Central nervous system activity of a Tabernaemontana arborea alkaloid extract involves serotonergic and opioidergic neurotransmission in murine models

Tabernaemontana arborea (Apocynaceae) is a Mexican tree species known to contain ibogan type alkaloids. This study aimed at determining central nervous system-related activities of an alkaloid extract obtained from the root bark of T. arborea. A gas chromatography-mass spectrometry (GC-MS) analysis was performed to describe the alkaloid profile of the extract. A wide dosing range (0.1 to 56.2 mg/kg) of this extract was evaluated in different murine models. Electrical brain activity was examined by electroencephalography (EEG). The extract's effects on motor coordination, ambulatory activity, and memory were analyzed based on the rotarod, open field (OFT), and object recognition tests (ORT), respectively. Antidepressant and antinociceptive activities were determined using the forced swimming test (FST) and the formalin assay, respectively. In order to elucidate the underlying mechanisms of action, the 5-HT1A receptor antagonist WAY100635 (1 mg/kg) or the opioid receptor antagonist naloxone (1 mg/kg) was included in the latter experiments. GC-MS analysis (μg/mg extract) confirmed the presence of the monoterpenoid indole alkaloids (MIAs) voacangine (207.00), ibogaine (106.33), vobasine (72.81), coronaridine (30.72), and ibogamine (24.2) as principal constituents of the extract, which exhibited dose- and receptor-dependent antidepressant (0.1 to 1 mg/kg; 5-HT1A) and antinociceptive (30 and 56.2 mg/kg; opioid) effects, without altering motor coordination, ambulatory activity, and memory. EEG indicated CNS depressant activity at high doses (30 and 56.2 mg/kg). The root bark of T. arborea contains a mixture of alkaloids that may hold therapeutic value in pain relief and the treatment of psychiatric diseases without causing neurotoxic activity at effective doses.

Lessons from mouse models of MPN

Over the past decades, a variety of MPN mouse models have been developed to express in HSC the main mutations identified in patients: JAK2^V617F, CALRdel52 or ins5 and MPL^W515L. These models mimic quite faithfully human PV or ET with their natural evolutions into MF and their hemostasis complications, demonstrating the driver function of these mutations in MPN. Here, we review these models and show how they have improved our general understanding of MPN regarding (1) the mechanisms of fibrosis, thrombosis/hemorrhages and disease initiation, (2) the roles of additional mutations and signaling pathways in disease progression and (3) the preclinical development of novel therapies. We also address controversial results between these models and remind how these models may differ from human MPN onset and also how basically mice are not humans, encouraging caution when one draw lessons from mice to humans. Furthermore, the contribution of germline genetic predisposition, HSC and niche aging, metabolic, oxidative, replicative or genotoxic stress, inflammation, immune escape and additional mutations need to be considered in further investigations to encompass the full complexity of human MPN in mice.

A comparative study of root canal shaping using protaper universal and protaper next rotary files in preclinical dental education

Background

Dentistry has undergone an evolution in endodontics practice caused by the advancement of rotary techniques for root canal preparation and their subsequent incorporation into the teaching of dentistry undergraduates. This research aimed to evaluate the shaping ability of third-year dental students as their first experience in rotary instrumentation using ProTaper Universal (PTU) and ProTaper Next (PTN) (Dentsply Maillefer) rotary instruments in simulated curved canals.

Methods

Forty students instrumented 200 simulated canals with a 40° curvature in resin blocks according to the manufacturer’s instructions with PTU and 39 students and 195 canals with PTN files. The canals were prepared at a speed of 300 rpm using a 16:1 reduction hand-piece powered by an electric motor (Xsmart; Dentsply Maillefer). The final apical preparation was set to F2 for the PTU and X2 for the PTN group. The change in canal curvature was evaluated based on Schneider technique using the AutoCAD 2007 software on post-digital photographs. The incidence of instrument fracture and deformation, the incidence of ledge, the change in working length (WL), and the working time were noted. The data were analyzed with Student’s t-test and Chi-Square test at a significance level of 0.05 using SPSS.

Results

PTN maintained the original canal curvature better, resulting in fewer fractures and ledges, and shaped the canals faster than the PTU (P < 0.05). The mean curves of the resin canals after the instrumentation for the PTU and PTN groups were 24.03° ± 3.14° and 25.64° ± 2.72°, respectively. Thirty-three (17.4%) PTU and 18 (9.3%) PTN files fractured (p < 0.05). Nine (4.5%) PTU and 2 (2.6%) PTN deformed (p > 0.05). The change in WL after instrumentation was 0.97 mm ± 0.95 mm in PTU and 0.96 mm ± 0.80 mm in PTN (p < 0.05). The mean times were 627 s ± 18 s for PTU and 379 s ± 18 s for PTN (p < 0.000).

Discussion

PTN can be recommended in severely curved root canals in terms of maintenance of the original canal curvature, superior instrument fracture and fewer ledges. Even if training before preparation provides an acceptable level of canal shaping for preclinical students, the use of NiTi rotary instruments should be included in the undergraduate dental curriculum, contributing to an increase in the quality of root canal shaping and, consequently, to an improvement of the clinical experience of students.

Severe cardiac trauma or myocardial ischemia? Pitfalls of polytrauma treatment in patients with ST-elevation after blunt chest trauma

Introduction

Thoracic injuries are the third most common injuries in polytrauma patients. The mechanism of injury and the clinical presentation are crucially important for adequate emergency treatment.

Presentation of case

Here we present a case of a 37-year-old male who was admitted to our level-1 trauma center after motor vehicle accident. The emergency physician on scene presented the patient with a myocardial infarction. During initial clinical trauma assessment the patient developed circulatory insufficiency so that cardiopulmonary resuscitation was necessary. Considering the preclinical and clinical course it was decided to proceed with thrombolysis. Despite consistently sufficient resuscitation measures circulatory function was not restored and the patient remained in asystole and passed away.

Discussion

The initial assessment showed cardiopulmonary instability. After applying thrombolysis a therapeutic point of no return was reached because surgical intervention was impossible but autopsy findings showed severe myocardial and pulmonary contusions likely due to shear forces.

Conclusion

This case outlines the importance of understanding the key mechanism of injury and the importance of communication at each stage of healthcare transfer. A transesophageal echocardiography can help to identify injuries after myocardial contusion.

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ECG changes after blunt chest trauma can be misleading.

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Only by knowing the cause of accident can avoid erroneous time-intensive diagnostics and ensure a proper overall assessment.

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A TEE can be a useful early adjunct in trauma management in the setting of ongoing instability because it can guide resuscitation efforts.

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A stantardized preclinical – trauma room protocol according to ALTS^® should be used during transfer.

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A thromblysis should be avoided in the acute setting because a blunt chest trauma can mimic a myocardial infarction.