Because of their potent and efficacious analgesic effects, opioids are the most commonly used medication for perioperative pain and pain as a result of cancer; however, their uses are extended to other conditions including cough 1 and diarrhoea. 2 Despite this, they are associated with a wide range of adverse effects such as tolerance, nausea and vomiting and respiratory depression. 3 In addition, long-term use of opioids may cause hormonal disturbances secondary to hypothalamic-pituitary malfunction. 4 Moreover, the presence of opioid receptors in non-CNS tissues results in various systemic impacts. 5 In addition opioids can modulate immune function at non-leucocyte targets. 6 Opioid receptors are members of the G protein coupled receptor (GPCR) superfamily. 7 Classical naloxone sensitive opioid receptors are classified as MOP (μ; mu), DOP (δ: delta) and KOP (κ: kappa). In addition the non-classical receptor for Nociceptin/ OrphaninFQ (N/OFQ), NOP, is a member of this family. 8 NOP is naloxone insensitive. Once endogenous ligands or exogenous drugs stimulate opioid receptors, two activation pathways are engaged. 9 The most well known pathway involves G-protein (guanine nucleotide binding protein) activation and subsequent inhibition of adenylyl cyclase (reducing cyclic AMP), activation of an outward K + current and closing of voltage gated Ca 2+ channels. 10 The second, pathway is responsible for receptor desensitization via internalization. 11 Opioid receptors are phosphorylated by GPCR kinases, resulting in the recruitment of β-arrestin and the non-receptor tyrosine kinase C-Src. This complex is internalized in clathrin-lined pits before either recycling to the cell surface or degradation. 10-12 Both pathways may end with stimulation of mitogen-activated protein kinases (MAPK); particularly extracellular-signal-regulated kinases(ERK) 1 and 2 pathway 10 and both are linked.
Introduction: Early detection of vascular alterations associated with disease can play a key role in diagnosis and evaluation of treatment strategies. Ultrasound is commonly used for real-time assessment of human blood vessels but the efficacy of preclinical ultrasound at providing a quantitative assessment of mouse models of vascular disease is relatively unknown. In this study, preclinical ultrasound was used in combination with a semi-automatic image processing method to track arterial distension alterations in mouse models of abdominal aortic aneurysm (AAA) and atherosclerosis. Methods: Longitudinal B-mode ultrasound images of the abdominal aorta were acquired using a preclinical ultrasound scanner. Arterial distension was assessed using a semi-automatic image processing algorithm to track vessel wall motion over the cardiac cycle and a standard, manual analysis method was applied for comparison. Results: Mean arterial distension was significantly lower in AAA mice between day 0 and day 7 post-onset of disease (p<0.01) and between day 0 and day 14 (p<0.001), while no difference was observed in sham control mice. The manual method detected a significant decrease (p<0.05) between day 0 and day 14 only. Atherosclerotic mice showed alterations in arterial distension relating to genetic modification and diet. Arterial distension was significantly lower (p<0.05) in Ldlr-/-(++/-) mice fed high fat western diet when compared with both wild type (++/++) mice and Ldlr-/-(++/-) mice fed chow diet. The manual method did not detect a significant difference between these groups. Conclusions: Arterial distension can be used as an early marker for the detection of arterial disease in small animal models. The semi-automatic analysis method provided increased sensitivity to differences between experimental groups when compared to the manual analysis method. Furthermore, a retrospective power calculation revealed that use of the semi-automatic method reduces the number of animals required per experiment.
Isolated bilateral absence of radial artery in association with other congenital anomalies, together named VACTERL (vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities) is a very rare phenomenon. We report a patient, known to have VACTERL association, and who presented with ESRD. He was on hemodialysis and had been subjected to multiple failed tries at vascular access due to congenital bilateral absence of radial arteries and other vascular anomalies. This case report highlights hemodialysis options in congenital bilateral absence of radial artery and probable VACTERL association showing superiority of arteriovenous fistula despite its accompanying complications. Key words: VACTERL; Abnormalities, Multiple / classification; Kidney / abnormalities; Limb Deformities, Congenital; Bilateral absent radial artery; Hemodialysis; AV fistula, Failure; AV fistula, Complications Abbreviations: VACTERL - Vertebral defects, Anal atresia, Cardiac defects, Tracheo-esophageal fistula, Renal anomalies, and Limb abnormalities; AVF - Arteriovenous fistula; ESRD - End-stage renal disease; AVG - Arteriovenous graft; CVC - Central venous catheter Citation: Kareem G, Mahbuba W. Difficult vascular access for hemodialysis in congenital bilateral absence of radial artery and probable VACTERL association: a case report. Anaesth. pain intensive care 2022;26(3):559-562. DOI: 10.35975/apic.v26i4.1966 Received: June 05, 2022; Reviewed: June 12, 2022; Accepted: June 17, 2022
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.