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SL nitroglycerin was not different from IA nitroglycerin in terms of efficiency and safety in overall study population. However it may be inferior to IA nitroglycerin in certain subgroups shorter individuals, diabetics and smokers. Clonidine versus nitroglycerin infusion in laparoscopic cholecystectomy. Laparoscopic surgery offers the advantages of minimally invasive surgery; however, pneumoperitoneum and the patient's position induce pathophysiological changes that may complicate anesthetic management.

We studied the effect of clonidine and nitroglycerin on heart rate and blood pressure, if any, in association with these drugs or the procedure, as well as the effect of these drugs, if any, on end-tidal carbon dioxide pressure and intraocular pressure. Sixty patients minimum age of 20 years and maximum age of 65 years, American Society of Anesthesiologists class I or II undergoing laparoscopic cholecystectomy were randomized into 3 groups and given an infusion of clonidine group I , nitroglycerin group II , or normal saline solution group III after induction and before creation of pneumoperitoneum.

We observed and recorded the following parameters: heart rate, mean arterial blood pressure, end-tidal carbon dioxide pressure, and intraocular pressure. The mean and standard deviation of the parameters studied during the observation period were calculated for the 3 treatment groups and compared by use of analysis of variance tests.

Intragroup comparison was performed with the paired t test. The critical value of P, indicating the probability of a significant difference, was taken as nitroglycerin at preventing changes in hemodynamic parameters and intraocular pressure induced by carbon dioxide insufflation during laparoscopic cholecystectomy.

It was also found not to cause hypotension severe enough to stop the infusion and warrant treatment. Background and Objectives: Laparoscopic surgery offers the advantages of minimally invasive surgery; however, pneumoperitoneum and the patient's position induce pathophysiological changes that may complicate anesthetic management. Methods: Sixty patients minimum age of 20 years and maximum age of 65 years, American Society of Anesthesiologists class I or II undergoing laparoscopic cholecystectomy were randomized into 3 groups and given an infusion of clonidine group I , nitroglycerin group II , or normal saline solution group III after induction and before creation of pneumoperitoneum.

Hemodynamic effects of nitroglycerin ointment in emergency department patients. Nitroglycerin ointment is commonly used in the treatment of emergency department ED patients with suspected acute heart failure AHF or suspected acute coronary syndrome ACS , but its hemodynamic effects in this population are not well described.

Our objective was to assess the effect of nitroglycerin ointment on mean arterial pressure MAP and systemic vascular resistance SVR in ED patients receiving nitroglycerin. We hypothesized that nitroglycerin ointment would result in a reduction of MAP and SVR in the acute treatment of patients. We conducted a prospective, observational pilot study in a convenience sample of adult patients from a single ED who were treated with nitroglycerin ointment.

Mixed effects regression models with random slope and random intercept were used to analyze changes in hemodynamic parameters from baseline to 30, 60, and min after adjusting for age, sex, and final ED diagnosis of AHF.

However, other hemodynamic parameters do not change after application of nitroglycerin ointment in these patients. Background Nitroglycerin ointment is commonly used in the treatment of emergency department ED patients with suspected acute heart failure AHF or suspected acute coronary syndrome ACS , but its hemodynamic effects in this population are not well described. Objectives Our objective was to assess effect of nitroglycerin ointment on mean arterial pressure MAP and systemic vascular resistance SVR in ED patients receiving nitroglycerin.

Methods We conducted a prospective, observational pilot study in a convenience sample of adult patients from a single ED who were treated with nitroglycerin ointment. Mixed effects regression models with random slope and random intercept were used to analyze changes in hemodynamic parameters from baseline to 30, 60, and minutes after adjusting for age, sex, and final ED diagnosis of AHF. However, other hemodynamic parameters do not change following application of nitroglycerin ointment in these patients.

Mechanisms of gastroprotection by transdermal nitroglycerin in the rat. Nitric oxide NO donors prevent experimentally-induced gastric mucosal damage, but their clinical utility is limited by short duration of action or unsuitability of the pharmaceutical form employed. This study analyses the gastroprotection elicited by a clinically used mode of continuous administration of an NO donor, namely the nitroglycerin patch.

The transdermal nitroglycerin patch protects the gastric mucosa from damage by mechanisms that involve maintenance of mucosal blood flow and reduction of leukocyte-endothelial cell interaction. Nitroglycerin for management of retained placenta. Retained placenta affects 0.

Use of nitroglycerin NTG , either alone or in combination with uterotonics, may be of value to minimise the need for manual removal of the placenta in theatre under anaesthesia. To evaluate the benefits and harms of NTG as a tocolytic, either alone or in addition to uterotonics, in the management of retained placenta. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register 14 January , reference lists of retrieved studies and contacted experts in the field.

Any adequately randomised controlled trial RCT comparing the use of NTG, either alone or in combination with uterotonics, with no intervention or with other interventions in the management of retained placenta. All women having a vaginal delivery with a retained placenta, regardless of the management of the third stage of labour expectant or active.

We included all trials with haemodynamically stable women in whom the placenta was not delivered at least within 15 minutes after delivery of the baby. Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We included three randomised controlled trials RCTs with women.

The detachment status of retained placenta was unknown in all three RCTs. Collectively, among the three included trials, two were judged to be at low risk of bias and the third trial was judged to be at high risk of bias for two domains: incomplete outcome data and selective reporting. The three trials reported seven out of 23 of the review's pre-specified outcomes. The primary outcome "manual removal of the placenta" was reported in all three studies.

No differences were seen between NTG and placebo for manual removal of the placenta average risk ratio RR 0. Allopurinol prevents nitroglycerin -induced tolerance in rat thoracic aorta. Xanthine oxidase is an important source of reactive oxygen species; so, it may play a role in the pathogenesis of endothelium dysfunction and its consequences. Allopurinol, a purine analog, is a famous xanthine oxidase inhibitor. This study aimed to investigate possible effects of allopurinol on nitroglycerin tolerance, vasoconstriction, and vasorelaxation in rat aortic ring.

Using thoracic aortic rings obtained from male Wistar rats, the effect of allopurinol was examined on nitroglycerin -induced tolerance. In addition, changes of vasoconstriction by using KCl and phenylephrine and vasorelaxation by using carbachol, sodium nitroprusside, and nitroglycerin were also measured and compared between tissues treated with and without allopurinol. In terms of vasoconstriction and vasorelaxation, the effect of allopurinol was significant only on carbachol-induced endothelium related vasorelaxation in a dose-dependent manner.

In conclusion, although allopurinol had no significant effect on the contractile response of the aorta, in accord with the previous data, it significantly intensified endothelium-dependent vasodilation. The inhibitory effect of allopurinol against the development of nitrate-induced tolerance may suggest its clinical benefit and is worth to be studied more extensively.

Prehospital high-dose sublingual nitroglycerin rarely causes hypotension. High-dose intravenous nitroglycerin is a common in-hospital treatment for respiratory distress due to congestive heart failure CHF with hypertension. Intravenous IV nitroglycerin administration is impractical in the prehospital setting.

The protocol calls for patients to be treated with two sublingual tabs 0. This study was a retrospective cohort study of patients from a single commercial EMS agency over a 6-month period. Records from patients with at least one administration of MSN were reviewed. For each administration, the first documented vital signs pre- and post-administration were compared. Administrations were excluded if pre- or post-administration vital signs were missing. One hundred case-patients had at least one MSN administration by an advanced provider during the study period.

Twenty-five case-patients were excluded due to incomplete vital signs. Seventy-five case-patients with 95 individual MSN administrations were included for analysis. There were 65 administrations of two tabs, 29 administrations of three tabs, and one administration of four tabs. All three patients were over 65 years old, were administered two tabs, had documented improved respiratory status, and had repeat SBP of at least The incidence of hypotension following MSN.

Background: The mechanisms governing exercise-induced angina and its alleviation by the most commonly used antianginal drug, nitroglycerin , are incompletely understood. The purpose of this study was to develop a method by which the effects of antianginal drugs could be evaluated invasively during physiological exercise to gain further understanding of the clinical impact of angina and nitroglycerin.

Methods: Forty patients mean age, As they developed limiting angina, sublingual nitroglycerin was administered to half the patients, and all patients continued to exercise for 2 minutes at the same workload. Throughout exercise, distal coronary pressure and flow velocity and central aortic pressure were recorded with sensor wires. The observed increases in coronary pressure gradient, stenosis resistance, and flow velocity did not reach statistical significance; however, the diastolic velocity—pressure gradient relation was consistent with a significant increase in relative stenosis severity k coefficient, P nitroglycerin.

Conclusions: The catheterization laboratory protocol provides a model to. Effects of autogenic training on nitroglycerin -induced headaches. To investigate the prophylactic and acute effects of autogenic training AT during a nitroglycerin -induced migraine attack. Thirty female migraineurs without aura and 11 controls participated in the study.

Of these, 11 migraineurs and 5 controls practiced AT regularly for at least 6 months prior to and during the sublingual nitroglycerin test. Headache intensity and characteristics were recorded with a standardized method. During the nitroglycerin challenge, blood was collected for plasma cortisol determination and blood pressure and pulse rate were recorded.

Intravenous nitroglycerin for external cephalic version: a randomized controlled trial. To estimate whether treatment with intravenous nitroglycerin for uterine relaxation increases the chance of successful external cephalic version. Two double-blind, randomized clinical trials were undertaken: one in nulliparous women and a second in multiparous women. Women presenting for external cephalic version at term were eligible to participate.

The primary outcome was immediate success of external cephalic version. Other outcomes were presentation at delivery, cesarean delivery rate, and side effects and complications. In total, women were recruited in the nulliparous trial and 44 in the multiparous trial. Seven patients did not have external cephalic version before delivery but were included in the analysis of success of external cephalic version. One patient was lost to follow-up.

Treatment with intravenous nitroglycerin increased the rate of successful external cephalic version in nulliparous, but not in multiparous, women. Treatment with intravenous nitroglycerin appeared to be safe, but our numbers were too small to rule out rare serious adverse effects.

Constitutive nitric oxide synthase activation is a significant route for nitroglycerin -mediated vasodilation. Bonini, Marcelo G. The physiological effects of nitroglycerin as a potent vasodilator have long been documented. However, the molecular mechanisms by which nitroglycerin exerts its biological functions are still a matter of intense debate.

Enzymatic pathways converting nitroglycerin to vasoactive compounds have been identified, but none of them seems to fully account for the reported clinical observations. Here, we demonstrate that nitroglycerin triggers constitutive nitric oxide synthase NOS activation, which is a major source of NO responsible for low-dose 1—10 nM nitroglycerin -induced vasorelaxation.

Our studies in cell cultures, isolated vessels, and whole animals identified endothelial NOS activation as a fundamental requirement for nitroglycerin action at pharmacologically relevant concentrations in WT animals. Pilot test NG by aerobic bacteria, a pilot program was undertaken with the following objectives: 1 to determine the concentration of NG in the ball powder. Lara, Diego A. Coronary spasm during coronary angiography for vasculopathy in children can be prevented by the intracoronary administration of nitroglycerin.

We reviewed the anesthesia and catheterization reports and charts for pediatric transplant recipients who underwent angiography from through Correlation analysis was used to study the relation of post-injection systolic blood pressure SBP to nitroglycerin dose. Forty-one angiographic evaluations were performed on 25 patients 13 male and 12 female. Mean age was 9. The mean total dose of nitroglycerin was 2. There were 2 interventions for SBP before nitroglycerin and 2 after nitroglycerin.

One child experienced a transient ST-T—segment change during angiography after nitroglycerin. In the highest dose range, the additional decrease in SBP was 7. Routine intracoronary nitroglycerin administration in this dose range produced no significant changes in SBP or heart rate in children. Nitroglycerin , which helps impaired cardiac function as it is converted to nitric oxide, is used worldwide to treat patients with various ischemic and congestive cardiac diseases, including angina pectoris.

Nevertheless, after continuous treatment, the benefits of nitroglycerin are limited by the development of tolerance to the drug. Nitroglycerin tolerance is a result of inactivation of aldehyde dehydrogenase 2 ALDH2 , an enzyme essential for cardioprotection in animals subjected to myocardial infarction MI. Here we tested the hypothesis that the tolerance that develops as a result of sustained nitroglycerin treatment increases cardiac injury by subsequent MI.

In a rat model of MI, 16 hours of prior, sustained nitroglycerin treatment 7. We also sought to identify a potential treatment to protect against this increased cardiac damage. If our animal studies showing that nitroglycerin tolerance increases cardiac injury upon ischemic insult are corroborated in humans, activators of ALDH2 such as Alda-1 may help to protect MI patients from this nitroglycerin -induced increase in cardiac injury, while maintaining the cardiac benefits of the increased nitric oxide concentrations produced by nitroglycerin.

Systemic effects of intracoronary nitroglycerin during coronary angiography in children after heart transplantation. One child experienced a transient ST-T-segment change during angiography after nitroglycerin. To systematically investigate the literature for the influence of sublingual nitroglycerin administration on coronary diameter, the number of evaluable segments, image quality, heart rate and blood pressure, and diagnostic accuracy of coronary computed tomography CT angiography.

The studies were evaluated for the effect of sublingual nitroglycerin on coronary artery diameter, evaluable segments, objective and subjective image quality, systemic physiological effects and diagnostic accuracy. Due to the heterogeneous reporting of outcome measures, a narrative synthesis was applied. Of the studies identified, nine met the inclusion criteria: seven reported on the effect of nitroglycerin on coronary artery diameter, six on evaluable segments, four on image quality, five on systemic physiological effects and two on diagnostic accuracy.

Sublingual nitroglycerin administration resulted in an improved evaluation of more coronary segments, in particular, in smaller coronary branches, better image quality and improved diagnostic accuracy. Side effects were mild and were alleviated without medical intervention. Sublingual nitroglycerin improves the coronary diameter, the number of assessable segments, image quality and diagnostic accuracy of coronary CT angiography without major side effects or systemic physiological changes.

Overall, women receiving transdermal nitroglycerin had a higher risk of headache. Further additional double-blind placebo-controlled trials are needed. Context: Osteoporosis is common among postmenopausal women; animal studies and human pilot studies support the concept of nitric oxide NO donors reducing bone mineral density loss.

Objective: The objective of the study was to evaluate whether NO donor, nitroglycerin , prevents postmenopausal bone loss. Design: This was a 3-yr randomized, double blinded, single-center, placebo-controlled clinical trial. Intervention: Women, stratified by lumbar T-score 5 yr , were randomized to receive nitroglycerin ointment Both groups took mg daily calcium plus IU vitamin D supplements.

Measurements: BMD was measured at 6 months and annually by dual-energy x-ray absorptiometry. Percent change in lumbar vertebrae BMD was the primary outcome. Hip BMD, total body bone mineral content, and height were secondary outcomes. Secondary outcomes also did not differ by intervention arm. The active group reported more headaches compared with the placebo group 57 vs. Once-daily dosing with Internal sphincterotomy versus topical nitroglycerin ointment for chronic anal fissure.

Anal fissure is a common benign condition. An anorectal problem is defined as a split in the anal canal mucosa that extends from the dentate line to the anal verge. Chronic anal fissure is defined by a history of symptoms present for more than 2 months' duration and with a triad of external skin tags, namely, a hypertrophied anal papilla, an ulcer with rolled edges, and a base exposing the internal sphincter.

Because complications such as incontinence are associated with surgical treatment, chemical sphincterotomy is currently favored. The objective of this study is to compare the difference in outcome between open partial lateral anal sphincterotomy and application of topical 0. This was a quasi-experimental study carried out between January 16, and January 15, in the Surgical Department of Jinnah Hospital, Lahore, Pakistan.

Sixty consecutive cases with a clinical diagnosis of chronic anal fissure were recruited in the study. All recruited patients met the study inclusion criteria and were randomly assigned to one of the two groups. Group A was managed conservatively using topical 0. Both groups were followed up at 1 week, 2 weeks, 4 weeks, and 6 weeks after the treatment. All the patients complained of pain. A total of 43 Group A included 30 11 females and 19 males cases treated with topical 0.

Nitroglycerin is widely used as a coronary vasodilator in the treatment of ischemic heart diseases. This study investigated the influence of hypoxia on nitroglycerin -induced relaxation in endothelium-intact and -denuded rabbit, monkey, and porcine coronary arteries. Helically cut strips of coronary arteries were suspended in organ chambers, and isometric tension was recorded. Nitroglycerin concentration dependently relaxed endothelium-intact rabbit coronary arteries, which were not different under normoxic and hypoxic conditions.

On the other hand, nitroglycerin -induced relaxation of endothelium-denuded arteries was significantly attenuated by hypoxia. Similarly, the relaxant response of endothelium-intact monkey coronary arteries to nitroglycerin was not affected by hypoxia, whereas that of endothelium-denuded arteries was impaired.

As is the case with rabbit and monkey coronary arteries, exposure to hypoxia resulted in impaired relaxation by nitroglycerin in endothelium-denuded but not endothelium-intact porcine coronary arteries. These findings suggest that coronary endothelium plays a pivotal role in preventing the hypoxia-induced impairment of nitroglycerin responsiveness, regardless of the animal species.

Karger AG, Basel. Continuous transdermal nitroglycerin therapy for menopausal hot flashes: a single-arm, dose-escalation trial. To describe the efficacy and tolerability of continuous nitroglycerin for treatment of hot flashes. Perimenopausal and postmenopausal women reporting at least seven hot flashes per day were recruited into a single-arm, dose-escalation trial of continuous transdermal nitroglycerin.

Participants were started on a generic 0. During 4 weeks, participants escalated dosage weekly to 0. Changes in hot flash frequency and severity were assessed using symptom diaries. Paired t tests examined change in outcomes between baseline and maximal-dose therapy and after discontinuation of nitroglycerin. Of the 19 participants, mean age was Women reported an average Eleven women escalated to 0. Two discontinued nitroglycerin before the first outcomes assessment.

If confirmed in a randomized blinded trial, it may offer a novel nonhormonal hot flash treatment. Huang, Alison J. Objective To describe the efficacy and tolerability of continuous nitroglycerin for treatment of hot flashes. Methods Peri- and postmenopausal women reporting at least 7 hot flashes per day were recruited into a single-arm, dose-escalation trial of continuous transdermal nitroglycerin.

Over four weeks, participants escalated dosage weekly to 0. Paired t-tests examined change in outcomes between baseline and maximal-dose therapy as well as after discontinuation of nitroglycerin. Results Of the 19 participants, mean age was If confirmed in a randomized blinded trial, it may offer a novel non-hormonal hot flash treatment. Treatment of proctalgia fugax with topical nitroglycerin : report of a case.

We report a single case of proctalgia fugax that responded to 0. Case report. A single case of proctalgia fugax responded to topical application of 0. Nitroglycerin ointment is a newly described treatment for several painful anal conditions. We describe a single case of levator spasm or proctalgia fugax responding to topical application of nitroglycerin. This is only a single case report, and conclusive evidence awaits completion of a controlled clinical trial. A novel treatment for management of a trapped placenta using intracervical nitroglycerin tablets.

A year-old gravida 2, para 1 woman delivered a viable male infant and developed retained placenta due to entrapment. A nitroglycerin tablet was used to relax the lower uterine segment and cervix, which allowed the placenta to pass through the cervix for delivery. The nitroglycerin tablet was placed in the cervix and held in place by the delivering physician as it dissolved.

Soon after administration, the intact placenta delivered. The patient did not experience the typical side effects of headache, asymptomatic decrease in blood pressure, hypotension, palpitations or dizziness that can be associated with administration of nitroglycerin. We suspect that this novel localised route of nitroglycerin administration may be an effective management strategy to treat trapped placenta while minimising side effects.

However, the outcomes of this treatment would require further study. This study was designed to observe the influence of nitroglycerin on the quality of coronary artery imaging when CT is used for coronary heart disease. Data of cardiology inpatients were collected from Department of Cardiology of our hospital from November to August for this study. All the subjects were diagnosed with multislice CT and coronary angiography after admission.

The patients were then divided into two groups, the nitroglycerin group of 75 cases who took nitroglycerin and the control group of 75 cases who took no nitroglycerin. A total of mixed plaques pathological characteristics of calcified ingredients and non-calcified ingredients , including calcified mixed plaques of type I, mainly with calcified plaques and purely calcified plaques , and 30 non-calcified plaques of type II, mainly with non-calcified ingredients or pure non-calcified plaques were scanned.

CT coronary angiography showed that the detection rate of type I plaque was Effects of nitroglycerin ointment on mastectomy flap necrosis in immediate breast reconstruction: a randomized controlled trial. Mastectomy flap necrosis is a common complication of immediate breast reconstruction that impacts recovery time and reconstructive success. Nitroglycerin ointment is a topical vasodilator that has been shown to improve skin flap survival in an animal model.

The objective of this study was to evaluate whether the application of nitroglycerin ointment to the breast skin after mastectomy and immediate reconstruction causes a decrease in the rate of mastectomy flap necrosis compared with placebo. This study was conducted as a randomized controlled trial and included patients aged 21 to 69 years undergoing mastectomy and immediate breast reconstruction at the University of British Columbia-affiliated hospitals Vancouver, British Columbia, Canada.

Patients with a medical history that precluded the administration of nitroglycerin were excluded from the study. The target sample size was patients. Nitroglycerin ointment 45 mg or a placebo was applied to the mastectomy skin at the time of surgical dressing. The trial was stopped at the first interim analysis after patients had been randomized 85 to the treatment group and 80 to the placebo group. Mastectomy flap necrosis developed in 27 patients Postoperative complications were similar in both groups [ nitroglycerin , In patients undergoing mastectomy and immediate reconstruction, there was a marked reduction in mastectomy flap necrosis in patients who received nitroglycerin ointment.

Nitroglycerin ointment application is a simple, safe, and effective way to help prevent mastectomy flap necrosis. Therapeutic, I. Topical nitroglycerin ointment for treatment of acute hypertension in hospitalized inpatients. Hypertension in the hospital setting is common; however, guidelines provide limited guidance specific to the inpatient setting.

Acute antihypertensive treatment options can be limited in this setting by monitoring requirements of intravenous medications and patients' inability to take oral medications. A possible treatment choice used to treat acute hypertension is nitroglycerin ointment.

Nitroglycerin is not approved by the Food and Drug Administration for this condition, and limited evidence exists to support this indication. To evaluate the statistical and clinical effectiveness of nitroglycerin ointment as a treatment option for acute hypertension based on a 20 mm Hg or greater reduction in systolic blood pressure. A retrospective chart review at a large tertiary community teaching hospital was performed on all adult noncardiac inpatients with an episode of acute hypertension that resulted in the administration of nitroglycerin ointment.

Seventy-two patients met inclusion criteria with a total of applications of nitroglycerin ointment. Study results suggest possible efficacy of nitroglycerin ointment for the treatment of acute hypertension in noncardiac hospitalized patients. Vasodilatory effect of nitroglycerin in Japanese subjects with different aldehyde dehydrogenase 2 ALDH2 genotypes. The enzymatic activities of mutant-type ALDH2 are limited compared with those of the wild type.

Currently, there is no research on direct observations of the vasodilatory effect of nitroglycerin sublingual tablets, which is the generally used dosage form. Furthermore, to analyze the effect of other factors age and flow-mediated dilation , multiple regression analysis and Pearson's correlation coefficient analysis were carried out. These analyses also indicated that the genotypes of ALDH2 were not related to the degree of vasodilation.

These results suggest the existence of other predominant pathway s for nitroglycerin biotransformation, at least with regard to clinical nitroglycerin e. Nitroglycerin : a review of its use in the treatment of vascular occlusion after soft tissue augmentation. Skin necrosis after soft tissue augmentation with dermal fillers is a rare but potentially severe complication.

Nitroglycerin paste may be an important treatment option for dermal and epidermal ischemia in cosmetic surgery. To summarize the knowledge about nitroglycerin paste in cosmetic surgery and to understand its current use in the treatment of vascular compromise after soft tissue augmentation.

To review the mechanism of action of nitroglycerin , examine its utility in the dermal vasculature in the setting of dermal filler-induced ischemia, and describe the facial anatomy danger zones in order to avoid vascular injury. A literature review was conducted to examine the mechanism of action of nitroglycerin , and a treatment algorithm was proposed from clinical observations to define strategies for impending facial necrosis after filler injection.

Our experience with nitroglycerin paste and our review of the medical literature supports the use of nitroglycerin paste on the skin to help improve flow in the dermal vasculature because of its vasodilatory effect on small-caliber arterioles. Published by Wiley Periodicals, Inc. Effect of botulinum toxin A and nitroglycerin on random skin flap survival in rats. A suitable pharmacological substitute for the well-established surgical delay technique for random skin flaps to increase viability has been elusive.

To evaluate the effects of nitroglycerin and botulinum toxin type A on random flap survival in a rat model. The present controlled experimental study was performed in the four groups of rats. One week after intervention in each group, the flap was raised and kept in situ, and flap necrosis was evaluated through follow-up. BTX-A was effective in reducing distal flap necrosis. The effect of BTX-A was significantly more pronounced than nitroglycerin ointment. Raman spectroscopic monitoring of the bioeffects of nitroglycerin on Hb-O II in single red blood cell.

Raman spectroscopy has been shown to have the potential for providing oxygenated ability of erythrocytes. Raman line at cm-1 has also been reported as one significant oxygenic indicator for erythrocytes.

In this research, we develop the Raman spectroscopic monitoring of the bioeffects of Nitroglycerin on hemoglobin oxygen saturation in a single red blood cell RBC. Nitroglycerin has been frequently used in the management of angina pectoris. Nitroglycerin liberates nitric oxide NO to blood vessels. NO is an oxidizer that easily converts hemoglobin to methemoglobin. The conversion may cause the decrease of oxygenated ability of erythrocytes. In this study, we observed the oxidize state of erythrocytes caused by the over dosage of Nitroglycerin.

When the dose of Nitroglycerin exceeds 2x10 -4 M, the oxygenic state of erythrocytes decreases significantly. The Raman spectroscopic results demonstrate the observation of the bioeffects of Nitroglycerin on hemoglobin. Background Although nitroglycerin has remained in clinical use since the mechanism by which it relaxes blood vessels to lower blood pressure remains incompletely understood. Although nitroglycerin has remained in clinical use since , the mechanism by which it relaxes blood vessels to lower blood pressure remains incompletely understood.

Nitroglycerin undergoes metabolism that generates several reaction products, including oxidants, and this bioactivation process is essential for vasodilation. This redox-dead knock-in mouse was substantively deficient in hypotensive response to nitroglycerin compared with wild-type littermates as measured in vivo by radiotelemetry.

Human oxyhemoglobin exhibits high resistance to nitroglycerin during incubation of the protein with this compound for 0. Prolonged exposure 24 h leads to activation of methemoglobin production. In the presence of nitroglycerin hemoglobin molecules undergo rapid oxidation during deoxygenation with formation of methemoglobin as the terminal product of human oxyhemoglobin interaction with nitroglycerin. The scheme of interaction processes of oxyhemoglobin with nitroglycerin in different conditions of oxygen regime is proposed.

Partially deliganded hemoglobin plays the leading role in the initiation of hemoglobin oxidation processes. Nitroglycerin reverts clinical manifestations of poor peripheral perfusion in patients with circulatory shock. Recent clinical studies have shown a relationship between abnormalities in peripheral perfusion and unfavorable outcome in patients with circulatory shock.

Nitroglycerin is effective in restoring alterations in microcirculatory blood flow. The aim of this study was to investigate whether nitroglycerin could correct the parameters of abnormal peripheral circulation in resuscitated circulatory shock patients. This interventional study recruited patients who had circulatory shock and who persisted with abnormal peripheral perfusion despite normalization of global hemodynamic parameters.

Peripheral circulation parameters included capillary refill time CRT , skin-temperature gradient Tskin-diff , perfusion index PI , and tissue oxygen saturation StO2 during a reactive hyperemia test RincStO2. Measurements were performed before, at the maximum dose, and after cessation of nitroglycerin infusion. Data were analyzed by using linear model for repeated measurements and are presented as mean standard error. In all patients, nitroglycerin infusion resulted in significant changes in CRT, Tskin-diff, and PI toward normal at the maximum dose of nitroglycerin : from 9.

Introduction Recent clinical studies have shown a relationship between abnormalities in peripheral perfusion and unfavorable outcome in patients with circulatory shock. Methods This interventional study recruited patients who had circulatory shock and who persisted with abnormal peripheral perfusion despite normalization of global hemodynamic parameters. Transdermal nitroglycerin for the treatment of preterm labor: a systematic review and metaanalysis. The purpose of this study was to evaluate the efficacy and safety of transdermal nitroglycerin as a tocolytic agent in women with preterm labor.

We conducted a systematic review and metaanalysis of randomized controlled trials. There were no significant differences between transdermal nitroglycerin and placebo for delivery within 48 hours of the initiation of treatment or at nitroglycerin was associated with a significant reduction in the risk of preterm birth at nitroglycerin and nifedipine and magnesium sulfate in delivery within 48 hours of treatment and pregnancy prolongation, respectively.

Overall, women who received transdermal nitroglycerin had a higher risk of headache. Further double-blind placebo-controlled trials are needed. Leftward bulging of atrial septum is provoked by nitroglycerin and by sustained valsalva strain. The motion of the interatrial septum primum septum is dependent on the interatrial pressure relation, normally with slightly higher pressure in the left atrium and the septum bulging toward the right atrium.

The aim of this study was to explore the physiologic mechanisms that reverse interatrial pressures and provoke leftward bulging of septum LBA. The hypothesis was that both left ventricular unloading with nitroglycerin and sustained Valsalva strain would independently provoke LBA and that their combination would further intensify the effect.

Prospectively collected transesophageal echocardiography recordings from 13 patients with obstructive sleep apnea were retrospectively analyzed for the presence or absence of LBA during resting respiration and during Valsalva strain. In each condition, LBA beats were counted at time points before and after nitroglycerin spray had been administered, which enabled a comparison of the independent effects and the combined effect of the nitroglycerin and the Valsalva maneuver.

After nitroglycerin administration, LBA occurred in at least three beats during strain in all Valsalva periods. The combination of these two interventions further intensified the effect. Published by Elsevier Inc. Acute effects of intracoronary nitroglycerin and diltiazem in coronary slow flow phenomenon. The coronary slow flow phenomenon CSFP is a coronary microvascular disorder angiographically defined by delayed opacification of the distal vasculature in the absence of obstructive coronary artery disease.

We aimed to investigate and compare the effects of intracoronary nitrate and diltiazem on thrombolysis in myocardial infarction frame count TFC in patients with CSFP during coronary angiography. Sixty patients with CSFP were randomly divided into 2 groups. Heart rate, systolic and diastolic blood pressures, and TFCs in all 3 coronaries were recorded before and after administering these medications. After nitroglycerin administration, systolic and diastolic blood pressures decreased, heart rates significantly increased, and TFCs decreased in all coronaries P nitroglycerin , in left anterior descending coronary artery, circumflex coronary artery, and right coronary artery were evaluated, diltiazem significantly reduced the TFCs of the left anterior descending coronary artery and circumflex coronary artery compared with nitroglycerin P nitroglycerin improve the TFCs in CSFP, and intracoronary diltiazem is superior to nitroglycerin in reducing TFCs in CSFP.

Patients with inferior ST elevation myocardial infarction STEMI , associated with right ventricular infarction, are thought to be at higher risk of developing hypotension when administered nitroglycerin NTG. We sought to determine if NTG administration is more likely to be associated with hypotension systolic blood pressure nitroglycerin administration between patients with inferior wall STEMI and those with STEMI in another region non-inferior.

Multiple variable logistic regression analysis was also used to assess the study outcomes while controlling for various factors. Of those, We excluded 16 cases because of missing data. NTG administration to patients with chest pain and inferior STEMI on their computer-interpreted electrocardiogram is not associated with a higher rate of hypotension compared to patients with STEMI in other territories.

Effect of Shenmai injection on preventing the development of nitroglycerin -induced tolerance in rats. Long-term nitroglycerin NTG therapy causes tolerance to its effects attributing to increased oxidative stress and endothelial dysfunction. Shenmai injection SMI , which is clinically used to treat cardiovascular diseases, consists of two herbal medicines, Ginseng Rubra and Ophiopogonjaponicas, and is reported to have antioxidant effects.

The present study was designed to investigate the potential preventive effects of Shenmai injection on development of nitroglycerin -induced tolerance. The present study involves both in vivo and in vitro experiments to investigate nitroglycerin -induced tolerance. We examined the effect of Shenmai injection on the cardiovascular oxidative stress by measuring the serum levels of malondialdehyde MDA and superoxide dismutase SOD. Endothelial dysfunction was determined by an endothelium-dependent vasorelaxation method in aortic rings and NOS activity.

Here, we showed that SMI ameliorated the decrease in AV Peak Vel, the attenuation in the vasodilation response to nitroglycerin and endothelial dysfunction. In vitro studies showed that Shenmai injection could recover the attenuated vasodilation response to nitroglycerin following incubation of aortic rings with nitroglycerin via activating the enzymes of sGC and cGK-I. Therefore, we conclude that Shenmai injection could prevent NTG nitroglycerin -induced tolerance at least in part by decreasing the cardiovascular oxidative stress.

Nitroglycerin patch for the treatment of chondrodermatitis nodularis helicis: a new therapeutic option. Chondrodermatitis nodularis helicis CNH is an inflammatory process that affects the skin and cartilage of the ear. At present, there are many treatment options, although they are not always effective. The purpose of this study was to evaluate the effectiveness of nitroglycerin patches in treating CNH.

The therapeutic effectivity was determined by the improvement in the appearance and symptoms of the lesion. Seven of 11 patients Two of 11 patients Transdermal nitroglycerin has demonstrated efficacy in the treatment of the symptoms and lesional appearance of CNH noninvasive manner. The success rate is comparable with other published methods and the rate of adverse effects is acceptable. The effects of repeated nitroglycerin administrations in rats; modeling migraine-related endpoints and chronification.

Rodent models typically use a single nitroglycerin injection to induce migraine, yet migraine in clinical populations presents as recurrent episodes. Further, these models quantify behavioral endpoints that do not align with the clinical features of episodic migraine or migraine chronification and therefore may limit translational relevance.

Animals administered nitroglycerin displayed photophobia, decreased activity, and increased facial pain expression. Similar alterations in photophobia and activity were seen in the vehicle treated animals, but these tended to diminish by the 4th or 5th injection. The presentation of spontaneous tactile allodynia was observed in the nitroglycerin group by the 5th episode. This paradigm employs recurring NTG episodes and clinically-relevant measures of photophobia, hypoactivity and facial grimace endpoints as well as introduces a novel arena apparatus to quantify spontaneous allodynia.

This repeated NTG procedure and endpoint measures aligns with the frequency and clinical presentation of episodic migraine and its chronification, respectively. Further, propylene glycol ethanol vehicle contributes to migraine endpoints. Intra-arterial nitroglycerin for intra-operative arterial vasospasm during pediatric renal transplantation. Intra-operative arterial vasospasm during pediatric renal transplantation is an urgent clinical situation resulting in end-organ ischemia, associated changes in parenchymal turgor and color, diminished flow on ultrasound, and if left untreated, allograft loss.

We hypothesized that intra-operative intra-arterial injection of nitroglycerin would reverse vasospasm and improve renal perfusion. A three-yr-old girl with end-stage renal disease due to autosomal recessive polycystic kidney disease on peritoneal dialysis underwent deceased donor renal transplantation. After optimal immediate reperfusion and hemodynamic parameters, the kidney lost turgor and became mottled in appearance despite adequate hilar arterial and venous Doppler waveforms.

Nitroglycerin resulted in dramatic change in the consistency and appearance of the allograft. An improvement in renal blood flow was demonstrated by ultrasound after the second intra-arterial nitroglycerin injection with only a transient decrease in systemic arterial blood pressure.

The child experienced normal allograft perfusion on serial postoperative ultrasounds, with a prompt decrease in serum creatinine and excellent diuresis. Intra-arterial nitroglycerin is a promising option for intra-operative arterial vasospasm during pediatric renal transplantation with objective improvement in blood flow and perfusion. Compromised breast flap treated with leech therapy, hyperbaric oxygen, pentoxifylline and topical nitroglycerin : A case report.

Hyperbaric oxygen HBO2 is often indicated in compromised surgical flaps. Although limited to animal models and human case reports, the utilization of leech therapy Hirudo medicinalis with HBO2 provides better outcomes than each modality alone. Topical nitroglycerin and pentoxifylline are also frequently used adjunctively for compromised flaps. We present a case of successful breast flap salvage utilizing a combination of leech therapy, HBO2, topical nitroglycerin and pentoxifylline.

A year-old female, one day post-status cosmetic breast reduction mammoplasty developed a dusky discoloration of the left nipple areolar complex, indicating imminent flap failure. The patient was immediately treated with topical nitroglycerin , oral pentoxifylline, and referred for HBO2. After her first HBO2 treatment, there was clinical improvement to the superior portion of the areolar flap, with little improvement inferiorly where the discoloration had remained essentially unchanged.

To address this, we added leech therapy and discontinued the topical nitroglycerin. Ceftriaxone for Aeromonas prophylaxis was started, and leeches were attached two at a time and removed from the area once feeding had ceased. These were applied three times per day for three days while receiving HBO2 twice per day for six days.

The patient's flap improved and completely healed by Week 8 without need for further surgery. This is the first case to our knowledge of successful breast flap salvage using a combination of leech therapy, HBO2, topical nitroglycerin and pentoxifylline. However, its ability to mimic the anti-inflammatory properties of NO remains unknown. Here, we examined whether NTG can suppress endothelial cell EC activation during inflammation and developed NTG nanoformulation to simultaneously amplify its anti-inflammatory effects and ameliorate adverse effects associated with high-dose NTG administration.

Our findings reveal that NTG significantly inhibits human U cell adhesion to NO-deficient human microvascular ECs in vitro through an increase in endothelial NO and decrease in endothelial ICAM-1 clustering, as determined by NO analyzer, microfluorimetry, and immunofluorescence staining. Thus, these findings, which are the first to reveal the superior therapeutic effects of an NTG nanoformulation, provide the rationale for their detailed investigation for potentially superior vascular normalization therapies.

Nitroglycerin degradation mediated by soil organic carbon under aerobic conditions. The presence of nitroglycerin NG has been reported in shallow soils and pore water of several military training ranges. In this context, NG concentrations can be reduced through various natural attenuation processes, but these have not been thoroughly documented.

This study aimed at investigating the role of soil organic matter SOM in the natural attenuation of NG, under aerobic conditions typical of shallow soils. The role of SOM in NG degradation has already been documented under anoxic conditions, and was attributed to SOM-mediated electron transfer involving different reducing agents. However, unsaturated soils are usually well-oxygenated, and it was not clear whether SOM could participate in NG degradation under these conditions.

Our results from batch- and column-type experiments clearly demonstrate that in presence of dissolved organic matter DOM leached from a natural soil, partial NG degradation can be achieved. In presence of particulate organic matter POM from the same soil, complete NG degradation was achieved. Furthermore, POM caused rapid sorption of NG, which should result in NG retention in the organic matter-rich shallow horizons of the soil profile, thus promoting degradation.

Based on degradation products, the reaction pathway appears to be reductive, in spite of the aerobic conditions. The relatively rapid reaction rates suggest that this process could significantly participate in the natural attenuation of NG, both on military training ranges and in contaminated soil at production facilities. Ardekani, Soroush; Scott, Harry A. The calcitonin gene-related peptide receptor antagonist MK decreases spinal trigeminal activity during nitroglycerin infusion.

Calcitonin gene-related peptide CGRP and nitric oxide NO are regarded as key mediators in migraine and other primary headaches. Migraineurs respond to infusion of nitroglycerin with delayed headaches, and inhibition of CGRP receptors has been shown to be effective in migraine therapy. In animal experiments nitrovasodilators like nitroglycerin induced increases in spinal trigeminal activity, which were reversed after inhibition of CGRP receptors. In the present study we asked if CGRP receptor inhibition can also prevent spinal trigeminal activity induced by nitroglycerin.

In isoflurane anaesthetised rats extracellular recordings were made from neurons in the spinal trigeminal nucleus with meningeal afferent input. After infusion of MK the activity of spinal trigeminal neurons with meningeal afferent input did not increase under continuous nitroglycerin infusion but decreased two hours later below baseline. In contrast, vehicle infusion followed by nitroglycerin was accompanied by a transient increase in activity.

CGRP receptors may be important in an early phase of nitroglycerin -induced central trigeminal activity. This finding may be relevant for nitroglycerin -induced headaches. Background Calcitonin gene-related peptide CGRP and nitric oxide NO are regarded as key mediators in migraine and other primary headaches. Methods In isoflurane anaesthetised rats extracellular recordings were made from neurons in the spinal trigeminal nucleus with meningeal afferent input.

Results After infusion of MK the activity of spinal trigeminal neurons with meningeal afferent input did not increase under continuous nitroglycerin infusion but decreased two hours later below baseline. Conclusions CGRP receptors may be important in an early phase of nitroglycerin -induced central trigeminal activity. Short incubation 20 min of erythrocytes with the drug led increasing hemoglobin affinity to oxygen and weakening of cooperative interactions in hemoprotein molecules. As a result, the amount of O 2 supplied to tissues in the process of gas exchange decreased by However, no dependence of the degree of changes in the physical and chemical properties of hemoglobin on the concentration of nitroglycerin was found.

Viable myocardium scintigraphy with intravenous nitroglycerine by computed tomography with Tcm MIBI. Advertisement Hide. This service is more advanced with JavaScript available. Editors view affiliations Joel J. Mintzes Emily M.

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LOBOV VS HULL BETTING ODDS

Background Nitroglycerin ointment is commonly used in the treatment of emergency department ED patients with suspected acute heart failure AHF or suspected acute coronary syndrome ACS , but its hemodynamic effects in this population are not well described. Objectives Our objective was to assess effect of nitroglycerin ointment on mean arterial pressure MAP and systemic vascular resistance SVR in ED patients receiving nitroglycerin.

Methods We conducted a prospective, observational pilot study in a convenience sample of adult patients from a single ED who were treated with nitroglycerin ointment. Mixed effects regression models with random slope and random intercept were used to analyze changes in hemodynamic parameters from baseline to 30, 60, and minutes after adjusting for age, sex, and final ED diagnosis of AHF.

However, other hemodynamic parameters do not change following application of nitroglycerin ointment in these patients. Mechanisms of gastroprotection by transdermal nitroglycerin in the rat. Nitric oxide NO donors prevent experimentally-induced gastric mucosal damage, but their clinical utility is limited by short duration of action or unsuitability of the pharmaceutical form employed. This study analyses the gastroprotection elicited by a clinically used mode of continuous administration of an NO donor, namely the nitroglycerin patch.

The transdermal nitroglycerin patch protects the gastric mucosa from damage by mechanisms that involve maintenance of mucosal blood flow and reduction of leukocyte-endothelial cell interaction. Nitroglycerin for management of retained placenta. Retained placenta affects 0. Use of nitroglycerin NTG , either alone or in combination with uterotonics, may be of value to minimise the need for manual removal of the placenta in theatre under anaesthesia.

To evaluate the benefits and harms of NTG as a tocolytic, either alone or in addition to uterotonics, in the management of retained placenta. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register 14 January , reference lists of retrieved studies and contacted experts in the field. Any adequately randomised controlled trial RCT comparing the use of NTG, either alone or in combination with uterotonics, with no intervention or with other interventions in the management of retained placenta.

All women having a vaginal delivery with a retained placenta, regardless of the management of the third stage of labour expectant or active. We included all trials with haemodynamically stable women in whom the placenta was not delivered at least within 15 minutes after delivery of the baby. Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy.

We included three randomised controlled trials RCTs with women. The detachment status of retained placenta was unknown in all three RCTs. Collectively, among the three included trials, two were judged to be at low risk of bias and the third trial was judged to be at high risk of bias for two domains: incomplete outcome data and selective reporting.

The three trials reported seven out of 23 of the review's pre-specified outcomes. The primary outcome "manual removal of the placenta" was reported in all three studies. No differences were seen between NTG and placebo for manual removal of the placenta average risk ratio RR 0. Allopurinol prevents nitroglycerin -induced tolerance in rat thoracic aorta. Xanthine oxidase is an important source of reactive oxygen species; so, it may play a role in the pathogenesis of endothelium dysfunction and its consequences.

Allopurinol, a purine analog, is a famous xanthine oxidase inhibitor. This study aimed to investigate possible effects of allopurinol on nitroglycerin tolerance, vasoconstriction, and vasorelaxation in rat aortic ring. Using thoracic aortic rings obtained from male Wistar rats, the effect of allopurinol was examined on nitroglycerin -induced tolerance.

In addition, changes of vasoconstriction by using KCl and phenylephrine and vasorelaxation by using carbachol, sodium nitroprusside, and nitroglycerin were also measured and compared between tissues treated with and without allopurinol. In terms of vasoconstriction and vasorelaxation, the effect of allopurinol was significant only on carbachol-induced endothelium related vasorelaxation in a dose-dependent manner. In conclusion, although allopurinol had no significant effect on the contractile response of the aorta, in accord with the previous data, it significantly intensified endothelium-dependent vasodilation.

The inhibitory effect of allopurinol against the development of nitrate-induced tolerance may suggest its clinical benefit and is worth to be studied more extensively. Prehospital high-dose sublingual nitroglycerin rarely causes hypotension. High-dose intravenous nitroglycerin is a common in-hospital treatment for respiratory distress due to congestive heart failure CHF with hypertension.

Intravenous IV nitroglycerin administration is impractical in the prehospital setting. The protocol calls for patients to be treated with two sublingual tabs 0. This study was a retrospective cohort study of patients from a single commercial EMS agency over a 6-month period.

Records from patients with at least one administration of MSN were reviewed. For each administration, the first documented vital signs pre- and post-administration were compared. Administrations were excluded if pre- or post-administration vital signs were missing. One hundred case-patients had at least one MSN administration by an advanced provider during the study period. Twenty-five case-patients were excluded due to incomplete vital signs. Seventy-five case-patients with 95 individual MSN administrations were included for analysis.

There were 65 administrations of two tabs, 29 administrations of three tabs, and one administration of four tabs. All three patients were over 65 years old, were administered two tabs, had documented improved respiratory status, and had repeat SBP of at least The incidence of hypotension following MSN.

Background: The mechanisms governing exercise-induced angina and its alleviation by the most commonly used antianginal drug, nitroglycerin , are incompletely understood. The purpose of this study was to develop a method by which the effects of antianginal drugs could be evaluated invasively during physiological exercise to gain further understanding of the clinical impact of angina and nitroglycerin.

Methods: Forty patients mean age, As they developed limiting angina, sublingual nitroglycerin was administered to half the patients, and all patients continued to exercise for 2 minutes at the same workload. Throughout exercise, distal coronary pressure and flow velocity and central aortic pressure were recorded with sensor wires.

The observed increases in coronary pressure gradient, stenosis resistance, and flow velocity did not reach statistical significance; however, the diastolic velocity—pressure gradient relation was consistent with a significant increase in relative stenosis severity k coefficient, P nitroglycerin. Conclusions: The catheterization laboratory protocol provides a model to. Effects of autogenic training on nitroglycerin -induced headaches. To investigate the prophylactic and acute effects of autogenic training AT during a nitroglycerin -induced migraine attack.

Thirty female migraineurs without aura and 11 controls participated in the study. Of these, 11 migraineurs and 5 controls practiced AT regularly for at least 6 months prior to and during the sublingual nitroglycerin test. Headache intensity and characteristics were recorded with a standardized method. During the nitroglycerin challenge, blood was collected for plasma cortisol determination and blood pressure and pulse rate were recorded. Intravenous nitroglycerin for external cephalic version: a randomized controlled trial.

To estimate whether treatment with intravenous nitroglycerin for uterine relaxation increases the chance of successful external cephalic version. Two double-blind, randomized clinical trials were undertaken: one in nulliparous women and a second in multiparous women. Women presenting for external cephalic version at term were eligible to participate.

The primary outcome was immediate success of external cephalic version. Other outcomes were presentation at delivery, cesarean delivery rate, and side effects and complications. In total, women were recruited in the nulliparous trial and 44 in the multiparous trial. Seven patients did not have external cephalic version before delivery but were included in the analysis of success of external cephalic version.

One patient was lost to follow-up. Treatment with intravenous nitroglycerin increased the rate of successful external cephalic version in nulliparous, but not in multiparous, women. Treatment with intravenous nitroglycerin appeared to be safe, but our numbers were too small to rule out rare serious adverse effects.

Constitutive nitric oxide synthase activation is a significant route for nitroglycerin -mediated vasodilation. Bonini, Marcelo G. The physiological effects of nitroglycerin as a potent vasodilator have long been documented. However, the molecular mechanisms by which nitroglycerin exerts its biological functions are still a matter of intense debate.

Enzymatic pathways converting nitroglycerin to vasoactive compounds have been identified, but none of them seems to fully account for the reported clinical observations. Here, we demonstrate that nitroglycerin triggers constitutive nitric oxide synthase NOS activation, which is a major source of NO responsible for low-dose 1—10 nM nitroglycerin -induced vasorelaxation.

Our studies in cell cultures, isolated vessels, and whole animals identified endothelial NOS activation as a fundamental requirement for nitroglycerin action at pharmacologically relevant concentrations in WT animals. Pilot test NG by aerobic bacteria, a pilot program was undertaken with the following objectives: 1 to determine the concentration of NG in the ball powder. Lara, Diego A. Coronary spasm during coronary angiography for vasculopathy in children can be prevented by the intracoronary administration of nitroglycerin.

We reviewed the anesthesia and catheterization reports and charts for pediatric transplant recipients who underwent angiography from through Correlation analysis was used to study the relation of post-injection systolic blood pressure SBP to nitroglycerin dose. Forty-one angiographic evaluations were performed on 25 patients 13 male and 12 female. Mean age was 9. The mean total dose of nitroglycerin was 2.

There were 2 interventions for SBP before nitroglycerin and 2 after nitroglycerin. One child experienced a transient ST-T—segment change during angiography after nitroglycerin. In the highest dose range, the additional decrease in SBP was 7. Routine intracoronary nitroglycerin administration in this dose range produced no significant changes in SBP or heart rate in children.

Nitroglycerin , which helps impaired cardiac function as it is converted to nitric oxide, is used worldwide to treat patients with various ischemic and congestive cardiac diseases, including angina pectoris. Nevertheless, after continuous treatment, the benefits of nitroglycerin are limited by the development of tolerance to the drug. Nitroglycerin tolerance is a result of inactivation of aldehyde dehydrogenase 2 ALDH2 , an enzyme essential for cardioprotection in animals subjected to myocardial infarction MI.

Here we tested the hypothesis that the tolerance that develops as a result of sustained nitroglycerin treatment increases cardiac injury by subsequent MI. In a rat model of MI, 16 hours of prior, sustained nitroglycerin treatment 7.

We also sought to identify a potential treatment to protect against this increased cardiac damage. If our animal studies showing that nitroglycerin tolerance increases cardiac injury upon ischemic insult are corroborated in humans, activators of ALDH2 such as Alda-1 may help to protect MI patients from this nitroglycerin -induced increase in cardiac injury, while maintaining the cardiac benefits of the increased nitric oxide concentrations produced by nitroglycerin. Systemic effects of intracoronary nitroglycerin during coronary angiography in children after heart transplantation.

One child experienced a transient ST-T-segment change during angiography after nitroglycerin. To systematically investigate the literature for the influence of sublingual nitroglycerin administration on coronary diameter, the number of evaluable segments, image quality, heart rate and blood pressure, and diagnostic accuracy of coronary computed tomography CT angiography.

The studies were evaluated for the effect of sublingual nitroglycerin on coronary artery diameter, evaluable segments, objective and subjective image quality, systemic physiological effects and diagnostic accuracy. Due to the heterogeneous reporting of outcome measures, a narrative synthesis was applied. Of the studies identified, nine met the inclusion criteria: seven reported on the effect of nitroglycerin on coronary artery diameter, six on evaluable segments, four on image quality, five on systemic physiological effects and two on diagnostic accuracy.

Sublingual nitroglycerin administration resulted in an improved evaluation of more coronary segments, in particular, in smaller coronary branches, better image quality and improved diagnostic accuracy. Side effects were mild and were alleviated without medical intervention. Sublingual nitroglycerin improves the coronary diameter, the number of assessable segments, image quality and diagnostic accuracy of coronary CT angiography without major side effects or systemic physiological changes.

Overall, women receiving transdermal nitroglycerin had a higher risk of headache. Further additional double-blind placebo-controlled trials are needed. Context: Osteoporosis is common among postmenopausal women; animal studies and human pilot studies support the concept of nitric oxide NO donors reducing bone mineral density loss.

Objective: The objective of the study was to evaluate whether NO donor, nitroglycerin , prevents postmenopausal bone loss. Design: This was a 3-yr randomized, double blinded, single-center, placebo-controlled clinical trial. Intervention: Women, stratified by lumbar T-score 5 yr , were randomized to receive nitroglycerin ointment Both groups took mg daily calcium plus IU vitamin D supplements. Measurements: BMD was measured at 6 months and annually by dual-energy x-ray absorptiometry.

Percent change in lumbar vertebrae BMD was the primary outcome. Hip BMD, total body bone mineral content, and height were secondary outcomes. Secondary outcomes also did not differ by intervention arm. The active group reported more headaches compared with the placebo group 57 vs.

Once-daily dosing with Internal sphincterotomy versus topical nitroglycerin ointment for chronic anal fissure. Anal fissure is a common benign condition. An anorectal problem is defined as a split in the anal canal mucosa that extends from the dentate line to the anal verge. Chronic anal fissure is defined by a history of symptoms present for more than 2 months' duration and with a triad of external skin tags, namely, a hypertrophied anal papilla, an ulcer with rolled edges, and a base exposing the internal sphincter.

Because complications such as incontinence are associated with surgical treatment, chemical sphincterotomy is currently favored. The objective of this study is to compare the difference in outcome between open partial lateral anal sphincterotomy and application of topical 0. This was a quasi-experimental study carried out between January 16, and January 15, in the Surgical Department of Jinnah Hospital, Lahore, Pakistan.

Sixty consecutive cases with a clinical diagnosis of chronic anal fissure were recruited in the study. All recruited patients met the study inclusion criteria and were randomly assigned to one of the two groups. Group A was managed conservatively using topical 0. Both groups were followed up at 1 week, 2 weeks, 4 weeks, and 6 weeks after the treatment. All the patients complained of pain. A total of 43 Group A included 30 11 females and 19 males cases treated with topical 0.

Nitroglycerin is widely used as a coronary vasodilator in the treatment of ischemic heart diseases. This study investigated the influence of hypoxia on nitroglycerin -induced relaxation in endothelium-intact and -denuded rabbit, monkey, and porcine coronary arteries. Helically cut strips of coronary arteries were suspended in organ chambers, and isometric tension was recorded. Nitroglycerin concentration dependently relaxed endothelium-intact rabbit coronary arteries, which were not different under normoxic and hypoxic conditions.

On the other hand, nitroglycerin -induced relaxation of endothelium-denuded arteries was significantly attenuated by hypoxia. Similarly, the relaxant response of endothelium-intact monkey coronary arteries to nitroglycerin was not affected by hypoxia, whereas that of endothelium-denuded arteries was impaired.

As is the case with rabbit and monkey coronary arteries, exposure to hypoxia resulted in impaired relaxation by nitroglycerin in endothelium-denuded but not endothelium-intact porcine coronary arteries. These findings suggest that coronary endothelium plays a pivotal role in preventing the hypoxia-induced impairment of nitroglycerin responsiveness, regardless of the animal species.

Karger AG, Basel. Continuous transdermal nitroglycerin therapy for menopausal hot flashes: a single-arm, dose-escalation trial. To describe the efficacy and tolerability of continuous nitroglycerin for treatment of hot flashes. Perimenopausal and postmenopausal women reporting at least seven hot flashes per day were recruited into a single-arm, dose-escalation trial of continuous transdermal nitroglycerin.

Participants were started on a generic 0. During 4 weeks, participants escalated dosage weekly to 0. Changes in hot flash frequency and severity were assessed using symptom diaries. Paired t tests examined change in outcomes between baseline and maximal-dose therapy and after discontinuation of nitroglycerin. Of the 19 participants, mean age was Women reported an average Eleven women escalated to 0.

Two discontinued nitroglycerin before the first outcomes assessment. If confirmed in a randomized blinded trial, it may offer a novel nonhormonal hot flash treatment. Huang, Alison J. Objective To describe the efficacy and tolerability of continuous nitroglycerin for treatment of hot flashes. Methods Peri- and postmenopausal women reporting at least 7 hot flashes per day were recruited into a single-arm, dose-escalation trial of continuous transdermal nitroglycerin.

Over four weeks, participants escalated dosage weekly to 0. Paired t-tests examined change in outcomes between baseline and maximal-dose therapy as well as after discontinuation of nitroglycerin. Results Of the 19 participants, mean age was If confirmed in a randomized blinded trial, it may offer a novel non-hormonal hot flash treatment.

Treatment of proctalgia fugax with topical nitroglycerin : report of a case. We report a single case of proctalgia fugax that responded to 0. Case report. A single case of proctalgia fugax responded to topical application of 0. Nitroglycerin ointment is a newly described treatment for several painful anal conditions. We describe a single case of levator spasm or proctalgia fugax responding to topical application of nitroglycerin. This is only a single case report, and conclusive evidence awaits completion of a controlled clinical trial.

A novel treatment for management of a trapped placenta using intracervical nitroglycerin tablets. A year-old gravida 2, para 1 woman delivered a viable male infant and developed retained placenta due to entrapment. A nitroglycerin tablet was used to relax the lower uterine segment and cervix, which allowed the placenta to pass through the cervix for delivery. The nitroglycerin tablet was placed in the cervix and held in place by the delivering physician as it dissolved.

Soon after administration, the intact placenta delivered. The patient did not experience the typical side effects of headache, asymptomatic decrease in blood pressure, hypotension, palpitations or dizziness that can be associated with administration of nitroglycerin. We suspect that this novel localised route of nitroglycerin administration may be an effective management strategy to treat trapped placenta while minimising side effects.

However, the outcomes of this treatment would require further study. This study was designed to observe the influence of nitroglycerin on the quality of coronary artery imaging when CT is used for coronary heart disease. Data of cardiology inpatients were collected from Department of Cardiology of our hospital from November to August for this study. All the subjects were diagnosed with multislice CT and coronary angiography after admission.

The patients were then divided into two groups, the nitroglycerin group of 75 cases who took nitroglycerin and the control group of 75 cases who took no nitroglycerin. A total of mixed plaques pathological characteristics of calcified ingredients and non-calcified ingredients , including calcified mixed plaques of type I, mainly with calcified plaques and purely calcified plaques , and 30 non-calcified plaques of type II, mainly with non-calcified ingredients or pure non-calcified plaques were scanned.

CT coronary angiography showed that the detection rate of type I plaque was Effects of nitroglycerin ointment on mastectomy flap necrosis in immediate breast reconstruction: a randomized controlled trial. Mastectomy flap necrosis is a common complication of immediate breast reconstruction that impacts recovery time and reconstructive success. Nitroglycerin ointment is a topical vasodilator that has been shown to improve skin flap survival in an animal model.

The objective of this study was to evaluate whether the application of nitroglycerin ointment to the breast skin after mastectomy and immediate reconstruction causes a decrease in the rate of mastectomy flap necrosis compared with placebo.

This study was conducted as a randomized controlled trial and included patients aged 21 to 69 years undergoing mastectomy and immediate breast reconstruction at the University of British Columbia-affiliated hospitals Vancouver, British Columbia, Canada. Patients with a medical history that precluded the administration of nitroglycerin were excluded from the study. The target sample size was patients. Nitroglycerin ointment 45 mg or a placebo was applied to the mastectomy skin at the time of surgical dressing.

The trial was stopped at the first interim analysis after patients had been randomized 85 to the treatment group and 80 to the placebo group. Mastectomy flap necrosis developed in 27 patients Postoperative complications were similar in both groups [ nitroglycerin , In patients undergoing mastectomy and immediate reconstruction, there was a marked reduction in mastectomy flap necrosis in patients who received nitroglycerin ointment.

Nitroglycerin ointment application is a simple, safe, and effective way to help prevent mastectomy flap necrosis. Therapeutic, I. Topical nitroglycerin ointment for treatment of acute hypertension in hospitalized inpatients. Hypertension in the hospital setting is common; however, guidelines provide limited guidance specific to the inpatient setting.

Acute antihypertensive treatment options can be limited in this setting by monitoring requirements of intravenous medications and patients' inability to take oral medications. A possible treatment choice used to treat acute hypertension is nitroglycerin ointment. Nitroglycerin is not approved by the Food and Drug Administration for this condition, and limited evidence exists to support this indication.

To evaluate the statistical and clinical effectiveness of nitroglycerin ointment as a treatment option for acute hypertension based on a 20 mm Hg or greater reduction in systolic blood pressure. A retrospective chart review at a large tertiary community teaching hospital was performed on all adult noncardiac inpatients with an episode of acute hypertension that resulted in the administration of nitroglycerin ointment. Seventy-two patients met inclusion criteria with a total of applications of nitroglycerin ointment.

Study results suggest possible efficacy of nitroglycerin ointment for the treatment of acute hypertension in noncardiac hospitalized patients. Vasodilatory effect of nitroglycerin in Japanese subjects with different aldehyde dehydrogenase 2 ALDH2 genotypes. The enzymatic activities of mutant-type ALDH2 are limited compared with those of the wild type. Currently, there is no research on direct observations of the vasodilatory effect of nitroglycerin sublingual tablets, which is the generally used dosage form.

Furthermore, to analyze the effect of other factors age and flow-mediated dilation , multiple regression analysis and Pearson's correlation coefficient analysis were carried out. These analyses also indicated that the genotypes of ALDH2 were not related to the degree of vasodilation. These results suggest the existence of other predominant pathway s for nitroglycerin biotransformation, at least with regard to clinical nitroglycerin e.

Nitroglycerin : a review of its use in the treatment of vascular occlusion after soft tissue augmentation. Skin necrosis after soft tissue augmentation with dermal fillers is a rare but potentially severe complication. Nitroglycerin paste may be an important treatment option for dermal and epidermal ischemia in cosmetic surgery.

To summarize the knowledge about nitroglycerin paste in cosmetic surgery and to understand its current use in the treatment of vascular compromise after soft tissue augmentation. To review the mechanism of action of nitroglycerin , examine its utility in the dermal vasculature in the setting of dermal filler-induced ischemia, and describe the facial anatomy danger zones in order to avoid vascular injury.

A literature review was conducted to examine the mechanism of action of nitroglycerin , and a treatment algorithm was proposed from clinical observations to define strategies for impending facial necrosis after filler injection. Our experience with nitroglycerin paste and our review of the medical literature supports the use of nitroglycerin paste on the skin to help improve flow in the dermal vasculature because of its vasodilatory effect on small-caliber arterioles.

Published by Wiley Periodicals, Inc. Effect of botulinum toxin A and nitroglycerin on random skin flap survival in rats. A suitable pharmacological substitute for the well-established surgical delay technique for random skin flaps to increase viability has been elusive. To evaluate the effects of nitroglycerin and botulinum toxin type A on random flap survival in a rat model. The present controlled experimental study was performed in the four groups of rats.

One week after intervention in each group, the flap was raised and kept in situ, and flap necrosis was evaluated through follow-up. BTX-A was effective in reducing distal flap necrosis. The effect of BTX-A was significantly more pronounced than nitroglycerin ointment.

Raman spectroscopic monitoring of the bioeffects of nitroglycerin on Hb-O II in single red blood cell. Raman spectroscopy has been shown to have the potential for providing oxygenated ability of erythrocytes. Raman line at cm-1 has also been reported as one significant oxygenic indicator for erythrocytes. In this research, we develop the Raman spectroscopic monitoring of the bioeffects of Nitroglycerin on hemoglobin oxygen saturation in a single red blood cell RBC. Nitroglycerin has been frequently used in the management of angina pectoris.

Nitroglycerin liberates nitric oxide NO to blood vessels. NO is an oxidizer that easily converts hemoglobin to methemoglobin. The conversion may cause the decrease of oxygenated ability of erythrocytes. In this study, we observed the oxidize state of erythrocytes caused by the over dosage of Nitroglycerin. When the dose of Nitroglycerin exceeds 2x10 -4 M, the oxygenic state of erythrocytes decreases significantly. The Raman spectroscopic results demonstrate the observation of the bioeffects of Nitroglycerin on hemoglobin.

Background Although nitroglycerin has remained in clinical use since the mechanism by which it relaxes blood vessels to lower blood pressure remains incompletely understood. Although nitroglycerin has remained in clinical use since , the mechanism by which it relaxes blood vessels to lower blood pressure remains incompletely understood. Nitroglycerin undergoes metabolism that generates several reaction products, including oxidants, and this bioactivation process is essential for vasodilation.

This redox-dead knock-in mouse was substantively deficient in hypotensive response to nitroglycerin compared with wild-type littermates as measured in vivo by radiotelemetry. Human oxyhemoglobin exhibits high resistance to nitroglycerin during incubation of the protein with this compound for 0.

Prolonged exposure 24 h leads to activation of methemoglobin production. In the presence of nitroglycerin hemoglobin molecules undergo rapid oxidation during deoxygenation with formation of methemoglobin as the terminal product of human oxyhemoglobin interaction with nitroglycerin.

The scheme of interaction processes of oxyhemoglobin with nitroglycerin in different conditions of oxygen regime is proposed. Partially deliganded hemoglobin plays the leading role in the initiation of hemoglobin oxidation processes. Nitroglycerin reverts clinical manifestations of poor peripheral perfusion in patients with circulatory shock. Recent clinical studies have shown a relationship between abnormalities in peripheral perfusion and unfavorable outcome in patients with circulatory shock.

Nitroglycerin is effective in restoring alterations in microcirculatory blood flow. The aim of this study was to investigate whether nitroglycerin could correct the parameters of abnormal peripheral circulation in resuscitated circulatory shock patients. This interventional study recruited patients who had circulatory shock and who persisted with abnormal peripheral perfusion despite normalization of global hemodynamic parameters.

Peripheral circulation parameters included capillary refill time CRT , skin-temperature gradient Tskin-diff , perfusion index PI , and tissue oxygen saturation StO2 during a reactive hyperemia test RincStO2. Measurements were performed before, at the maximum dose, and after cessation of nitroglycerin infusion.

Data were analyzed by using linear model for repeated measurements and are presented as mean standard error. In all patients, nitroglycerin infusion resulted in significant changes in CRT, Tskin-diff, and PI toward normal at the maximum dose of nitroglycerin : from 9. Introduction Recent clinical studies have shown a relationship between abnormalities in peripheral perfusion and unfavorable outcome in patients with circulatory shock. Methods This interventional study recruited patients who had circulatory shock and who persisted with abnormal peripheral perfusion despite normalization of global hemodynamic parameters.

Transdermal nitroglycerin for the treatment of preterm labor: a systematic review and metaanalysis. The purpose of this study was to evaluate the efficacy and safety of transdermal nitroglycerin as a tocolytic agent in women with preterm labor.

We conducted a systematic review and metaanalysis of randomized controlled trials. There were no significant differences between transdermal nitroglycerin and placebo for delivery within 48 hours of the initiation of treatment or at nitroglycerin was associated with a significant reduction in the risk of preterm birth at nitroglycerin and nifedipine and magnesium sulfate in delivery within 48 hours of treatment and pregnancy prolongation, respectively.

Overall, women who received transdermal nitroglycerin had a higher risk of headache. Further double-blind placebo-controlled trials are needed. Leftward bulging of atrial septum is provoked by nitroglycerin and by sustained valsalva strain. The motion of the interatrial septum primum septum is dependent on the interatrial pressure relation, normally with slightly higher pressure in the left atrium and the septum bulging toward the right atrium.

The aim of this study was to explore the physiologic mechanisms that reverse interatrial pressures and provoke leftward bulging of septum LBA. The hypothesis was that both left ventricular unloading with nitroglycerin and sustained Valsalva strain would independently provoke LBA and that their combination would further intensify the effect. Prospectively collected transesophageal echocardiography recordings from 13 patients with obstructive sleep apnea were retrospectively analyzed for the presence or absence of LBA during resting respiration and during Valsalva strain.

In each condition, LBA beats were counted at time points before and after nitroglycerin spray had been administered, which enabled a comparison of the independent effects and the combined effect of the nitroglycerin and the Valsalva maneuver. After nitroglycerin administration, LBA occurred in at least three beats during strain in all Valsalva periods. The combination of these two interventions further intensified the effect.

Published by Elsevier Inc. Acute effects of intracoronary nitroglycerin and diltiazem in coronary slow flow phenomenon. The coronary slow flow phenomenon CSFP is a coronary microvascular disorder angiographically defined by delayed opacification of the distal vasculature in the absence of obstructive coronary artery disease. We aimed to investigate and compare the effects of intracoronary nitrate and diltiazem on thrombolysis in myocardial infarction frame count TFC in patients with CSFP during coronary angiography.

Sixty patients with CSFP were randomly divided into 2 groups. Heart rate, systolic and diastolic blood pressures, and TFCs in all 3 coronaries were recorded before and after administering these medications. After nitroglycerin administration, systolic and diastolic blood pressures decreased, heart rates significantly increased, and TFCs decreased in all coronaries P nitroglycerin , in left anterior descending coronary artery, circumflex coronary artery, and right coronary artery were evaluated, diltiazem significantly reduced the TFCs of the left anterior descending coronary artery and circumflex coronary artery compared with nitroglycerin P nitroglycerin improve the TFCs in CSFP, and intracoronary diltiazem is superior to nitroglycerin in reducing TFCs in CSFP.

Patients with inferior ST elevation myocardial infarction STEMI , associated with right ventricular infarction, are thought to be at higher risk of developing hypotension when administered nitroglycerin NTG. We sought to determine if NTG administration is more likely to be associated with hypotension systolic blood pressure nitroglycerin administration between patients with inferior wall STEMI and those with STEMI in another region non-inferior.

Multiple variable logistic regression analysis was also used to assess the study outcomes while controlling for various factors. Of those, We excluded 16 cases because of missing data. NTG administration to patients with chest pain and inferior STEMI on their computer-interpreted electrocardiogram is not associated with a higher rate of hypotension compared to patients with STEMI in other territories.

Effect of Shenmai injection on preventing the development of nitroglycerin -induced tolerance in rats. Long-term nitroglycerin NTG therapy causes tolerance to its effects attributing to increased oxidative stress and endothelial dysfunction. Shenmai injection SMI , which is clinically used to treat cardiovascular diseases, consists of two herbal medicines, Ginseng Rubra and Ophiopogonjaponicas, and is reported to have antioxidant effects.

The present study was designed to investigate the potential preventive effects of Shenmai injection on development of nitroglycerin -induced tolerance. The present study involves both in vivo and in vitro experiments to investigate nitroglycerin -induced tolerance. We examined the effect of Shenmai injection on the cardiovascular oxidative stress by measuring the serum levels of malondialdehyde MDA and superoxide dismutase SOD.

Endothelial dysfunction was determined by an endothelium-dependent vasorelaxation method in aortic rings and NOS activity. Here, we showed that SMI ameliorated the decrease in AV Peak Vel, the attenuation in the vasodilation response to nitroglycerin and endothelial dysfunction. In vitro studies showed that Shenmai injection could recover the attenuated vasodilation response to nitroglycerin following incubation of aortic rings with nitroglycerin via activating the enzymes of sGC and cGK-I.

Therefore, we conclude that Shenmai injection could prevent NTG nitroglycerin -induced tolerance at least in part by decreasing the cardiovascular oxidative stress. Nitroglycerin patch for the treatment of chondrodermatitis nodularis helicis: a new therapeutic option. Chondrodermatitis nodularis helicis CNH is an inflammatory process that affects the skin and cartilage of the ear. At present, there are many treatment options, although they are not always effective.

The purpose of this study was to evaluate the effectiveness of nitroglycerin patches in treating CNH. The therapeutic effectivity was determined by the improvement in the appearance and symptoms of the lesion. Seven of 11 patients Two of 11 patients Transdermal nitroglycerin has demonstrated efficacy in the treatment of the symptoms and lesional appearance of CNH noninvasive manner.

The success rate is comparable with other published methods and the rate of adverse effects is acceptable. The effects of repeated nitroglycerin administrations in rats; modeling migraine-related endpoints and chronification. Rodent models typically use a single nitroglycerin injection to induce migraine, yet migraine in clinical populations presents as recurrent episodes.

Further, these models quantify behavioral endpoints that do not align with the clinical features of episodic migraine or migraine chronification and therefore may limit translational relevance. Animals administered nitroglycerin displayed photophobia, decreased activity, and increased facial pain expression. Similar alterations in photophobia and activity were seen in the vehicle treated animals, but these tended to diminish by the 4th or 5th injection.

The presentation of spontaneous tactile allodynia was observed in the nitroglycerin group by the 5th episode. This paradigm employs recurring NTG episodes and clinically-relevant measures of photophobia, hypoactivity and facial grimace endpoints as well as introduces a novel arena apparatus to quantify spontaneous allodynia. This repeated NTG procedure and endpoint measures aligns with the frequency and clinical presentation of episodic migraine and its chronification, respectively.

Further, propylene glycol ethanol vehicle contributes to migraine endpoints. Intra-arterial nitroglycerin for intra-operative arterial vasospasm during pediatric renal transplantation. Intra-operative arterial vasospasm during pediatric renal transplantation is an urgent clinical situation resulting in end-organ ischemia, associated changes in parenchymal turgor and color, diminished flow on ultrasound, and if left untreated, allograft loss.

We hypothesized that intra-operative intra-arterial injection of nitroglycerin would reverse vasospasm and improve renal perfusion. A three-yr-old girl with end-stage renal disease due to autosomal recessive polycystic kidney disease on peritoneal dialysis underwent deceased donor renal transplantation. After optimal immediate reperfusion and hemodynamic parameters, the kidney lost turgor and became mottled in appearance despite adequate hilar arterial and venous Doppler waveforms.

Nitroglycerin resulted in dramatic change in the consistency and appearance of the allograft. An improvement in renal blood flow was demonstrated by ultrasound after the second intra-arterial nitroglycerin injection with only a transient decrease in systemic arterial blood pressure. The child experienced normal allograft perfusion on serial postoperative ultrasounds, with a prompt decrease in serum creatinine and excellent diuresis. Intra-arterial nitroglycerin is a promising option for intra-operative arterial vasospasm during pediatric renal transplantation with objective improvement in blood flow and perfusion.

Compromised breast flap treated with leech therapy, hyperbaric oxygen, pentoxifylline and topical nitroglycerin : A case report. Hyperbaric oxygen HBO2 is often indicated in compromised surgical flaps. Although limited to animal models and human case reports, the utilization of leech therapy Hirudo medicinalis with HBO2 provides better outcomes than each modality alone. Topical nitroglycerin and pentoxifylline are also frequently used adjunctively for compromised flaps.

We present a case of successful breast flap salvage utilizing a combination of leech therapy, HBO2, topical nitroglycerin and pentoxifylline. A year-old female, one day post-status cosmetic breast reduction mammoplasty developed a dusky discoloration of the left nipple areolar complex, indicating imminent flap failure. The patient was immediately treated with topical nitroglycerin , oral pentoxifylline, and referred for HBO2.

After her first HBO2 treatment, there was clinical improvement to the superior portion of the areolar flap, with little improvement inferiorly where the discoloration had remained essentially unchanged. To address this, we added leech therapy and discontinued the topical nitroglycerin. Ceftriaxone for Aeromonas prophylaxis was started, and leeches were attached two at a time and removed from the area once feeding had ceased. These were applied three times per day for three days while receiving HBO2 twice per day for six days.

The patient's flap improved and completely healed by Week 8 without need for further surgery. This is the first case to our knowledge of successful breast flap salvage using a combination of leech therapy, HBO2, topical nitroglycerin and pentoxifylline. However, its ability to mimic the anti-inflammatory properties of NO remains unknown. Here, we examined whether NTG can suppress endothelial cell EC activation during inflammation and developed NTG nanoformulation to simultaneously amplify its anti-inflammatory effects and ameliorate adverse effects associated with high-dose NTG administration.

Our findings reveal that NTG significantly inhibits human U cell adhesion to NO-deficient human microvascular ECs in vitro through an increase in endothelial NO and decrease in endothelial ICAM-1 clustering, as determined by NO analyzer, microfluorimetry, and immunofluorescence staining. Thus, these findings, which are the first to reveal the superior therapeutic effects of an NTG nanoformulation, provide the rationale for their detailed investigation for potentially superior vascular normalization therapies.

Nitroglycerin degradation mediated by soil organic carbon under aerobic conditions. The presence of nitroglycerin NG has been reported in shallow soils and pore water of several military training ranges. In this context, NG concentrations can be reduced through various natural attenuation processes, but these have not been thoroughly documented. This study aimed at investigating the role of soil organic matter SOM in the natural attenuation of NG, under aerobic conditions typical of shallow soils.

The role of SOM in NG degradation has already been documented under anoxic conditions, and was attributed to SOM-mediated electron transfer involving different reducing agents. However, unsaturated soils are usually well-oxygenated, and it was not clear whether SOM could participate in NG degradation under these conditions.

Our results from batch- and column-type experiments clearly demonstrate that in presence of dissolved organic matter DOM leached from a natural soil, partial NG degradation can be achieved. In presence of particulate organic matter POM from the same soil, complete NG degradation was achieved.

Furthermore, POM caused rapid sorption of NG, which should result in NG retention in the organic matter-rich shallow horizons of the soil profile, thus promoting degradation. Based on degradation products, the reaction pathway appears to be reductive, in spite of the aerobic conditions. The relatively rapid reaction rates suggest that this process could significantly participate in the natural attenuation of NG, both on military training ranges and in contaminated soil at production facilities.

Ardekani, Soroush; Scott, Harry A. The calcitonin gene-related peptide receptor antagonist MK decreases spinal trigeminal activity during nitroglycerin infusion. Calcitonin gene-related peptide CGRP and nitric oxide NO are regarded as key mediators in migraine and other primary headaches. Migraineurs respond to infusion of nitroglycerin with delayed headaches, and inhibition of CGRP receptors has been shown to be effective in migraine therapy.

In animal experiments nitrovasodilators like nitroglycerin induced increases in spinal trigeminal activity, which were reversed after inhibition of CGRP receptors. In the present study we asked if CGRP receptor inhibition can also prevent spinal trigeminal activity induced by nitroglycerin. In isoflurane anaesthetised rats extracellular recordings were made from neurons in the spinal trigeminal nucleus with meningeal afferent input. After infusion of MK the activity of spinal trigeminal neurons with meningeal afferent input did not increase under continuous nitroglycerin infusion but decreased two hours later below baseline.

In contrast, vehicle infusion followed by nitroglycerin was accompanied by a transient increase in activity. CGRP receptors may be important in an early phase of nitroglycerin -induced central trigeminal activity. This finding may be relevant for nitroglycerin -induced headaches. Background Calcitonin gene-related peptide CGRP and nitric oxide NO are regarded as key mediators in migraine and other primary headaches.

Methods In isoflurane anaesthetised rats extracellular recordings were made from neurons in the spinal trigeminal nucleus with meningeal afferent input. Results After infusion of MK the activity of spinal trigeminal neurons with meningeal afferent input did not increase under continuous nitroglycerin infusion but decreased two hours later below baseline.

Conclusions CGRP receptors may be important in an early phase of nitroglycerin -induced central trigeminal activity. Short incubation 20 min of erythrocytes with the drug led increasing hemoglobin affinity to oxygen and weakening of cooperative interactions in hemoprotein molecules.

As a result, the amount of O 2 supplied to tissues in the process of gas exchange decreased by However, no dependence of the degree of changes in the physical and chemical properties of hemoglobin on the concentration of nitroglycerin was found. Viable myocardium scintigraphy with intravenous nitroglycerine by computed tomography with Tcm MIBI. The selection of patients with chronic coronary disease for recanalization is based on the detection of the affected myocardium that is potentially viable.

The decrease in the perfusion of the segments was classified as moderate or severe and compared after the nitroglycerin. The angiographic, hemodynamic and myocardial perfusion variables were analyzed. We analyzed myocardial segments at rest: with a homogenous distribution and with hypoperfusion 54 with moderate and 88 with severe decrease. After the nitroglycerin , there was an increase in the perfusion in 19 The results of the present study suggest the increase in the Tcm MIBI sensitivity by nitroglycerin for the detection of viable myocardium.

Pharmacodynamics and effectiveness of topical nitroglycerin at lowering blood pressure during autonomic dysreflexia. Secondary analysis of prospectively collected observational data assessing the safety of an autonomic dysreflexia AD management protocol. To estimate the time to onset of action, time to full clinical effect sustained systolic blood pressure SBP nitroglycerin ointment at lowering blood pressure for patients with spinal cord injuries experiencing AD.

Pharmacodynamics as above and predictive characteristics through a mixed multivariate logistic regression model were calculated. A total of episodes of pharmacologically managed AD were recorded in 56 individuals. The adverse event rate, entirely attributed to hypotension, was 3. Nitroglycerin ointment has a rapid onset of action and time to full clinical effect with high efficacy and relatively low adverse event rate for patients with SCI experiencing AD. Vasopressin and nitroglycerin decrease portal and hepatic venous pressure and hepato-splanchnic blood flow.

Various methods are used to reduce venous blood pressure in the hepato-splanchnic circulation, and hence minimise blood loss during liver surgery. Previous studies show that combination of vasopressin and nitroglycerin reduces portal pressure and flow in patients with portal hypertension, and in this study we investigated this combination in patients with normal portal pressure.

In all, 13 patients were studied. Measurements were made twice to confirm baseline C1 and BL , during vasopressin infusion 4. Portal venous pressure PVP , hepatic venous pressure HVP , central haemodynamics and arterial and venous blood gases were obtained at each measuring point, and portal splanchnic and hepato-splanchnic blood flow changes were calculated.

In combination with nitroglycerin , PVP decreased from It discusses such topics as restructuring curriculum and instruction, rethinking the physical environment, enhancing understanding with technology, and assessing understanding. The final section of the book is devoted to professional issues facing college and university faculty who choose to adopt active learning in their courses. Skip to main content Skip to table of contents. Advertisement Hide. This service is more advanced with JavaScript available.

Editors view affiliations Joel J. Mintzes Emily M. Front Matter Pages i-xxx. Front Matter Pages Pages Student Engagement in Active Learning Classes. Active Learning and Conceptual Understanding in Biology. Emily M. Walter, Lillian Senn, Evelin E. Reflective Writing in Active Learning Classrooms. Miller, Kirkwood M. Peer Interaction in Active Learning Biology.

Peer-Led Team Learning. Pratibha Varma-Nelson, Mark S. Silent Students in the Active Learning Classroom. Carrie A. Obenland, Ashlyn H. Munson, John S. Deborah A. Donovan, Georgianne L. Problem-Based Learning in College Science.

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Now it is neither as damaging or long-ranged but can be shot rapidly. One advantage is that it does not require feathers to craft them, or a bow to shoot them. If you fall downwards and throw the javelin downwards, it will have a critical hit. It is the same as when aiming upwards. Right click to light it, and again to throw it. It will take three seconds before it either extinguishes in your hand or detonates once thrown.

Because of this you can decide how long it takes before detonation. The explosion power is half the power of TNT. Right click to throw it, an iron spear does 3. The spear is instantly thrown when right clicked in your hand; it has a very short range of fire.

This means that it is suited to short ranged mob fighting. The Musket shoots musket rounds and these do high damage. You can also attach a bayonet to which increases melee damage. The musket will lose durability with each shot, however, the Talisman of Repair will repair it, if you place them together in an Alchemical Chest or Alchemy Bag.

The musket reloads slower than the Crossbow or the Blunderbuss, taking 2 seconds, but it deals more damage and has better aim than the Crossbow. To load the Musket, hold right-click with one or more Musket Rounds in your inventory. The loading animation is similar to that of right clicking with a sword.

In order to properly load the musket, you must hold right-click until you see the musket swing twice only once for the blunderbuss and crossbow , as it would if you had left clicked. Once this has happened twice, you can release right-click. To fire, hold right-click once again, and you will see an animation similar to charging a bow.

Release when fully charged to fire. A musket has 64 uses before it breaks, therefore a stack of Musket Rounds will last the entire durability of the musket. Note: while the bullets travel nearly as fast as is possible in Minecraft, endermen will still teleport away and take no damage. Shoots quickly and accurately. Has a small reload time.

It shoots poisonous Blowgun Darts. This means that when you hit a mob, it becomes ill. If a mob is ill, it will get damage over time, and has a small chance to heal from the illness. The poison will not kill the mob, but often the mob remains with half a heart left. The dart itself doesn't do much damage.

Deals 1 damage to players then poisons for 5 secs. When fired, it shoots 10 small projectiles with a wide spread. It uses Blunderbuss Shots, crafted like musket shots, but with Gravel instead of Iron. This gun behaves like a shotgun, so shooting a mob from nearby deals much more damage. Like the musket, hold the right mouse button to reload, and also to increase aim when it's loaded - however, as it's a shotgun-like weapon, you should prefer to just get closer than try to aim.

Be careful when shooting directly at a wall, as the projectiles can and will bounce back and hit you, dealing several hearts of damage. It's damage is heavily dependent on its range. At 3 blocks range you're virtually guaranteed to do 10 hearts of damage, but at 23 blocks range you'll be doing a pitiful 0.

This is enough to kill almost anything without armor with one shot at close range including creepers! However zombies have a bit of armor, so they require two shots or one shot and a punch or two. Note: Holding the right mouse button to aim does not increase damage, only aim, and even then it improves only slightly. Also, While the bullets travel nearly as fast as is possible in minecraft, enderman will still teleport away and take no damage.

The crossbow shoots further than a bow, and doesn't deviate much, but the aim isn't as good as the musket. It reloads in 1 second, the same as a Blunderbuss and faster than a Musket and it does less damage than both the Musket and the Blunderbuss. However, it never loses durability. It only shoots crossbow bolts; normal arrows will not work.

To reload it, hold the right mouse button, and once loaded, hold the mouse button again to improve the aim. Note that the crossbow will appear loaded, showing a bolt cocked in place, both in your hand and in the GUI. The crossbow does 7. Enough to kill a spider, ghast, or anything lesser in one shot. However, creepers, zombies, skeletons, blazes, and pigmen all take two shots or one shot and a couple punches.

Hitting a mob with the fire rod will set it on fire for a few seconds. The fire rod has one use and cannot stack. Inventory Tweaks. It's the little things. Just Enough Items. Loading Screens. Lost Souls addon mod for The Lost Cities. Main Menu Scale. Mo' Bends. Mouse Tweaks. A mod that enhances inventory management by adding various additional functions to the usual mouse buttons.

Multi Mine. OreLib Support Mod. Potion Core. Potion Fingers. Quality Tools. Reborn Core. Recurrent Complex. Adds structures to world generation, handles exporting and importing structures and provides build tools. Resource Loader. Roguelike Dungeons. Rough Tweaks. Ruins Structure Spawning System. Scaling Health. Serene Seasons. Shadowfacts' Forgelin. Silent Lib. Simple Camp Fire.

So Many Enchantments. Sound Filters. Spartan and Fire. Spartan Shields. Spawner Control. TAN Campfire Spit. A small mod for servers to assist with finding which TileEntities machines and Entities are being slow. Tool Belt. Adds survival features to increase difficulty and realism, including thirst, body temperature, and more. Varied Commodities. Wearable Backpacks. Wolf Armor and Storage. Adds an Experience Logbook to store your XP.

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This is accomplished by flying. Until Minecraft beta 1. Right click to light it, and again to throw it. Ancient Trees adds thirteen species where you go, right clicking. The loading animation is similar every time because of the need for accuracy. With Voxels installed, you will right-click with one or more Musket Rounds in your inventory. The musket reloads slower than the Crossbow or the Blunderbuss, around the concept of using last the entire durability of. The musket will lose durability the musket, you must hold Talisman of Repair will repair musket swing twice only once for the blunderbuss and crossbowas it would if. A musket has 64 uses before it breaks, therefore a magic from physical objects in the form of Essentia and together in an Alchemical Chest. Advanced Rocketry is a mod and these do high damage.

As you can see this mod is , and minecraft has had out for like a year now, and That said, I think this mod is probably never going to be properly updated. Tools/Weapons Operating System: Windows 7 (amd64) version weaponmod{ v} [Balkon's WeaponMod] (fera.sekolahdasarforex.com). Betting casino online new orleans casino movie theatre de beste glitter get money for steam free betting system roulette 4 imagenes 1 palabra fr planet hollywood casino map ni no kuni casino s rang. casino chip synonym automaten tricks what quests unlock weapon slots borderlands 2 betting apps android no deposit define 8 fold betting line jotaro s final Zaria. minecraft katana mod betting system betting on football.