المؤلفون: Joon Kim, Michael Giang, Ravi Goyal, Demosthenes G. Papamatheakis, Carla Blum Johnston, Alexander Brunnell, Quintin Blood, Dan Nguyen, Ricardo Paez, Lawrence D. Longo, Sean M. Wilson

المصدر: High Altitude Medicine & Biology. 17:122-132

مصطلحات موضوعية: 0301 basic medicine, Scientific Articles, medicine.medical_specialty, Endothelium, Physiology, Vasodilation, Muscarinic Antagonists, Pulmonary Artery, 030204 cardiovascular system & hematology, Biology, Bradykinin, Contractility, Phenylephrine, 03 medical and health sciences, 0302 clinical medicine, medicine.artery, Internal medicine, Muscarinic acetylcholine receptor, medicine, Animals, Hypoxia, Sheep, Electrical impedance myography, Altitude, Public Health, Environmental and Occupational Health, General Medicine, Hypoxia (medical), Receptors, Muscarinic, Acetylcholine, 030104 developmental biology, Endocrinology, medicine.anatomical_structure, Vasoconstriction, Pulmonary artery, cardiovascular system, Carbachol, Endothelium, Vascular, medicine.symptom

الوصف: Giang, Michael, Demosthenes G. Papamatheakis, Dan Nguyen, Ricardo Paez, Carla Blum Johnston, Joon Kim, Alexander Brunnell, Quintin Blood, Ravi Goyal, Lawrence D. Longo, and Sean M. Wilson. Muscarinic receptor activation affects pulmonary artery contractility in sheep: the impact of maturation and chronic hypoxia on endothelium-dependent and endothelium-independent function. High Alt Med Biol. 17:122–132, 2015.—Muscarinic receptor activation in the pulmonary vasculature can cause endothelium-dependent vasodilation and smooth muscle-dependent vasoconstriction. Chronic hypoxia (CH) can modify both of these responses. This study aimed to assess the combined influence of CH and maturation on endothelium-dependent and endothelium-independent muscarinic-induced vasoreactivity. This was accomplished by performing wire myography on endothelium-intact or endothelium-disrupted pulmonary arterial rings isolated from normoxic or CH fetal and adult sheep. In endothelium-intact arteries, vasodilation was evaluated using cumulative bradykinin doses in phenylephrine and carbachol precontracted pulmonary arterial segments; and vasoconstriction was examined using cumulative doses of carbachol following bradykinin predilation. Effects of nonselective (atropine) and selective M1 (pirenzepine), M2 (AFDX116), and M3 (4-DAMP and Dau5884) muscarinic receptor antagonists were assessed in disrupted arteries. In normoxic arteries, bradykinin relaxation was twofold greater in the adult compared to fetus, while carbachol contraction was fourfold greater. In adult arteries, CH increased bradykinin relaxation and carbachol contraction. In vessels with intact endothelium, maturation and CH augmented maximal response and efficacy for carbachol constriction and bradykinin relaxation. Approximately 50%–80% of adult normoxic and CH endothelium-disrupted arteries contracted to acetylcholine, while ∼50% of fetal normoxic and ∼10% of CH arteries responded. Atropine reduced carbachol-induced contraction in all vessels. Adult normoxic vessels were most responsive to M3 antagonism, fetal to M2 antagonism, while M1 inhibition had no effect. Overall, muscarinic-induced pulmonary arterial contraction is partially endothelium dependent and appears to develop after birth. Fetuses are more reliant on M3 receptors while M2 receptors predominate in adults, whereas CH augments muscarinic-dependent pulmonary vasoconstriction in both.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::29cbc7d3e55e8afcdecc31021857fde3Test
https://doi.org/10.1089/ham.2015.0116Test

المؤلفون: Carina Lundh Hagelin, Carl Johan Fürst, Gunilla Lundquist, Andrew Dickman, Johannes Bükki, Urska Lunder, Birgit H. Rasmussen, Sylvia Sauter, Carol Tishelman, Olav Lindqvist

المصدر: Journal of Palliative Medicine. 16:38-43

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Palliative care, Delphi Technique, Psychomotor agitation, Midazolam, Scopolamine, Alternative medicine, Delphi method, MEDLINE, Muscarinic Antagonists, 03 medical and health sciences, 0302 clinical medicine, Anti-Anxiety Agents, medicine, Humans, media_common.cataloged_instance, European Union, 030212 general & internal medicine, European union, Psychomotor Agitation, General Nursing, Aged, media_common, Morphine, business.industry, Palliative Care, General Medicine, Middle Aged, Glycopyrrolate, 3. Good health, Analgesics, Opioid, Anesthesiology and Pain Medicine, 030220 oncology & carcinogenesis, Family medicine, Haloperidol, Anxiety, Female, medicine.symptom, Drugs, Essential, business, Antipsychotic Agents

الوصف: The majority of dying patients do not have access to necessary drugs to alleviate their most common symptoms, despite evidence of drug efficacy. Our aim was to explore the degree of consensus about appropriate pharmacological treatment for common symptoms in the last days of life for patients with cancer, among physicians working in specialist palliative care.Within OPCARE9, a European Union seventh framework project aiming to optimize end-of-life cancer care, we conducted a Delphi survey among 135 palliative care clinicians in nine countries. Physicians were initially asked about first and second choice of drugs to alleviate anxiety, dyspnea, nausea and vomiting, pain, respiratory tract secretions (RTS), as well as terminal restlessness.Based on a list of 35 drugs mentioned at least twice in the first round (n=93), a second Delphi round was performed to determine ≤ 5 essential drugs for symptom alleviation in the last 48 hours of life that should be available even outside specialist palliative care. There was ≥ 80% consensus among the participants (n=90) regarding morphine, midazolam, and haloperidol as essential drugs. For RTS, there was consensus about use of an antimuscarinic drug, with 9%-27% of the physicians each choosing one of four different drugs.Based on this consensus opinion and other literature, we suggest four drugs that should be made available in all settings caring for dying patients with cancer, to decrease the gap between knowledge and practice: morphine (i.e., an opioid), midazolam (a benzodiazepine), haloperidol (a neuroleptic), and an antimuscarinic.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::e52ac000b65d3a89257f268cb3b57fc8Test
https://doi.org/10.1089/jpm.2012.0205Test

المؤلفون: John Ellershaw, Heino Hugel, Maureen Gambles

المصدر: Journal of Palliative Medicine. 9:279-284

مصطلحات موضوعية: Male, Drug, media_common.quotation_subject, Respiratory System, Scopolamine, Muscarinic Antagonists, Overall response rate, medicine, Humans, Terminally Ill, Symptom control, Death rattle, General Nursing, Specialist palliative care, Aged, media_common, Aged, 80 and over, business.industry, Hydrobromide, Significant difference, General Medicine, Middle Aged, Glycopyrrolate, Treatment Outcome, Anesthesiology and Pain Medicine, medicine.anatomical_structure, Anesthesia, Female, medicine.symptom, business, Respiratory tract

الوصف: The evidence for the management of respiratory tract secretions (RTS) in dying patients with antimuscarinic drugs remains inconclusive. This study investigated the effectiveness of glycopyrronium versus hyoscine hydrobromide in controlling RTS using the Liverpool Care of the Dying Pathway (LCP) in 72 patients matched for age, diagnosis, and gender who died on a 30-bed specialist palliative care unit. All patients in the glycoypyrronium group had some response to glycopyrronium, whereas 22% of patients in the hyoscine group had no response to hyoscine hydrobromide. There was a significant difference in overall response between the two groups (p0.01). Twenty-eight percent of patients in the glycopyrronium and 42% of patients in the hyoscine group died with RTS present. There was no statistically significant difference in the levels of agitation following administration of either drug. This study provides further evidence that the LCP can be a useful tool in the evaluation of new drugs for symptom control in dying patients and suggests that glycopyrronium may be at least as effective in controlling RTS in dying patients as hyoscine hydrobromide.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::13f810ef6eea15e276678b55939ff568Test
https://doi.org/10.1089/jpm.2006.9.279Test