significant difference in oxygenation index at T2-T4 (P 0.05). There were no significant difference in biochemical indexes between group F and group D at T0 (P>0.05). Conclusions Continuous blood purification for perioperative patients with septic shock improved patients′ outcome: stabilizing homeostasis, maintaining the hemodynamics, reducing the doses of vasoactive drugs, improving patients′ tolerance and recovery rate. Key words: Perioperative period; Septic shock; Continuous blood purification

Level of uric acid and uric acid/creatinine ratios in correlation with stage of Parkinson disease

This study aims to investigate relationship between the level of uric acid (UA) and UA/creatinine ratios (UA/Cr) to the stage of Parkinson disease (PD).A total of 120 cases of PD patients who were admitted in our hospital between 2013 and 2015 were enrolled into this study; these 120 cases of PD patients were divided into 3 groups, according to Hoehn–Yahr (H-Y) classification: early stage (1–2 classification), medium stage (2.5–3 classification), and advanced stage (4–5 classification); UA and UA/Cr level in each group was compared. Then, factors including age, gender, dopamine dosage, UA, and UA/Cr levels were analyzed to find the independent predictive factors of PD by logistic regression.UA and UA/Cr levels in the early and medium stage PD patients were significantly higher than in the advanced stage ones. UA and UA/Cr levels in patients with good prognosis were significantly higher than in the poor ones.UA and UA/Cr levels are negatively correlated with the stages of PD and are independent negatively predicting biological indexes of PD incidence and progression.

THE INTERNET IS MAKING PEOPLE LESS INTELLIGENT / A INTERNET ESTÁ TORNANDO AS PESSOAS MENOS INTELIGENTES

The purpose of this scientific article that uses a bibliographic method is to demonstrate that the internet is a world open to facilitate, because with it we stop using our brain as we should or could. Today's children see the greatest difficulty in tasks as mundane as reading or research. They are addicted to the online world that guarantees a high dose of dopamine in a single click. Achievements are easy and achievable in almost any application, be it a like on a social network or a game goal. This type of routine creates a vicious cycle, the need for dopamine generates more anxiety and this leads to tiredness due to cortisol and other released hormones that result in fatigue. We store with emotion and there are no more emotions for storage that make a difference. Emotions are conditioned to virtual realities. The cycle of achievements puts us in an anxiety that impairs attention and in the absence of focus there is no memorization and, without memorization, there is no acquisition of knowledge, we return to a vicious cycle, and to break this new paradigm, that this article is made necessary to discuss the topic.

Incidence and Predictors of Postoperative Need for High-Dose Inotropic Support in Patients Undergoing Cardiac Surgery for Infective Endocarditis

Patients with infective endocarditis undergoing cardiac surgery are a high-risk population. Few data on incidence and predictors of need for high-dose inotropic support in this setting are currently available. Retrospective study. Tertiary-care hospital. Ninety consecutive patients undergoing cardiac surgery for infective endocarditis. None. Baseline, intraoperative and outcome data were collected. Stepwise multiple logistic regression analysis was performed to identify preoperative predictors of postoperative hemodynamic support. High-dose postoperative inotropic support was defined as inotropic score >10 (calculated as dobutamine dose (in µg/kg/min) + dopamine dose (in µg/kg/min) + (epinephrine dose [in µg/kg/min] × 100) + (norepinephrine dose [in µg/kg/min] × 100) + (milrinone dose [in µg/kg/min] × 10) + (vasopressin dose [in U/kg/min] × 10 000) + (levosimendan dose [in µg/kg/min] × 50) or need for mechanical circulatory support at intensive care unit admission. Postoperative high-dose inotropic or mechanical circulatory support was required in 57 cases (61%). Stepwise multiple logistic regression identified 5 variables independently associated with need for postoperative circulatory support: male sex (odds ratio [OR] = 10.9), surgery duration (OR for every minute increase = 1.01), impairment of kidney function (eGFR <60 mL/min/m2 - OR = 19), preoperative new-onset heart failure (defined by clinical, imaging and laboratory parameters - OR = 5.30), and low preoperative platelet count (for every 1×103/μl increase - OR = 0.99). Patients undergoing cardiac surgery for infective endocarditis are at high risk for postoperative hemodynamic instability. Preoperative organ failure is an important determinant for postoperative hemodynamic instability.

Trends in the Use of Inotropes to List Adult Heart Transplant Candidates at Status 1A.

The number of adult heart transplant candidates waiting at the most urgent status 1A has increased over time despite the expansion of geographic sharing of hearts in 2006. We aimed to determine whether candidates listed with inotropes contribute to the excess status 1A candidates. The initial registrations of all adult heart-only candidates listed from 2000 to 2015 were analyzed using the Scientific Registry of Transplant Recipients data set. Trends in listing status, justifications, and candidate factors were measured. Adjusted trends in listing status pre- and post-geographic sharing were estimated using multilevel logistic regression. Competing risks models provided trends in transplant-free waitlist survival. There were 46 853 adult heart-alone listings during 2000 to 2015. Pre-sharing, status 1A listing was unchanged over time (adjusted odds ratio, 0.98; 95% confidence interval, 0.78-1.23). Post-sharing, the adjusted odds of status 1A listing increased 117% over 9 years (adjusted odds ratio 2.17, 95% confidence interval, 1.82-2.58). The number of candidates listed as status 1A with inotropes increased by 193 a year, whereas the dobutamine, dopamine, and milrinone doses used decreased 49%, 55%, and 29% (P<0.001). The risk of waitlist death or deterioration of status 1A inotrope candidates relative to status 2 candidates decreased 62% for 2006 to 2010 and 70% for 2011 to 2015 compared with that for 2003 to 2006. After the wider geographic sharing of hearts in 2006, transplant programs used multiple inotropes to list candidates at status 1A more frequently with progressively lower doses. Concurrently, the status 1A inotrope candidate waitlist outcomes improved substantially. These trends suggest that overtreatment with multiple inotropes contributes to the current critical excess of status 1A candidates.

Terlipressin-induced modifications of Doppler ultrasound signals of systemic arteries in preterm infants with vasoactive-resistant patent ductus arteriosus: A pilot study.

To study the effects of terlipressin (TP) infusion on systemic perfusion, estimated with pulsed-wave Doppler ultrasonography of systemic arteries, in a population of extremely low birth-weight (ELBW) preterm infants with vasoactive-resistant ductus arteriosus. This prospective, observational cohort included, during five years, 12 ELBW infants with hemodynamically significant patent ductus arteriosus and absent or reversed diastolic flow at Doppler ultrasonography of systemic arteries, despite treatment and high-dose vasoactive support. We measured flow velocity of the anterior cerebral, right renal, and superior mesenteric arteries before and after TP infusion. Changes were evaluated by Spearman's rho coefficient analysis, Wilcoxon signed-rank, and Friedman test. Time-averaged mean velocity of the renal artery (P = .028) increased, while renal pulsatility (P = .010) and resistance (P = .004) indexes, and cerebral artery resistance index (P = .021) decreased after TP infusion. Time-averaged mean velocity of the anterior cerebral artery proportionately increased with dopamine dose (rho = 0.678; P = .015), but showed opposite shifts after TP (rho = -0.662; P = .024). These changes suggest that TP may improve systemic perfusion in the ELBW infants with vasoactive-resistant ductus arteriosus.

Neurotransmitter changes in rat brain regions following glyphosate exposure

The effects of glyphosate oral exposure (35, 75, 150 and 800mg/kg bw, 6 days) on brain region monoamine levels of male Wistar rats were examined. Glyphosate-treated rats (35, 75, 150 and 800mg/kg bw, 6 days), had no visible injury, i.e., no clinical signs of dysfunction were observed. After last dose of glyphosate, serotonin (5-HT), dopamine (DA) and norepinephrine (NE) and its metabolites levels were determined in the brain regions striatum, hippocampus, prefrontal, cortex, hypothalamus and midbrain, by HPLC. Glyphosate caused statistically significant changes in the 5-HT and its metabolite 5-hydroxy-3-indolacetic acid (5-HIAA), DA and its metabolites 3,4-hydroxyphenylacetic acid (DOPAC) and homovanillic acid (HVA), and NE and its metabolite 3-metoxy-4-hydroxyphenylethyleneglycol (MHPG) levels in a brain regional- and dose-related manner. Moreover, glyphosate, dose-dependent, evoked a statistically significant increase in 5-HT turnover in striatum and hypothalamus and in DA turnover in prefrontal cortex and hippocampus, and a statistically significant decrease in NE turnover in prefrontal cortex and hypothalamus. The present findings indicate that glyphosate significantly altered central nervous system (CNS) monoaminergic neurotransmitters in a brain regional- and dose-related manner, effects that may contribute to the overall spectrum of neurotoxicity caused by this herbicide.

Influence of catecholamines at different dosages on the function of the LiDCO sensor in isoflurane anesthetized horses

To compare the lithium dilution method for cardiac output (LiDCO) and bolus-thermo-dilution (BTD) measurements before and during infusion of dobutamine, dopamine, phenylephrine, or noradrenaline at 2 different doses in anesthetized horses and to examine the correlation between sensor voltages (saline-blood exposed) and possible measurement errors. Prospective experimental study. University teaching hospital. Nine Warmblood horses. Following 90 minutes of equilibration, 3 different doses of dobutamine (0.5-3 μg/kg/min), dopamine (1-5 μg/kg/min), phenylephrine (0.5-3 μg/kg/min), or noradrenaline (0.1-0.5 μg/kg/min) were administered for 15 minutes in anesthetized horses, and measurements using the LiDCO were performed at the lowest and highest doses. Pairs of LiDCO and BTD measurements were collected and sensor voltages exposed to blood and saline were measured before and at the end of each infusion period. Agreement between LiDCO and BTD was assessed with the Bland-Altman method. The biases (2 standard deviations) before infusion of dobutamine, dopamine, phenylephrine, and noradrenaline were 1.1 (5.7), 1.6 (7.3), 0.2 (6.6), and 1.5 (4.1) L/min, respectively, and minimally and nonsignificantly changed following low-dose catecholamine infusions. Following infusion of higher doses, biases were significantly higher compared to baseline with 10.7 (7.8), 11.2 (11.9), 6.9 (11.7), and 3.5 (3.8) L/min, respectively. The difference between saline- and blood-exposed sensor voltage decreased during infusion of high doses of catecholamines with correlations (rs = 0.62) between cardiac output differences and sensor voltage differences (saline-blood). This study demonstrated that catecholamines could lead to overestimation in a dose-dependent fashion in LiDCO measurements. Monitoring changes in sensor voltage differences (saline-blood) is a valuable and clinically applicable tool to predict errors in LiDCO measurements.