Nitroglycerin Group Research Articles

A Comparative Study of the Effectiveness of Transdermal Nitroglycerine Patches and Oral Nifedipine in Prolongation of Pregnancy in Women With Preterm Labour.

Backgrounds A significant contributor to newborn morbidity and mortality is preterm birth. Several techniques have been employed to identify patients at risk of premature labour. However, these predictors are not always effective because of their multifactorial aetiology. Preterm labour can be suppressed largely through tocolysis. This study compared the effectiveness and safety of transdermal nitroglycerine and oral nifedipine in preventing premature labour. Methods This study was done at Acharya Vinoba Bhave Rural Hospital, Sawangi, Wardha, Maharashtra, from December 2020 to November 2022, on 130 women presenting with preterm labour pains between 28 and 37 weeks of gestational age. All the women selected were randomized into two equal groups by using the envelope method. Sixty-five women were given a nitroglycerine patch (Group A), and the rest (65 women) were given an oral nifedipine tablet (group B). The variables studied were mean days of prolongation of pregnancy, treatment outcome, steroid coverage, along with feto-maternal outcomes among both groups. Results The percentage of women whose pregnancy was prolonged for at least 48 hours in the nitroglycerine group was 75.3%, and in the nifedipine group it was 93.8%. Failure to achieve tocolysis, defined as delivery within 48 hours, was seen significantly more in the nitroglycerine group (24.6%) than in the nifedipine group (6.1%). The overall foetal outcomes were comparable in both groups. Conclusion Oral nifedipine was found to be superior to transdermal nifedipine patches in terms of efficacy and safety in the management of preterm labour, with a better side effect profile.

Nitroglycerin improves the visibility of fibula-free flap perforators on computed tomography angiography in patients with oral or maxillofacial lesion

PurposeTo investigate the improvement of image quality and visualization of fibula-free flap (FFF) perforators on computed tomography angiography (CTA) after administration of sublingual nitroglycerin (NTG) tablets. MethodsA total of 60 patients with oral or maxillofacial lesions before CTA of the lower extremity were randomly divided into two groups (NTG group and non-NTG group). The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR), overall image quality and grading of vessels were evaluated and compared. The lumen diameters of the major arteries and the proximal and distal peroneal perforators were measured. The number of visible perforators in muscular clearance and muscular layer was also counted and compared between the two groups. ResultsThe CNR of posterior tibial artery and overall image quality of CTA images in the NTG group was significantly higher than that in the non-NTG group (p < 0.05), although the SNR and CNR of other arteries did not show significant differences (p > 0.05). The lumen diameters of the peroneal artery and its perforators, anterior tibial artery, and posterior tibial artery were significantly larger in the NTG group (p < 0.001), while no significant difference prevailed in the diameter of the popliteal artery between the two groups (p = 0.298). Compared with the non-NTG group, a significant increase in the number of visible perforators was noted in the NTG group (p < 0.001). ConclusionsThe administration of sublingual NTG in CTA of the lower extremity can improve the image quality and visualization of perforators, which aids to surgeons select the optimum FFF.

Comparative effect of deliberate hypotensive anesthesia using nitroglycerine vs. phentolamine on event related potentials and cognitive functions in patients undergoing septoplasty: a randomized controlled trial

BackgroundPostoperative cognitive dysfunction is a noteworthy complication of deliberate hypotensive anesthesia. The aim of this work was to compare the effect of deliberate hypotensive anesthesia using nitroglycerine versus phentolamine on event-related potentials and cognitive function in patients undergoing septoplasty surgery.MethodsThis prospective randomized controlled trial was conducted on 80 patients indicated for septoplasty under general anesthesia; 40 patients received intra-operative Nitroglycerine and 40 patients received intra-operative Phentolamine. Cognitive assessment (using Paired Associate Learning test (PALT) and Benton Visual Retention test (BVRT)) and P300 recording were done for all included patients pre-operatively and one week postoperatively.ResultsThe scores of PALT and Benton BVRT significantly declined one week following surgery in both Nitroglycerine and Phentolamine groups. There was no statistically significant difference between Nitroglycerine and Phentolamine groups in the postoperative decline in either PALT or BVRT (P-value = 0.342, 0.662 respectively). The values of P300 latency showed a significant delay one week following surgery in both Nitroglycerine and Phentolamine groups (P-value ≤ 0.001, 0.001), but in Nitroglycerine group, the delay is significantly higher than in Phentolamine group (P-value = 0.003). The values of P300 amplitude significantly decreased one week following surgery in both Nitroglycerine and Phentolamine groups (P-value ≤ 0.001, 0.001), but there was no statistically significant difference between Nitroglycerine and Phentolamine groups (P-value = 0.099).ConclusionPhentolamine is preferred over nitroglycerin in deliberate hypotensive anesthesia because it has less harmful effect on cognitive function than nitroglycerin.

Evaluation of Vasodilatory Effect of Nitroglycerin in Cardioplegia Solution on Patients Undergoing Coronary Artery Bypass Graft Surgery.

This study aimed to evaluate the vasodilatory effect of nitroglycerin (NTG) in cardioplegia solution on changes in troponin I and creatine phosphokinase-MB (CPK-MB) levels during coronary artery bypass graft (CABG) surgery. A randomized controlled double-blind clinical trial was performed on 44 patients who were candidates for CABG surgery. These patients were divided into two groups. In the first group (NTG group), 3 mg/kg NTG was added to the cardioplegia solution, while 10 cc placebo (distilled water) was added to the cardioplegia solution in the second group (control group). Troponin I and CPK-MB levels were then assessed before and after the surgery. In this study, 72.7% and 27.3% of patients in the NTG group and 68.2% and 31.8% of patients in the control group were male and female, respectively. In addition, 9.1% within the age range of 40-50 years, 27.3% within the age range of 50-60 years, and 63.6% within the age range of more than 60 years were present in the NTG group. Moreover, 18.2% within the age range of 40-50 years, 36.4% within the age range of 50-60 years, and 45.5% within the age range of more than 60 years were present in the control group. Although the mean cardiopulmonary bypass (CPB) and cross-clamp time was insignificantly higher in the NTG group compared to the control group. In addition, troponin I and CPK-MB levels after surgery in the NTG group with the mean of 2090.68 ± 1856.07 and 97.27 ± 38.17 were significantly lower than those of the control group with the mean of 2697.02 ± 5586.56 and 137.95 ± 227.99, respectively (P-value <0.05). According to the results of this study, although troponin I and CPK-MB levels increased significantly after CABG surgery, this increase was significantly lower in the intervention group compared to the control group following the administration of NTG.

Comparison of Botulinum Toxin Injection and Botulinum Toxin Injection with Glyceryl Trinitrate for Treatment of Chronic Anal Fissure

Anal fissure (AF) is an illness of anal canal and is characterized by cracks appearing in stratified squamous epithelium of distal anal canal. The tear, being present in the squamous part of the epithelium, causes considerable pain, fresh bleeding while defecation. The current study is planned to compare the Botulinum toxin Injection and botulinum toxin Injection with Glyceryl trinitate for the treatment of chronic anal fissure in terms of healing. Materials and Methods: Patients will be sent home after one hour with stool softener .while patients in group B will be will receive treatment with 0.2 ml (20 units) Botulinum toxin injection plus 1 gram 0.2% topical glyceryl trinitate cream 8 hourly with dose of 1 gram on middle fingers tip and apply it 1 cm2 in anal canal circumferentially. In both groups, patients will be assessed at follow up after 2 , 4 and 8 weeks post treatment. At follow up, patients will be examined for healing (yes or no) and any other side effect will be documented. Results: In Botulinum toxin injection group, 26(78.8%) had wound healing after 2 months and 30(90.9%) in Botulinum toxin injection with glyceryl trinitrate group with a p-value = 0.170. Conclusion: Botulinum toxin injection with glycerylyl trinitrate is a better technique for treatment of chronic anal fissure healing in comparison with Botulinum toxin injection alone. Keywords: Chronic Anal Fissure, Treatment, Botulinum Injection, Botilinum Injection with Glyceyl Trintrate, Comparison

Management of Incidental Uncontrolled Elevation of Intraoperative Blood Pressure: A Comparative Study on Nitroglycerine Versus Dexmedetomidine Infusion.

Uncontrolled elevation of intraoperative blood pressure can result in deleterious effects with increased risk of morbidity and mortality. We aimed to compare nitroglycerine infusion with dexmedetomidine infusion in controlling accidental intraoperative uncontrolled hypertension. This comparative study was conducted on 73 hypertensive patients undergoing cancer surgeries who experienced uncontrolled intraoperative hypertension. The data of 38 patients were retrieved from the medical records for the nitroglycerine group and 35 patients were prospectively enrolled for the dexmedetomidine group. Group N received nitroglycerine infusion (0.3 - 1 µg/kg/min), while group D received dexmedetomidine infusion (0.2 - 0.7 µg/kg/h). Both groups were comparable regarding their demographic data and clinical characteristics. Systolic, diastolic, and mean arterial pressure (MAP) values were significantly lower in group N compared to group D during the period between 60 and 120 minutes intraoperatively (P < 0.001). Heart rate values were significantly lower in group D than in group N (P < 0.001). Postoperative sedation scores were better for group D with lower analgesic requirements (P < 0.001). Dexmedetomidine infusion can be used to manage the uncontrolled intraoperative elevation of blood pressure in selected patient population.

COMPARATIVE STUDY ON THE EFFICACY OF TOPICAL METRONIDAZOLE, TOPICAL NITROGLYCERINE, AND TOPICAL DILTIAZEM IN THE MANAGEMENT OF CHRONIC ANAL FISSURE

Background and Aims: Chronic anal fissure (CAF) is usually managed with surgical modalities but it imposes huge cost with recurrence rates. Hence, topical therapies are preferred is such cases which has a good patient acceptability rate. The present study aims to compare the topical metronidazole (MTZ), diltiazem (DTZ), and glyceryl trinitrate (GTN) in terms of healing rate and pain reduction in CAF patients. Methods: This was a randomized and prospective study conducted on 90 patients with CAF. The patients were grouped as follows (n=30), Group 1; 1% MTZ gel, Group 2; 0.2% Nitroglycerin ointment, and Group 3 (n=30): 2% DTZ ointment. The patients were evaluated at 2, 4, and 6 weeks for pain using visual analogue score (VAS) and healing rate. The results were compared and p&lt;0.05 was considered as significant. Results: The VAS scores between the groups was found to be non-significant (p&gt;0.05), however the VAS scores where markedly reduced within the group at 6 weeks. The healing rate was higher in MTZ group (90%) as compared to GTN (83.3%) and DTZ group (83.3%) but it was not significant. Regarding side effect, burning sensation was observed in MTZ and GTN, DTZ groups were devoid of side effects. Conclusion: The MTZ was more effective with good healing rate but with few side effects. Regarding the pain reduction, all the groups displayed equivocal effects. Thus topical MTZ is a suitable agent for the faster healing of CAF and thus avoids the requirement of surgical options.

Comparison of spasmolytic regimen for prevention of radial artery spasm during the distal radial approach: A single-center, randomized study.

The distal radial approach (DRA) for coronary catheterization is increasingly being used worldwide yet the optimal medication regimen to prevent radial artery spasm (RAS), an important factor for the success of the procedure, remains unclear. The aim of this study is to examine the effectiveness of medication for preventing RAS via the DRA. This was a prospective, comparative randomized study including 400 patients who underwent coronary catheterization via DRA in single center by three experienced DRA operators. Patients were randomized to either nitroglycerin (NTG) injection (N = 200) or NTG plus verapamil (N = 200) to compare the effectiveness and safety of these regimens. There were no differences between the groups in the changes in radial artery diameter at most spastic area (0.34 ± 0.20 in the NTG group, 0.35 ± 0.20 in the NTG plus verapamil group; P = 0.73). There was no difference between the groups in the ratio of patients without arm pain during the procedure (95.0% in the NTG group, 93.5% in the NTG plus verapamil group; P = 0.67). However, there was a greater reduction in diastolic blood pressure in the NTG plus verapamil group (-8.3 ± 7.9 mmHg) than in the NTG group (-6.6 ± 7.6 mmHg) (P = 0.03). Intra-arterial injection of NTG as a single agent is effective and safe in the prevention of RAS during coronary catheterization via the DRA compared with a cocktail regimen of NTG plus verapamil. https://cris.nih.go.kr, identifier KCT0005177.

Methods for increasing distal radial artery diameter.

Our study aimed to find the maximum rate of increase in distal radial artery size. Diameter measurements were obtained on transverse and sagittal sections of the artery with a high-frequency linear transducer (Philips ClearVue L12-4 Mhz). In the baseline evaluation, radial artery and distal radial artery diameters were measured. The patients were divided into two groups: patients with flow-mediated dilatation in Group I and patients with 30 mg Topical Nitroglycerin in Group II. Group II patients were divided into two groups 30 minutes after topical nitroglycerin; patients with flow-mediated dilatation (FDM) in Group IIa, patients with wrist warming plus FMD in Group IIb. A significant increase was found between baseline and second measurements in the radial artery (2.64±0.46 and 2.36±0.39 mm; p=0.02 in Group I, 2.78±0.38 and 2.39±0.25 mm; p=0.01 in Group II) and distal radial artery (2.29±0.49 and 1.93±0.37 mm; p=0.02 in Group I, 2.32±0.28 and 1.96±0.44 mm; p=0.04 in Group II) diameters. Radial (3.02±0.55 and 2.78±0.38 mm; p<0.01) and distal radial artery (2.55±0.32 and 2.32±0.28 mm; p=0.01) diameters increased compared to the second measurements in Group IIa. Radial (3.25±0.35 and 2.78±0.38 mm; p<0.01) and distal radial artery (2.88±0.12 and 2.32±0.28 mm; p<0.01) diameters increased compared to the second measurements in Group IIb. The results of the final evaluations of the two groups were compared, radial (3.02±0.55 and 3.25±0.35 mm; p=0.04) and distal radial artery (2.55±0.32 and 2.88±0.12 mm; p=0.03) diameters were found to be significantly higher in Group IIb than Group IIa. When comparing baseline and final evaluations, the radial artery diameter was increased by 37%, and the distal radial artery diameter was increased by 49% in Group IIb. We increased the radial artery diameter higher proportion than defined in the literature.

Acute sleep deprivation aggravates nitroglycerin-evoked hyperalgesia in mice.

Sleep deprivation can trigger migraine, and migraineurs often choose to sleep to relieve headaches during acute migraine. This study aimed to explore the effect of acute sleep deprivation on hyperalgesia induced by nitroglycerin in mice. In part one, after either 6-h sleep deprivation or 6-h normal sleep, mice were intraperitoneally injected with nitroglycerin or saline. The mechanical pain threshold and withdrawal latency of the hindpaw were measured every 30min for 6h. Next, the same sleep deprivation and injection procedure was performed with new mice, and mice were sacrificed 4.5h after injection. The trigeminal nucleus caudalis and upper cervical spinal segments were taken for immunofluorescence Fos staining. In part two, after injection of saline or nitroglycerin, the mice were either deprived of sleep for 6h or allowed to sleep without interference. The mechanical and thermal pain threshold were measured after 6h. In part three, we compared the sleep time of mice after intraperitoneal injection of saline or nitroglycerin without interference. Sleep deprivation for 6h did not cause any changes in the baseline pain thresholds in mice. However, pretreatment with 6-h sleep deprivation significantly prolonged the duration of hyperalgesia induced by nitroglycerin. Additionally, the expression of Fos at 4.5h was significantly higher in the 6-h sleep deprivation and nitroglycerin group than in the other three groups. When intraperitoneal injection was given first, the mechanical pain threshold of the hind paw was significantly lower in the group that received nitroglycerin with 6-h sleep deprivation than in the other groups. Compared to the saline injection, one-time nitroglycerin injection would result in a significant increase in sleep latency and decrease in sleep duration for the normal mice. Acute sleep deprivation significantly aggravated the hyperalgesia induced by nitroglycerin in mice, which highlights the importance of sleep disorders for migraine.

Comparison of the effects of tranexamic acid, nitroglycerin, and remifentanil on the prevention of bleeding during herniated lumbar intervertebral disc surgery: A randomized clinical trial.

Surgery is a well-known and effective method of treating lumbar intervertebral disc herniation. The present study aimed to compare the effects of administering tranexamic acid (TXA), nitroglycerin (NTG), and remifentanil (REF) on hemorrhage prevention during herniated lumbar intervertebral disc surgery. A double-blind clinical trial was conducted on 135 participants undergoing lumbar intervertebral disc surgery. A randomized block design was used for subject assignment to three groups including TXA, NTG, and REF. The hemodynamic parameters, bleeding rate, hemoglobin level, and the amount of infused propofol were measured and recorded after surgery. Data were then analyzed in SPSS software using Chi-square test and analysis of variance. The mean age of participants in the study was 42.12 ± 7.93 years, and all three groups were equal in terms of demographic characteristics (P > 0.05). The mean arterial pressure (MAP) of the TXA and NTG groups was notably higher than the REF group (P < 0.008). The mean heart rate (HR) of the TXA and NTG groups was notably higher than the REF group (P < 0.05). The propofol dosage used in the TXA group was higher than the two groups of NTG and REF (P < 0.001). Among participants undergoing lumbar intervertebral disc surgery, the greatest MAP variability was observed in the NTG group. Higher mean HR and propofol consumption was observed in the NTG and TXA groups when compared to REF. No statistically significant differences were noted between groups in oxygen saturation or bleeding risk. Based on these findings, REF may be considered a preferred surgical adjunct over TXA and NTG during lumbar intervertebral disc surgery.

Preterm Labour Management with Glyceryl Trinitrate Patch and Isoxsuprine: A Longitudinal Study

Introduction: Nitric oxide donors in the form of nitroglycerine and β-mimetic drugs (Isoxsuprine hydrochloride) are commonly used in managing preterm labour. It is one of the most challenging obstetric complications encountered by obstetricians, as well as preterm neonates for paediatricians. Preterm labour refers to the onset of uterine contractions of sufficient strength and frequency to effect progressive dilatation and effacement of the cervix between 20 and 37 weeks of gestation. Aim: To compare the effects of transdermal Glyceryl Trinitrate (GTN) with Isoxsuprine in terms of maternal complications, perinatal outcomes, and their tocolytic effectiveness. Materials and Methods: A hospital-based longitudinal study was conducted in the Department of Obstetrics and Gynaecology at JNU Medical College and Research Centre, Jaipur, Rajasthan, India. The study duration of the study was one year, from March 2022 to February 2023. A total number of 100 cases of preterm labour were enrolled and equally divided into two groups: Groups A (GTN patch) and group B (Isoxsuprine) with a defined dosing schedule. Singleton pregnancies with intact membranes and gestational age of 26-36 weeks were included in the study, metting the diagnostic criteria for preterm labour. Both the groups received pharmacological intervention, and outcome measures such as success rate of treatment (i.e., prolongation of labour),. maternal side effects, and foetal outcomes {Neonatal Intensive Care Unit (NICU) admission and Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score) were measured and evaluated. Predefined parameters and other data were tabulated in Microsoft Excel and statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 20.0. The Chi-square test was applied to identify significant differences. Results: The incidence of preterm labour was highest in the age group of 21-30 years (76% in Group A and 70% in Group B) among patients treated with nitroglycerine and isoxsuprine, respectively. The mean prolongation of pregnancy in the nitroglycerine group was 21.42 days, and in the isoxsuprine group, it was 16.22 days (p=0.042). The most common side effect in the nitroglycerine group was headache (60%), while in the isoxsuprine group, it was maternal hypotension (24%). The mean APGAR score in Group A and Group B was 8.18 and 8.06, respectively. It was observed that 24% of newborns in the nitroglycerine group and 36% in the isoxsuprine group required NICU admission. The success rate was 90% in the nitroglycerine group and 80% in the isoxsuprine group. Conclusion: Both drugs were effective in prolonging pregnancy for the first 48 hours, but nitroglycerine was found to be slightly better in terms of success rate. Nitroglycerin was more acceptable to patients with preterm labour, as it did not have to be administered through painful injections.

Impact of nitroglycerin on machine-learning fractional flow reserve in coronary computed tomography (CT)-angiography.

Nitroglycerin administration prior to examination improves stenosis assessment of coronary computed tomography (CT) angiography (CCTA). However, whether nitroglycerin influences CT-derived fractional flow reserve (FFR, CT-FFR) evaluation remains unclear. This study aimed to investigate the effect of nitroglycerin on diagnostic performance of CT-FFR. In this single-center retrospective study, 107 consecutive patients suspected of coronary artery disease (CAD) with nitroglycerin administration prior to CCTA in 2019 were matched to 107 patients without nitroglycerin in 2016 from Fuwai Hospital. All patients underwent CCTA and invasive FFR in a month. Vessel-based and patient-based accuracy and diagnostic performance of CT-FFR were compared between the two groups, as well as image quality, coronary artery diameter and evaluability. Quantitative variables were compared by Kruskal-Wallis H test. Categorical variables and rates were compared by χ2 test or Fisher exact test. A total of 214 patients (56.1±8.9 years, 155 male) with 237 target lesion vessels were analyzed, including 120 vessels in nitroglycerin and 117 vessels in non-nitroglycerin group. Per-vessel based accuracy of CT-FFR was higher in nitroglycerin group {80.0% [95% confidence interval (CI): 71.7-86.7%] vs. 68.4% (59.1-76.7%), P=0.041}. On a per-patient basis, nitroglycerin administration improved the accuracy [83.2% (74.7-89.7%) vs. 68.2% (58.5-76.9%), P=0.01], specificity [82.7% (69.7-91.8%) vs. 61.9% (48.8-73.9%), P=0.01], positive predictive value (PPV) [83.6% (73.6-90.4%) vs. 58.6% (50.0-66.9%), P=0.004], and area under the curve (AUC) [0.83 (0.75-0.89) vs. 0.71 (0.61-0.79), P=0.03] of CT-FFR. Vessel diameters (left main arteries: 4.3 vs. 3.8 mm, P<0.001; left anterior descending arteries: 3.1 vs. 2.9 mm, P=0.001; left circumflex arteries: 2.9 vs. 2.7 mm, P=0.01; right coronary arteries: 3.7 vs. 3.4 mm, P=0.001) and number of evaluable coronary arteries (11.0 vs. 8.0, P<0.001) were larger in nitroglycerin group. Nitroglycerin administration prior to CCTA has positive effects on diagnostic performance of CT-FFR.

Abstract 10765: Association Between Prehospital Nitroglycerin and Clinical Outcome in Acute Coronary Syndrome

Introduction: Whether prehospital Nitroglycerin use is associated with major adverse cardiac events (MACE) remains unknown in the era of primary percutaneous coronary intervention (PCI) using stents. Hypothesis: We hypothesized that prehospital Nitroglycerin use would be associated with MACE in acute coronary syndrome (ACS) patients who underwent primary PCI. Methods: This retrospective observational study enrolled 947 consecutive patients who received the emergent PCI. Patients were classified into the two groups, with and without prehospital Nitroglycerin use. 250 patients were given prehospital Nitroglycerin sublingually or via oral spray or intravenously. The clinical outcome was MACE defined as a composite of all-cause death, myocardial infarction, and stroke at a one-year follow-up. Results: The Systolic blood pressure at the emergency department was 132 (105, 141) mmHg in the prehospital Nitroglycerin, and 135 (113, 158) mmHg in the non-Nitroglycerin group (P &lt; 0.001). Kaplan-Meier survival curves revealed that the MACE frequency was higher in the prehospital Nitroglycerin group (p = 0.021). Multivariate Cox regression analysis revealed that the prehospital Nitroglycerin use (hazard ratio, 1.65; 95% confidence interval [CI], 1.02-2.65; p = 0.002) was an independent predictor for MACE. Prehospital Nitrogricerin use, Killip classification, and Ejection fraction models resulted in a c-statistic with a statistically significant 95% PI and moderate discriminative performance (c-statistic=0.763; 95% CI, 0.7111-0.816, p&lt;0.001). Conclusions: The present results suggested that the prehospital Nitroglycerin use might worsen the one-year prognosis in ACS patients undergoing primary PCI.

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Anal Fissures.

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Anal Fissures.

A c-Fos activation map in nitroglycerin/levcromakalim-induced models of migraine

BackgroundChronic migraine is a common and highly disabling disorder. Functional MRI has indicated that abnormal brain region activation is linked with chronic migraine. Drugs targeting the calcitonin gene-related peptide (CGRP) or its receptor have been reported to be efficient for treating chronic migraine. The CGRP signaling was also shared in two types of chronic migraine models (CMMs). However, it remains unclear whether the activation of specific brain regions could contribute to persistent behavioral sensitization, and CGRP receptor antagonists relieve migraine-like pain in CMMs by altering specific brain region activation. Therefore, it’s of great interest to investigate brain activation pattern and the effect of olcegepant (a CGRP receptor-specific antagonist) treatment on alleviating hyperalgesia by altering brain activation in two CMMs, and provide a reference for future research on neural circuits.MethodsRepeated administration of nitroglycerin (NTG) or levcromakalim (LEV) was conducted to stimulate human migraine-like pain and establish two types of CMMs in mice. Mechanical hypersensitivity was evaluated by using the von Frey filament test. Then, we evaluated the activation of different brain regions with c-Fos and NeuN staining. Olcegepant was administered to explore its effect on mechanical hyperalgesia and brain region activation.ResultsIn two CMMs, acute and basal mechanical hyperalgesia was observed, and olcegepant alleviated mechanical hyperalgesia. In the NTG-induced CMM, the medial prefrontal cortex (mPFC), anterior cingulate cortex (ACC), and the caudal part of the spinal trigeminal nucleus (Sp5c) showed a significant increase of c-Fos expression in the NTG group (p < 0.05), while pre-treatment with olcegepant reduced c-Fos expression compared with NTG group (p < 0.05). No significant difference of c-Fos expression was found in the paraventricular thalamic nucleus (PVT) and ventrolateral periaqueductal gray (vlPAG) between the vehicle control and NTG group (p > 0.05). In the LEV-induced CMM, mPFC, PVT, and Sp5c showed a significant increase of c-Fos expression between vehicle control and LEV group, and olcegepant reduced c-Fos expression (p < 0.05). No significant difference in c-Fos expression was found in vlPAG and ACC (p > 0.05).ConclusionsOur study demonstrated the activation of mPFC and Sp5c in two CMMs. Olcegepant may alleviate hyperalgesia of the hind paw and periorbital area by attenuating brain activation in CMMs.

Prehospital transdermal glyceryl trinitrate in patients with presumed acute stroke (MR ASAP): an ambulance-based, multicentre, randomised, open-label, blinded endpoint, phase 3 trial

Pooled analyses of previous randomised studies have suggested that very early treatment with glyceryl trinitrate (also known as nitroglycerin) improves functional outcome in patients with acute ischaemic stroke or intracerebral haemorrhage, but this finding was not confirmed in a more recent trial (RIGHT-2). We aimed to assess whether patients with presumed acute stroke benefit from glyceryl tr initrate started within 3 h after symptom onset. MR ASAP was a phase 3, randomised, open-label, blinded endpoint trial done at six ambulance services serving 18 hospitals in the Netherlands. Eligible participants (aged ≥18 years) had a probable diagnosis of acute stroke (as assessed by a paramedic), a face-arm-speech-time test score of 2 or 3, systolic blood pressure of at least 140 mm Hg, and could start treatment within 3 h of symptom onset. Participants were randomly assigned (1:1) by ambulance personnel, using a secure web-based electronic application with random block sizes stratified by ambulance service, to receive either transdermal glyceryl trinitrate 5 mg/day for 24 h plus standard care (glyceryl trinitrate group) or to standard care alone (control group) in the prehospital setting. Informed consent was deferred until after arrival at the hospital. The primary outcome was functional outcome assessed with the modified Rankin Scale (mRS) at 90 days. Safety outcomes included death within 7 days, death within 90 days, and serious adverse events. Analyses were based on modified intention to treat, and treatment effects were expressed as odds ratios (ORs) or common ORs, with adjustment for baseline prognostic factors. We separately analysed the total population and the target population (ie, patients with intracerebral haemorrhage, ischaemic stroke, or transient ischaemic attack). The target sample size was 1400 patients. The trial is registered as ISRCTN99503308. On June 24, 2021, the MR ASAP trial was prematurely terminated on the advice of the data and safety monitoring board, with recruitment stopped because of safety concerns in patients with intracerebral haemorrhage. Between April 4, 2018, and Feb 12, 2021, 380 patients were randomly allocated to a study group. 325 provided informed consent or died before consent could be obtained, of whom 170 were assigned to the glyceryl trinitrate group and 155 to the control group. These patients were included in the total population. 201 patients (62%) had ischaemic stroke, 34 (10%) transient ischaemic attack, 56 (17%) intracerebral haemorrhage, and 34 (10%) a stroke-mimicking condition. In the total population (n=325), the median mRS score at 90 days was 2 (IQR 1-4) in both the glyceryl trinitrate and control groups (adjusted common OR 0·97 [95% CI 0·65-1·47]). In the target population (n=291), the 90-day mRS score was 2 (2-4) in the glyceryl trinitrate group and 3 (1-4) in the control group (0·92 [0·59-1·43]). In the total population, there were no differences between the two study groups with respect to death within 90 days (adjusted OR 1·07 [0·53-2·14]) or serious adverse events (unadjusted OR 1·23 [0·76-1·99]). In patients with intracerebral haemorrhage, 12 (34%) of 35 patients allocated to glyceryl trinitrate versus two (10%) of 21 allocated to the control group died within 7 days (adjusted OR 5·91 [0·78-44·81]); death within 90 days occurred in 16 (46%) of 35 in the glyceryl trinitrate group and 11 (55%) of 20 in the control group (adjusted OR 0·87 [0·18-4·17]). We found no sign of benefit of transdermal glyceryl trinitrate started within 3 h of symptom onset in the prehospital setting in patients with presumed acute stroke. The signal of potential early harm of glyceryl trinitrate in patients with intracerebral haemorrhage suggests that glyceryl trinitrate should be avoided in this setting. The Collaboration for New Treatments of Acute Stroke consortium, the Brain Foundation Netherlands, the Ministry of Economic Affairs, Stryker, Medtronic, Cerenovus, and the Dutch Heart Foundation.

The Effect of Vasodilator Drugs on Intima Damage in Preparation of the Saphenous Vein Graft

Introduction: The most important issue in the success of coronary bypass surgery is the quality of the grafts used. In this study, the effect of vasodilator drugs for intimal damage on the harvested saphenous veins of coronary bypass patients was investigated. Patients and Methods: A total of 10 patients who underwent coronary bypass surgery, had 2-cm long segments of saphenous veins harvested and divided into four study groups. Isotonic solutions in Group I (control group) and Group II, verapamil in Group III, and nitroglycerin in Group IV were applied to the saphenous veins at equal times, in the control group under 20 mmHg and in the other groups 100 mmHg pressure. Upon the completion of the preparation, saphenous vein grafts were studied with light and electron microscopy. Endothelial cell loss and intimal and medial edema were considered in evaluations. Scoring was done from 0 to 3. A median score was assessed for each group. Results: There was a statistically significant difference between the control and saline groups in terms of endothelial and media damage (0.7 ± 0.48, 2.8 ± 0.42) (p&lt; 0.001), while there was no statistically significant difference between the control group and the verapamil and nitroglycerin groups (0.7 ± 0.48, 1.4 ± 0.54) (0.7 ± 0.48, 1.2 ± 0.44) (p&gt; 0.05). Likewise, no statistically significant difference was found between verapamil and nitroglycerin (1.4 ± 0.54, 1.2 ± 0.44) (p&gt; 0.05). It was determined that the verapamil and nitroglycerin groups had the closest score to the control group, the endothelial and medial damage was minimal in the verapamil and nitroglycerin group, like the control group, and a large amount of endothelial and media damage was observed in the saline group. Conclusion: The use of vasodilators (verapamil or nitroglycerin) in the preparation of the saphenous vein graft increases the early and late success of vein grafts by protecting the tunica intima and media in the graft, preventing the formation of thrombus in the early period and the development of branchendothelial fibromuscular hyperplasia and atherosclerosis in the late period.

Uso de nitroglicerina subcut�nea para facilitar el acceso radial en procedimientos coronarios (Estudio NiSAR)

espanolIntroduccion y objetivos: Se evaluo si la utilizacion sistematica de nitroglicerina subcutanea previa a cualquier intento de canulacion podiIa mejorar de forma significativa el acceso transradial (nitroglicerina subcutanea acceso radial [NiSAR]). Metodos: Se incluyeron todos los pacientes sometidos a angiografiIa coronaria en un estudio prospectivo, multiceIntrico, doble ciego y aleatorizado, y se dividio la poblacion en 2 grupos: grupo de nitroglicerina y grupo control. Los objetivos primarios del estudio fueron el numero total de punciones radiales, el tiempo total de acceso y de procedimiento, la necesidad de cambio a acceso femoral y la puntuacion de disconfort local. El objetivo secundario fue la evaluacion del pulso antes y tras la anestesia. Ademas, un subgrupo de pacientes fue evaluado con ecografiIa de la arteria radial. Resultados: Se incluyeron 736 pacientes: 379 en el grupo de nitroglicerina y 357 en el grupo C. El numero promedio de intentos de puncion radial fue similar en ambos (1,70 frente a 1,76; p = 0,42). No hubo diferencias significativas en los 2 grupos con respecto al tiempo total del acceso y del procedimiento (61,1 y 33,3 s frente a 63 y 33,4 s; p = 0,66 y p = 0,64, respectivamente). Tampoco se encontraron diferencias significativas entre los 2 grupos en la tasa de conversion a acceso femoral (7,1 en el grupo de nitroglicerina frente a 8,4% en el grupo C; p = 0,52). Sin embargo, el iIndice de malestar local y el de pulso tras la anestesia fueron significativamente mejores en el grupo de nitroglicerina (2,34 frente a 2,76, p Conclusiones: El uso sistematico de nitroglicerina subcutanea previo a la puncion radial no estuvo asociado a una reduccion en el numero de punciones ni en el tiempo de acceso, pero el menor malestar local y el aumento del calibre de la arteria radial podriIan justificar su uso en la practica cliInica para mejorar la experiencia del acceso transradial tanto en el paciente como en el operador. EnglishIntroduction and objectives: We assessed whether the routine use of subcutaneous nitroglycerin prior to a cannulation attempt improves transradial access significantly (the NiSAR study [subcutaneous nitroglycerin in radial access]). Methods: Patients undergoing a coronary angiography were enrolled in a prospective, double-blind, multicenter, randomized trial in 2 groups (nitroglycerin group vs control group). The primary endpoints were the overall number of puncture attempts, access and procedural time, switch to transfemoral access, and local perceived discomfort score. The secondary endpoints were the pre- and post-anesthetic pulse score. A subgroup of patients underwent ultrasound scans performed through the radial artery. Results: 736 patients were enrolled in the trial: 379 in the nitroglycerin group and 357 in control group. The average number of puncture attempts was similar (1.70 vs 1.76; P = .42). Access and procedural time did not change significantly (61.1 s and 33.3 s vs 63 s and 33.4 s; P = .66 and P = .64, respectively). No significant differences were found either between the 2 groups in the number of switches to transfemoral access (7.1% vs 8.4%; P = .52). However, the average local perceived discomfort score and post-anesthetic pulse score were significantly better in the nitroglycerin group (2.34 vs 2.76; P Conclusions: The routine use of subcutaneous nitroglycerin prior to radial puncture was not associated with fewer punctures or shorter access times. However, the lower local perceived discomfort and enlargement of the radial artery size would justify its daily use in the routine clinical practice to enhance the transradial experience for both patients and operators.

Local nitroglycerin to facilitate peripheral arterial cannulation in children: systematic review and meta-analysis

BackgroundNeonates and children admitted to intensive care units require peripheral arterial cannulation to monitor their blood pressures and for blood sampling, but many times it is unsuccessful.ObjectiveTo conduct a systematic...