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The study examined the effect of [[alpha].sub.2]-adrenoreceptor ([[alpha].sub.2]-AR) activation against the background of preliminary blockage of [I.sub.f] on the performance of Langerndorff-isolated rat heart. Stimulation of [[alpha].sub.2]-AR in isolated rat hearts against the background of ZD7288 in concentrations of [10.sup.-9] M and 3x[10.sup.-5] M changed the negative dynamics of myocardial inotropy to positive (by 25 and 38%; p<0.05). Activation of [[alpha].sub.2]-AR produced opposite effects on HR. [I.sub.f] blockade abolished tachycardia caused by activation of [[alpha].sub.2]-AR; HR deceleration in response to [[alpha].sub.2]-AR agonist against the background of [I.sub.f] blocker in a concentration [10.sup.-9] M was 41% (p<0.05). We observed negative dynamics of coronary flow (by 38%; p<0.05) in isolated adult rat hearts after application of [[alpha].sub.2]-AR agonist against the background of [I.sub.f] blockade ([10.sup.-9] M). Key Words: [alpha]2-adrenergic receptors; [I.sub.f]; isolated heart; rat

Background: Posterior percutaneous endoscopic cervical discectomy (P-PECD) has been increasingly used for cervical spondylotic radiculopathy (CSR), while few studies have reported on its medium-long-term outcomes. This study aims to investigate the medium-long-term efficacy and imaging findings of P-PECD in the treatment of single-segment CSR. Methods: The data of 51 patients with single-segment CSR treated with P-PECD were retrospectively analyzed. Efficacy was evaluated using visual analog scale (VAS) scores of neck and arm, Japanese Orthopaedic Association (JOA) score, neck disability index (NDI), and modified Macnab criteria. Radiologic parameters were measured before and after the operation, including cervical Cobb angle, range of motion (ROM), intervertebral space height, as well as horizontal and angular displacement at the operative level. Results: The VAS scores of neck and arm, JOA score, and NDI were significantly improved postoperatively compared with those before the operation, and the differences were statistically significant (P <0.05). Based on the modified Macnab criteria at the final follow-up, 94.12% showed excellent to good outcomes. Postoperatively, the cervical Cobb angle was 10.63 [+ or -] 1.79[degrees], ROM was 6.33 [+ or -] 1.11[degrees], the intervertebral space height was 4.63 [+ or -] 0.85 mm, horizontal and angular displacement at the operative level were 0.88 [+ or -] 0.68 mm and 4.25 [+ or -] 1.04[degrees], respectively, and there were no significantly changed at the final follow-up. Conclusion: P-PECD for single-segment CSR has the advantages of less trauma, less bleeding, a low complication rate, faster postoperative recovery, and less impact on cervical mobility and stability, which has excellent medium-long-term efficacy. Keywords: cervical spondylotic radiculopathy, percutaneous endoscopic, discectomy, minimally invasive

Dexmedetomidine (Dexdor ® ) is a highly selective α 2 -adrenoceptor agonist. It has sedative, analgesic and opioid-sparing effects and is suitable for short- and longer-term sedation in an intensive care setting. In the randomized, double-blind, multicentre MIDEX and PRODEX trials, longer-term sedation with dexmedetomidine was noninferior to midazolam and propofol in terms of time spent at the target sedation range, as well as being associated with a shorter time to extubation than midazolam or propofol, and a shorter duration of mechanical ventilation than midazolam. Patients receiving dexmedetomidine were also easier to rouse, more co-operative and better able to communicate than patients receiving midazolam or propofol. Dexmedetomidine had beneficial effects on delirium in some randomized, controlled trials (e.g. patients receiving dexmedetomidine were less likely to experience delirium than patients receiving midazolam, propofol or remifentanil and had more delirium- and coma-free days than patients receiving lorazepam). Intravenous dexmedetomidine had an acceptable tolerability profile; hypotension, hypertension and bradycardia were the most commonly reported adverse reactions. In conclusion, dexmedetomidine is an important option for sedation in the intensive care setting.

This study evaluated the use of contrast-enhanced voiding urosonography (CE-VUS) as a radiation-free alternative to retrograde cystourethrography (RCUG) for detecting vesicoureteral reflux (VUR) in young dogs. While RCUG is the standard diagnostic method in veterinary medicine, CE-VUS has shown a high accuracy in pediatric human medicine. A total of 62 dogs aged 6 weeks to 12 months were examined using both CE-VUS and RCUG. This study assessed 124 ureterorenal units and found a 94.4% agreement between the two methods. CE-VUS demonstrated a 94.1% sensitivity and a 94.4% specificity, with a negative predictive value of 99%, indicating a strong reliability in ruling out VUR. Additionally, CE-VUS identified six cases of VUR not seen with RCUG. No adverse effects were reported, and CE-VUS was well tolerated. Its advantages include the absence of radiation, dynamic real-time imaging, and the ability to perform repeated evaluations. This study concludes that CE-VUS is a safe, accurate, and practical tool for diagnosing VUR in young dogs and may serve as a valuable alternative to RCUG in clinical practice.

Dexmedetomidine (Precedex®), a pharmacologically active dextroisomer of medetomidine, is a selective α 2 -adrenergic receptor agonist. It is indicated in the US for the sedation of mechanically ventilated adult patients in an intensive care setting and in non-intubated adult patients prior to and/or during surgical and other procedures. This article reviews the pharmacological properties, therapeutic efficacy and tolerability of dexmedetomidine in randomized, double-blind, placebo-controlled, multicentre studies in these indications. Post-surgical patients in an intensive care setting receiving dexmedetomidine required less rescue sedation with intravenous propofol or intravenous midazolam to achieve and/or maintain optimal sedation during the assisted ventilation period than placebo recipients, according to two randomized, double-blind, multinational studies. Moreover, significantly more dexmedetomidine than placebo recipients acquired and/or maintained optimal sedation without rescue sedation. Sedation with dexmedetomidine was also effective in terms of the total dose of morphine administered, with dexmedetomidine recipients requiring less morphine than placebo recipients; with regard to patient management, dexmedetomidine recipients were calmer and easier to arouse and manage than placebo recipients. Intravenous dexmedetomidine was effective as a primary sedative in two randomized, double-blind, placebo-controlled, multicentre studies in adult patients undergoing awake fibre-optic intubation or a variety of diagnostic or surgical procedures requiring monitored anaesthesia care. In one study, significantly fewer dexmedetomidine than placebo recipients required rescue sedation with intravenous midazolam to achieve and/or maintain optimal sedation; conversely, in another study, rescue sedation with intravenous midazolam was not required by significantly more dexmedetomidine than placebo recipients. Primary sedation with intravenous dexmedetomidine was also effective in terms of the secondary efficacy endpoints, including the mean total dose of midazolam and fentanyl administered and the percentage of patients requiring further sedation (in addition to dexmedetomidine or placebo and midazolam), with, for the most part, significant between-group differences observed in favour of dexmedetomidine over placebo. In general, no significant differences were observed between the dexmedetomidine and placebo treatment groups in the anaesthesiologists’ assessment of ease of intubation, haemodynamic stability, patient cooperation and/or respiratory stability. Intravenous dexmedetomidine is generally well tolerated when utilized in mechanically ventilated patients in an intensive care setting and for procedural sedation in non-intubated patients. Dexmedetomidine is associated with a lower rate of postoperative delirium than midazolam or propofol; it is not associated with respiratory depression. While dexmedetomidine is associated with hypotension and bradycardia, both usually resolve without intervention. Thus, intravenous dexmedetomidine provides a further option as a short-term (<24 hours) primary sedative in mechanically ventilated adult patients in an intensive care setting and in non-intubated adult patients prior to and/or during surgical and other procedures.

It is increasingly recognized that early perturbation of energy metabolism might have important implications in management and ultimately the neurological outcome in patients with traumatic brain injury (TBI). At the same time, treatments and screening tools successfully developed in preclinical TBI models have failed to translate to the clinic. As ferrets possess primate-like gyrencephalic brains that may better replicate the human response to neurologic injury, the goal of this study was to noninvasively measure brain energy metabolism after injury in a ferret model of TBI. To this end, metabolic imaging of hyperpolarized (HP) [1-[sup.13]C]pyruvate (Pyr) and its conversion to lactate (Lac) and bicarbonate (Bic) was performed in ferrets before and after combined under-vehicle blast and controlled cortical impact injury. Reduced Bic/Pyr, reflecting reduced pyruvate dehydrogenase activity, was detected 8–10 days post-injury whereas no difference in Lac/Pyr was observed. These results demonstrate the feasibility of using metabolic imaging of HP [1-[sup.13]C]Pyr to measure perturbations in brain energy metabolism in a novel highly translatable animal model of TBI. The method may contribute to both improved understanding of injury mechanisms and more effective drug development.

Dexmedetomidine is an α 2 -adrenoceptor agonist with sedative, anxiolytic, sympatholytic, and analgesic-sparing effects, and minimal depression of respiratory function. It is potent and highly selective for α 2 -receptors with an α 2 :α 1 ratio of 1620:1. Hemodynamic effects, which include transient hypertension, bradycardia, and hypotension, result from the drug’s peripheral vasoconstrictive and sympatholytic properties. Dexmedetomidine exerts its hypnotic action through activation of central pre- and postsynaptic α 2 -receptors in the locus coeruleus, thereby inducting a state of unconsciousness similar to natural sleep, with the unique aspect that patients remain easily rousable and cooperative. Dexmedetomidine is rapidly distributed and is mainly hepatically metabolized into inactive metabolites by glucuronidation and hydroxylation. A high inter-individual variability in dexmedetomidine pharmacokinetics has been described, especially in the intensive care unit population. In recent years, multiple pharmacokinetic non-compartmental analyses as well as population pharmacokinetic studies have been performed. Body size, hepatic impairment, and presumably plasma albumin and cardiac output have a significant impact on dexmedetomidine pharmacokinetics. Results regarding other covariates remain inconclusive and warrant further research. Although initially approved for intravenous use for up to 24 h in the adult intensive care unit population only, applications of dexmedetomidine in clinical practice have been widened over the past few years. Procedural sedation with dexmedetomidine was additionally approved by the US Food and Drug Administration in 2003 and dexmedetomidine has appeared useful in multiple off-label applications such as pediatric sedation, intranasal or buccal administration, and use as an adjuvant to local analgesia techniques.