UR-144, synthetic cannabinoid receptor agonist, induced cardiomyoblast toxicity mechanism comprises cytoplasmic Ca2+ and DAPK1 related autophagy and necrosis

UR-144, a cannabinoid receptor agonist, is widely used alone or in combination with other synthetic cannabinoids (SCs) all over the world. At overdose, cardiovascular symptoms have been reported and the underlying molecular mechanisms of these adverse effects are not known. It is highly important to clarify the toxic effects of UR-144 for the treatment of poisoning. In the present study, the molecular mechanism of cytotoxic effects of UR-144 is evaluated on a cardiomyoblastic cell line using WST-1 and LDH assays. Apoptosis/necrosis, autophagy, and ROS (reactive oxygen species) levels were determined using flow cytometry. Cytoplasmic Ca²⁺ levels were measured by using a fluorogenic calcium-binding dye. Released and cytoplasmic troponin T levels, a specific marker of cardiotoxicity, were examined with western blot. For the evaluation of the role of DAPK1, on UR-144-induced cell death, DAPK1 activity and DAPK1 protein level were investigated. Its cytotoxic effects increased in a dose-dependent manner for WST-1 and LDH assays, while membrane damage, one of the signs of necrotic cell death, was more remarkable than damage to mitochondria. Cytoplasmic Ca²⁺ levels rose after high-dose UR-144 treatment and inhibition of DAPK1 activity ameliorated UR-144-induced cytotoxicity. Released troponin T significantly increased at a dose of 200 µM. ROS and total antioxidant capacity of cells were both reduced following high dose UR-144 treatment. The results indicated that UR-144-induced autophagic and necrotic cell death might be a consequence of elevated cytoplasmic Ca²⁺ levels and DAPK1 activation. However, in vivo/clinical studies are needed to identify molecular mechanisms of cardiotoxic effects of UR-144.

Comparison of Epidural and Combined Spinal–Epidural Analgesia in the Management of Labour without Pain

The effects of combined spinal–epidural analgesia (CSEA) and epidural analgesia (EA) were studied in 50 healthy parturients randomly allocated to receive bupivacaine plus fentanyl either epidurally, or intrathecally and epidurally. Significant differences from baseline values were seen in systolic blood pressure at all time-points except for 4 h in the EA group and at 3 and 4 h in the CSEA group. Significant differences from baseline values were seen in diastolic blood pressure at 1, 2, 3 and 4 h in the EA group, whereas no significant differences from baseline were seen in the CSEA group. Pain scores in both groups were significantly decreased compared with baseline and all scores, except at 2h, were significantly lower in the CSEA group compared with the EA group. The duration of labour and total amount of drugs used were significantly decreased and cervical dilatation was faster with CSEA compared with EA. In conclusion, CSEA was associated with more rapid onset of analgesia and faster progress in cervical dilatation compared with EA, and can be used safely for labour analgesia.

A case of fetal carbamazepine syndrome with right hemihypoplasia of the entire body

Anticonvulsant drugs taken by pregnant women to prevent seizures are among the most common causes of potential harm to the fetus. It has been suggested that carbamazepine was less teratogenic than the other drugs. Here, we report a case of fetal carbamazepine syndrome presenting with facial dysmorphism, congenital heart defect, skeletal abnormalities, renal agenesis, ambiguous genitalia, anal atresia, and right hemihypoplasia of the entire body. To the best of our knowledge this is the most severe case of fetal carbamazepine syndrome in the literature. This case can provide useful data about teratogenicity of carbamazepine therapy during the pregnancy.

Total antioxidant capacity and total oxidant status in perinatal asphyxia in relation to neurological outcome

This study aimed to investigate the global oxidant/antioxidant status of infants with perinatal asphyxia and its relation to neurological outcomes. A prospective controlled study including term infants with perinatal asphyxia was conducted. Blood samples were obtained from patients and controls at 6-24 h and on the 3rd day of life for TAC and TOS measurement and OSI values were calculated. Neurodevelopment was evaluated at 12 months of age in survivors using Bayley scales of infant development II (BSID II). 17 term infants with perinatal asphyxia and 17 healthy controls were enrolled. On the first day of life TAC, TOS and OSI were significantly higher in patients with perinatal asphyxia (p<0.001). Total antioxidant capacity decreased significantly on day 3 compared to first day of life in the patient group (p=0.04). Infants with seizures and abnormal amplitude-integrated electroencephalography recordings had higher TOS and OSI levels in the 1st day. There was no correlation between TAC, TOS and OSI levels and BSID II scores. In conclusion oxidant/antioxidant balance is disturbed in favour of oxidants in perinatal asphyxia. Degree of oxidative stress is related to severity of neurological involvement in the first days of life.

The effects of bupivacaine, ropivacaine and mepivacaine on the contractility of rat myometrium

Local anesthetic agents are commonly used for obstetric anesthesia and analgesia. We determined the effects of bupivacaine, ropivacaine and mepivacaine on the contractility of isolated pregnant rat uterine muscle strips. Uterine specimens were obtained from 18- to 21-day pregnant Wistar rats (n = 28). Myometrial strips were obtained from the uterine horns after removing the fetuses and non-uterine tissue, incubated in organ baths and contractions stimulated with oxytocin. When contractions became regular, strips were exposed to increasing concentrations of the study drugs. Mepivacaine (n = 8), ropivacaine (n = 10) and bupivacaine (n = 10) were used at cumulative doses from 10(-8) to 10(-4) mol/L. Two of the local anesthetics, bupivacaine most, ropivacaine least, caused a dose-dependent inhibition of uterine contractility. In contrast, mepivacaine significantly increased uterine contractility. Bupivacaine, ropivacaine and mepivacaine were found to have no effect on frequency of uterine contractions. These results demonstrate that bupivacaine and ropivacaine may inhibit myometrium contractility.

Dimethly sulphoxide lowers ICP after closed head trauma

Ten patients with closed head trauma and elevated intracranial pressure (ICP) ranging from 40-127 mm Hg were treated with intravenous dimethyl sulphoxide (DMSO) every 6 h for 1-10 days. Four patients received DMSO and intermittent oxygen. All patients showed a reduction of ICP after 24 h and 7 had normal ICP after 6 days of treatment. Two patients died of their injuries. Neurological assessment at the time of discharge showed 2 patients with severe neurological deficits and 6 patients with mild to no deficit. After a 3 month follow-up, 1 patient remained severely impaired and 7 patients showed mild to no deficit. It appears that intravenous DMSO can rapidly reduce elevated ICP in severe closed-head injury and that it improves neurological outcome.

Dimethyl sulfoxide in the management of patient with brain swelling and increased intracranial pressure after severe closed head injury

The results of a prospective study on the effects of dimethyl sulfoxide (DMSO) in patients with severe closed head injuries causing brain edema and increase in intracranial pressure (ICP) are presented. 10 patients were selected and carefully analyzed according to Glasgow coma scale (GCS) scores and severity of brain edema. The results demonstrate that DMSO rapidly reduces the raised ICP, increases the cerebral perfusion pressure (CPP) and improves the neurological course and outcome without affecting the systemic blood pressure and patient responsiveness except only in one patient. We also point out that the rebound effect does not occur.