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Background: Obstetric induction procedures are expensive, and little is known of the specific difference in cost between inpatient and outpatient protocols for these procedures. Objective: The objective of this study was to examine the difference in health care costs, maternal and neonatal morbidity, and cesarean birth rates for inpatient versus outpatient Foley induction protocols. Material and methods: We conducted a retrospective study using deliveries from 2013 to 2015 that received an outpatient or inpatient Foley catheter induction. Inductions were matched by race, parity, and maternal age. We used univariate and multivariate logistic regression to test the association between type of induction, length of stay, and cost. Maternal and neonatal factors and cesarean rates were also considered. Results: A total of 163 outpatient Foley inductions were matched 1:1 to inpatient inductions. Outpatient inductions were more likely to have a shorter length of hospitalization from admission to discharge (a 7.17‐hour difference, 95% CI, 71.00, 77.59) and lower costs of hospitalization ($408 per patient, 95% CI, 4305, 4714). In the univariate analysis, there was no difference in rate of cesarean birth (OR 0.95, 95% CI, 0.61, 1.48). However, in the multivariate analysis, there was a decreased rate of cesarean for outpatient inductions (OR 0.5, 95% CI, 0.26, 0.97). Conclusions: Outpatient Foley catheter induction appears to be a safe, cost‐effective method for induction of labor. Generating protocols allowing patients to receive quality care in an outpatient setting is increasingly important in current health care environments. [ABSTRACT FROM AUTHOR]

Wide use is made of β-agonists in therapy due to their smooth muscle–relaxant properties. They also have a side effect of increasing muscle mass. Besides improving oxygen utilisation as bronchodilators, β-agonists increase protein synthesis and promote fat burning. The growth- and performance-enhancing effects are often exploited in illegal use. The guiding objective of this study was to develop a procedure for the determination of β-agonists by a single method in different types of matrices. Five grams of homogenised samples were subjected to enzymatic hydrolysis with β-glucuronidase in ammonium acetate, pH 5.2. Purification was performed by solid phase extraction. Analytes were eluted with 10% acetic acid in methanol. The eluted β-agonists were analysed by high-performance liquid chromatography–tandem mass spectrometry. Validation results met the requirement of the confirmation criteria according to European Commission Decision 2002/657/EC in terms of apparent recoveries (93.2–112.0%), repeatability (3.1–7.1%) and intra-laboratory reproducibility (4.1–8.2%). The method can be successfully applied in the detection and determination of clenbuterol, salbutamol, mabuterol, mapenterol, terbutaline, brombuterol, zilpaterol, isoxsuprine and ractopamine in feed, drinking water, urine, muscle, lung and liver matrices. [ABSTRACT FROM AUTHOR]

Urethral obstruction is always an emergency for male ferrets and can lead to hyperkalemia. Surgical treatment under general anesthesia can be required. Untreated hyperkalemia before anesthetic induction can be fatal. A 2-year-old, 1.01 kg, neutered male ferret (Mustela putorius furo) was presented for lethargy, hematuria, and stranguria. Radiographs revealed urolithiasis involving the bladder and urethra. When presented for anesthesia, the ferret had hyperkalemia. Before anesthesia, the potassium was normalized rapidly through a combination of saline, dextrose, insulin, and terbutaline. Terbutaline was added to the therapeutic regime as a result of persistent hyperkalemia. Severe hypotension developed during anesthesia which can be partially attributed to the peripheral vasodilatory effect of terbutaline. Hypoglycemia developed as a result of failure to monitor blood glucose level frequently during surgery and suboptimal regime used for insulin and dextrose. Potassium level in a hyperkalemic ferret can be normalized before anesthesia with a combination of therapeutic agents like saline, sodium bicarbonate, insulin, and dextrose. In a case of persistent hyperkalemia, terbutaline can be added to the therapeutic plan. It is important that blood pressure and blood glucose level are monitored closely to prevent hypotension possibly due to terbutaline and hypoglycemia as a result of insulin. The purpose of this report is to describe a case of a ferret with hyperkalemia that needed rapid correction before anesthesia. [ABSTRACT FROM AUTHOR]

Objective: Current treatments for blast-induced lung injury are limited to supportive procedures including mechanical ventilation. The study aimed to investigate the role of post-trauma-induced oedema generation in the function of time and trauma intensity and the probable role of beta 2-adrenergic receptors (β2-ARs) agonists on pulmonary oedema. The study is conducted using an ex vivo model after an experimental in vivo blast-induced thorax trauma in rats. Methods: Rats were randomised and divided into two groups, blast and sham. The blast group were anaesthetised and exposed to the blast wave (3.16 ± 0.43 bar) at a distance of 3.5 cm from the thorax level. The rats were sacrificed 10 min after the blast, the lungs explanted and treated with terbutaline, formoterol, propranolol or amiloride to assess the involvement of sodium transport. Other groups of rats were exposed to distances of 5 and 7 cm from the thorax to reduce the intensity of the injury. Further, one group of rats was studied after 180 min and one after 360 min after a 3.5 cm blast injury. Sham controls were exposed to identical procedures except for receiving blast overpressure. Results: Lung injury and oedema generation depended on time after injury and injury intensity. Perfusion with amiloride resulted in a further increase in oedema formation as indicated by weight gain (p < 0.001), diminished tidal volume (Tv) (p < 0.001), and increased airway resistance (p < 0.001). Formoterol caused a significant increase in the Tv (p < 0.001) and a significant decrease in the airway resistance (p < 0.01), while the lung weight was not influenced. Trauma-related oedema was significantly reduced by terbutaline in terms of lung weight gain (p < 0.01), Tv (p < 0.001), and airway resistance (p < 0.01) compared to control blast-injured lungs. Terbutaline-induced effects were completely blocked by the β-receptor antagonist propranolol (p < 0.05). Similarly, amiloride, which was added to terbutaline perfusion, reversed terbutaline-induced weight gain reduction (p < 0.05). Conclusions: β2-adrenoceptor stimulation had a beneficial impact by amiloride-dependent sodium and therefore, fluid transport mechanisms on the short-term ex vivo oedema generation in a trauma-induced in vivo lung injury of rats.

Objective: To investigate the effect of Azithromycin Sequential Therapy Combined with terbutaline sulfate on pulmonary function and serum levels of interleukin-6 (IL-6), procalcitonin (PCT) and C-reactive protein (CRP) in children with Mycoplasma pneumoniae pneumonia (MPP). Methods: 80 children with MPP were selected from January 2018 to December 2019, and they were divided into control group (40 cases, azithromycin sequential treatment) and experimental group (40 cases, Azithromycin combined with terbutaline sulfate treatment) according to the order of admission. The curative effect, clinical symptom remission time, lung function, adverse reactions and serum inflammatory factors were compared between the two groups. Results: The recovery time of chest X-ray, hospitalization time, rales disappearance time, fever abatement time and cough disappearance time of the experimental group were shorter than those of the control group (P<0.05). The clinical total effective rate of the experimental group after treatment was 95.00% (38/40), which was higher than 77.50% (31/40) of the control group (P<0.05). After treatment, forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), peak expiratory flow rate (PEF) of the experimental group were higher than those of the control group, while IL-6, PCT and CRP of the experimental group were lower than those of the control group (P<0.05). There was no difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion: Azithromycin Sequential Therapy Combined with terbutaline sulfate in the treatment of MPP children can effectively relieve the clinical symptoms, reduce the inflammatory reaction and improve the lung function of children, with mild adverse reactions and significant synergistic effect. [ABSTRACT FROM AUTHOR]

Sensitive and simple colorimetric method was developed for determination of methyldopa and terbutaline sulphate in pure and pharmaceutical dosage forms. The method was based on reduction of silver ions by the cited drugs in basic medium at 90 °C to silver nanoparticles in the presence of stabilizing agent as polyvinylpyrrolidone. The formed silver nanoparticles were distinguished by UV-Vis absorption spectroscopy indicating the characteristic surface plasmon resonance which can be also observed as intense yellow color solution. The plasmon absorbance of the silver nanoparticles was measured at 410 nm for quantitative estimation of methyldopa and terbutaline sulphate over the range of 80-480 and 40-600 ng/mL respectively. Limit of detection was obtained as 26, 13 ng/mL for methyldopa and terbutaline sulphate respectively. The eco-friendly developed method could be successfully applied to the pharmaceutical formulations with studying the interference of different excipients. [ABSTRACT FROM AUTHOR]

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In sections 2.4. and 2.5. of the originally published version of the article, the information provided about the manufacturer and distributor of the bipolar disk electrode SEN‐15‐2 was incorrect. The correct name of the company manufacturing and distributing the device is MSB‐MET Ltd, Balatonfüred, Hungary.We apologize for this error. [Extracted from the article]

Neonatal ventricular tachycardia (VT) is an extremely rare condition. We present a 35-week-old gestation neonate who developed tachycardia following maternal exposure to terbutaline. Upon transfer to our neonatal intensive care unit, an electrocardiogram (ECG) was obtained which was consistent with VT. The arrhythmia did not respond to vagal maneuvers or adenosine but resolved following cardioversion demonstrated on postcoversion ECG. At outpatient follow-up, the infant had no further episodes of arrhythmia. To the best of our knowledge, this represents the first case describing terbutaline-induced fetal or neonatal VT.

In order to obtain high yield and product quality of terbutaline sulfate, the synthetic method of terbutaline sulfate is studied. Terbutaline sulfate is synthesized from 3,5-dibenzyloxyacetophenone by bromination, alkylation reaction, carbonyl reduction and catalytic hydrodebenzylation. The reaction conditions and parameters are optimized and improved. Bromination is optimized,with tetrahydrofuran and methanol as solvents,tetrabutylammonium tribromide is used instead of liquid bromide and copper bromide as bromination reagent, n(3,5-dibenzyloxyacetophenone)∶n(tetrabutyl ammonium bromide)=1∶1.3,the reaction time could be reduced to 6 hours, and the yield is up to 99.1%.In condensation reaction, with benzyl tert-butylamine instead of tert-butylamine,n(3, 5-dibenzyloxy-alpha-Bromoacetophenone)∶n(benzyl tert-butylamine)=1∶3, the yield is 69.9%. In catalytic hydrodebenzylation, the amount of Raney Ni is 15% in solvent methanol, the pressure is 1.0 MPa,temperatuer is 40 ℃,and the yield is up to 90.2%. Under the optimized conditions,the total yield is 62.4%,and the purity is 99.90%(by HPLC), the impurities are less than 0.1%. The structures of the target compound are confirmed by 1H-NMR and 13C-NMR. The improved synthesis process with mild reaction conditions, simple operation, and high yield is more suitable for industrial production.

ObjectiveHypersympathetic activity is prominent in rheumatoid arthritis, and major life stressors precede onset in ~80% of patients. These findings and others support a link between stress, the sympathetic nervous system and disease onset and progression. Here, we extend previous research by evaluating how selective peripherally acting α/β2-adrenergic drugs affect joint destruction in adjuvant-induced arthritis.MethodsComplete Freund’s adjuvant induced inflammatory arthritis in male Lewis rats. Controls received no treatment. Arthritic rats then received vehicle or twice-daily treatment with the α-adrenergic antagonist, phentolamine (0.5 mg/day) and the β2-adrenergic agonist, terbutaline (1200 µg/day, collectively named SH1293) from day (D) of disease onset (D12) through acute (D21) and severe disease (D28). Disease progression was assessed in the hind limbs using dorsoplantar widths, X-ray analysis, micro-computed tomography, and routine histology on D14, D21, and D28 post-immunization.ResultsOn D21, SH1293 significantly attenuated arthritis in the hind limbs, based on reduced lymphocytic infiltration, preservation of cartilage, and bone volume. Pannus formation and sympathetic nerve loss were not affected by SH1293. Bone area and osteoclast number revealed high- and low-treatment-responding groups. In high-responding rats, treatment with SH1293 significantly preserved bone area and decreased osteoclast number, data that correlated with drug-mediated joint preservation. SH1293 suppressed abnormal bone formation based on reduced production of osteophytes. On D28, the arthritic sparing effects of SH1293 on lymphocytic infiltration, cartilage and bone sparing were maintained at the expense of bone marrow adipocity. However, sympathetic nerves were retracted from the talocrural joint.Conclusion and SignificanceOur findings support a significant delay in early arthritis progression by treatment with SH1293. Targeting sympathetic neurotransmission may provide a strategy to slow disease progression.

Objective: Hypersympathetic activity is prominent in rheumatoid arthritis, and major life stressors precede onset in ~80% of patients. These findings and others support a link between stress, the sympathetic nervous system and disease onset and progression. Here, we extend previous research by evaluating how selective peripherally acting α/β2-adrenergic drugs affect joint destruction in adjuvant-induced arthritis. Methods: Complete Freund's adjuvant induced inflammatory arthritis in male Lewis rats. Controls received no treatment. Arthritic rats then received vehicle or twice-daily treatment with the α-adrenergic antagonist, phentolamine (0.5 mg/day) and the β2-adrenergic agonist, terbutaline (1200 µg/day, collectively named SH1293) from day (D) of disease onset (D12) through acute (D21) and severe disease (D28). Disease progression was assessed in the hind limbs using dorsoplantar widths, X-ray analysis, micro-computed tomography, and routine histology on D14, D21, and D28 post-immunization. Results: On D21, SH1293 significantly attenuated arthritis in the hind limbs, based on reduced lymphocytic infiltration, preservation of cartilage, and bone volume. Pannus formation and sympathetic nerve loss were not affected by SH1293. Bone area and osteoclast number revealed high- and low-treatment-responding groups. In high-responding rats, treatment with SH1293 significantly preserved bone area and decreased osteoclast number, data that correlated with drug-mediated joint preservation. SH1293 suppressed abnormal bone formation based on reduced production of osteophytes. On D28, the arthritic sparing effects of SH1293 on lymphocytic infiltration, cartilage and bone sparing were maintained at the expense of bone marrow adipocity. However, sympathetic nerves were retracted from the talocrural joint. Conclusion and Significance: Our findings support a significant delay in early arthritis progression by treatment with SH1293. Targeting sympathetic neurotransmission may provide a strategy to slow disease progression. [ABSTRACT FROM AUTHOR]

Abstract: Experimental data have suggested that in neuropathic pain, tricyclic antidepressants may work solely through a β2-agonist action. The aim of this study was to test if the β2-agonist terbutaline relieves painful polyneuropathy. The study was a randomized, double-blind, placebo-controlled and active-controlled, 3-way, cross-over trial among patients with painful polyneuropathy. The treatment periods were of 5 weeks' duration and were preceded by 1 week for washout and 1 week for baseline observations. The patients received terbutaline (5-15 mg), imipramine (30-150 mg), or placebo in a random order. Drug doses depended on age and metabolizer status. The change in total pain recorded from ratings in diaries (numeric rating scale [NRS] 0-10) was the primary outcome, and the change in rating of specific pain symptoms (NRS 0-10), patient global impression of change, and sleep disturbance were secondary outcomes. Forty-seven patients were randomized. The median score for total pain changed from NRS 6.4 to 6.1 from baseline to week 5 on terbutaline with an average effect during the treatment period as compared with placebo of 0.13 (95% confidence interval -0.12 to 0.38, P = 0.32). The median score for total pain on imipramine changed from NRS 6.6 to 4.8 with an average effect as compared with placebo of -1.17 (95% confidence interval -1.42 to -0.92, P < 0.001). Secondary outcomes were also unaltered by terbutaline but improved by imipramine. The β2-agonist terbutaline has no effect in painful polyneuropathy. β2-agonism seems not to be an important mechanism of action of tricyclic antidepressants in neuropathic pain. [ABSTRACT FROM AUTHOR]

Introduction: Budesonide-formoterol taken as needed is an emerging treatment for mild asthma. Objective: We used data from the SYGMA studies to assess the safety of As-needed budesonide-formoterol compared with As-needed terbutaline and compared with maintenance budesonide. Methods: SYGMA 1 and 2 were 52-week, double-blind, parallel-group studies in patients aged ≥ 12 years with physician-assessed mild asthma. Patients were randomized to As-needed budesonide-formoterol 200/6 μg, twice-daily budesonide 200 μg as maintenance plus As-needed terbutaline 0.5 mg, and As-needed terbutaline 0.5 mg (SYGMA 1 only). Adverse events (AEs), serious AEs (SAEs), discontinuations due to AEs (DAEs), and study-defined asthma-related discontinuations from corresponding treatment groups in both studies were pooled. SYGMA 1 data were used for comparisons with As-needed terbutaline alone. Results: The pooled analysis included 3366 patients in the As-needed budesonide-formoterol group and 3369 in the budesonide maintenance group, with AEs in 40.8% and 42.5% of patients, respectively. Common AEs included viral upper respiratory tract infection (viral URTI) and URTI. SAE, DAE, and asthma-related discontinuation rates were similar with As-needed budesonide-formoterol and maintenance budesonide. Potential local and systemic corticosteroid class effects were reported in ≤ 1% of patients for each budesonide-containing regimen. In SYGMA 1, AEs were more common in the As-needed terbutaline (n = 1277) than As-needed budesonide-formoterol (n = 1277) groups (42.7 vs. 38.0%), as were DAEs (2.9 vs. 0.8%) and asthma-related discontinuations (1.6 vs. 0.3%). Conclusions: Budesonide-formoterol anti-inflammatory reliever therapy is generally well-tolerated in patients with mild asthma and has a safety profile similar to that of daily budesonide. No new safety signals were identified. ClinicalTrial.gov Identifiers: NCT02149199 (SYGMA 1) and NCT02224157 (SYGMA 2). [ABSTRACT FROM AUTHOR]