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Background: Vagal nerve denervation during the heart transplant procedure results in higher resting heart rates in these recipients compared to the general population. Relative bradycardia (RB) is a common and often temporary post‐operative complication that can be managed with agents like terbutaline; however, little data exist on the efficacy, safety, and necessity of long‐term terbutaline use post‐heart transplant. Methods: This was a single‐center, retrospective, descriptive study conducted at a large academic medical center investigating oral terbutaline use for RB management in heart transplant recipients. Outcomes included time to and reason for terbutaline discontinuation post‐transplant, adverse event rates, and permanent pacemaker (PPM) placement rates. Results: In the 229 patients included, the median (IQR) time to terbutaline initiation was 8 (5, 12) days post‐heart transplant, with a median (IQR) time to discontinuation of 56 (20, 96) days from the first dose. In most cases, terbutaline was successfully tapered off outpatient due to the resolution of RB. Tachyarrhythmias occurred in 29 (12.7%) patients without long‐term sequelae. At 3 months post‐transplant, PPM had been placed for chronotropic support in 15 patients (6.6%) with a median time (IQR) to PPM placement of 24 (19, 77) days from transplant. Conclusion: This study's overall low PPM placement rate suggests that early sinus node dysfunction can be treated with pharmacotherapy without committing to a permanent device, and that terbutaline can be used safely in early post‐heart transplant recipients. If patients require long‐term chronotropic support, the risk‐benefit of PPM placement versus continued terbutaline should be considered. [ABSTRACT FROM AUTHOR]

This study presents a new method for simultaneous determination of fenoterol, procaterol, clenbuterol, terbutaline and isoprenaline drugs using thin-layer chromatography assisted by image analysis (HPTLC-IA) combined with sensitive detection modes. Separation of the selected drugs was obtained using HPTLC Silica gel 60 F254 plates and mixture of isopropyl alcohol, ethyl acetate and ammonia (20:25:1.5 v/v/v) as mobile phase. UV detection mode combined with the use of 2,2-diphenyl-1-picrylhydrazyl (DPPH•) and 2,2'-azino-bis (3-ethylbenzothiazoline)-6-sulfonic acid (ABTS+•) radicals were applied for the first time for sensible detection of the separated drugs. Grey, green, red and blue scales respectively were selected for image analysis and accurate quantification of spot area. According to the obtained result, the use of DPPH• and ABTS+• reagents revealed a higher sensitivity in detection and accurate quantification of the analyzed drugs. Lower limit of detection (LOD = 0.07 ± 0.03 µg/spot; 0.09 ± 0.03 µg/spot and 0.10 ± 0.04 µg/spot) was obtained for fenoterol, procaterol and terbutaline using the ABTS+• radical and red scale selection for image processing. With the exception of isoprenaline, the proposed HPTLC-IA method showed a good separation of fenoterol, procaterol, clenbuterol and terbutaline drugs from other compounds in urine samples. Good recovery was obtained for these drugs in spiked urine samples. [ABSTRACT FROM AUTHOR]

Determination and evaluation active substances in chemical settings is extremely difficult, linked to chemical waste in water sewage, and may eventually have an influence on public health. As a result, efforts are being made globally to find other, perhaps less hazardous ways. Hereby, we aimed to determine two pharmaceutical products for the detection of phenylephrine hydrochloride and terbutaline sulphate using green chemistry. The procedure involves oxidizing phenylephrine hydrochloride and terbutaline sulphate using potassium permanganate as an oxidant and decolorizing the surplus of potassium permanganate in the reaction with Nile blue dye. The results confirmed that this method has provided easy and precise evaluation of phenylephrine hydrochloride and terbutaline sulphate at concentrations ranging from (0.4-4.5) µg /ml, with molar absorption capacity of (6.9x104 ) l‧mol-1 ‧cm -1 for phenylephrine hydrochloride and (1.44×105 ) l‧mol-1 ‧cm-1 for terbutaline sulphate. The methodologies have precisely determined the pharmaceutical dosage forms of the tested drugs, agreeing with previously tested and stated values and standard compounds. [ABSTRACT FROM AUTHOR]

Objective: To describe the clinical course and treatment of 3 dogs with peripheral vasopressor extravasation. Case Series Summary: Although vasopressor extravasation (VE) is a well‐documented complication in human medicine, literature describing VE and its management in veterinary patients is sparse. VE increases patient morbidity by causing local tissue injury and necrosis. The gold standard treatment for VE, phentolamine, has been periodically limited in supply in human medicine and is not consistently available for use in veterinary medicine. An alternative protocol proposed for use in people with VE combines topical nitroglycerin application with subcutaneous terbutaline infiltration. In this report, a treatment protocol utilizing these therapies was used to treat 3 dogs with VE and secondary tissue injury. New or Unique Information Provided: This report describes 3 cases of VE‐induced tissue injury in dogs. In addition, this report describes the use of perivascular terbutaline infiltration and topical nitroglycerin application as therapeutic management for VE in dogs. [ABSTRACT FROM AUTHOR]

Recently, the diagnosis of autism spectrum disorder (ASD) has increased from 1 in 150 to every 1 in 36 children in the United States, warranting a need for novel prevention and therapeutic strategies. Broad-spectrum cannabidiol oil, free from delta-9-tetrahydrocannabinol, the psychoactive component of cannabis, may be one such therapeutic. It has a high safety profile and is frequently used as a complementary and integrative intervention by persons experiencing symptoms of anxiety, stress, and inflammation. Using a neurodevelopmental rat model of ASD (based on neuroinflammation induced by stress and terbutaline exposure during pre- and postnatal development), we sought to prevent the development of ASD-like behaviors in male offspring by administering broad-spectrum cannabidiol oil to dams throughout pregnancy (10 mg/kg, i.p., daily, embryonic days 3–16). To assess an ASD-like phenotype in the offspring, we used three behavioral measures relevant to three core ASD symptoms: 1) social communication (time spent vocalizing when alone); 2) repetitive behavior (marbles buried during a marble burying test); and 3) social interaction (time spent interacting with a novel conspecific during the three-chamber social interaction test). Broad-spectrum cannabidiol oil given during pregnancy decreased scores for all three ASD-related behavioral responses, resulting in an overall significant prevention of the ASD-like phenotype. These findings highlight the potential of broad-spectrum cannabidiol oil as a complementary and integrative approach for prevention of stressor-induced sequelae relevant to development of an ASD-like phenotype.

Abstract Background An improper host immune response to Mycoplasma pneumoniae generates excessive inflammation, which leads to the impairment of pulmonary ventilation function (PVF). Azithromycin plus inhaled terbutaline has been used in the treatment of Mycoplasma pneumoniae pneumonia (MPP) in children with impaired pulmonary function, but previous randomized controlled trials (RCTs) showed inconsistent efficacy and safety. This study is aimed to firstly provide a systematic review of the combined therapy. Methods This study was registered at the International Prospective Register of Systematic Reviews (PROSPERO CRD42023452139). A PRISMA-compliant systematic review and meta-analysis was performed. Six English and four Chinese databases were comprehensively searched up to June, 2023. RCTs of azithromycin sequential therapy plus inhaled terbutaline were selected. The revised Cochrane risk of bias tool for randomized trials (RoB2) was used to evaluate the methodological quality of all studies, and meta-analysis was performed using Stata 15.0 with planned subgroup and sensitivity analyses. Publication bias was evaluated by a funnel plot and the Harbord’ test. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation recommendations. Results A total of 1,938 pediatric patients from 20 RCTs were eventually included. The results of meta-analysis showed that combined therapy was able to significantly increase total effectiveness rate (RR = 1.20, 95%CI 1.15 to 1.25), forced expiratory volume in one second (SMD = 1.14, 95%CIs, 0.98 to 1.29), the ratio of forced expiratory volume in one second/forced vital capacity (SMD = 2.16, 95%CIs, 1.46 to 2.86), peak expiratory flow (SMD = 1.17, 95%CIs, 0.91 to 1.43). The combined therapy was associated with a 23% increased risk of adverse reactions compared to azithromycin therapy alone, but no significant differences were found. Harbord regression showed no publication bias (P = 0.148). The overall quality of the evidence ranged from moderate to very low. Conclusions This first systematic review and meta-analysis suggested that azithromycin sequential therapy plus inhaled terbutaline was safe and beneficial for children with MPP. In addition, the combined therapy represented significant improvement of PVF. Due to lack of high-quality evidence, our results should be confirmed by adequately powered RCTs in the future.

Background: An improper host immune response to Mycoplasma pneumoniae generates excessive inflammation, which leads to the impairment of pulmonary ventilation function (PVF). Azithromycin plus inhaled terbutaline has been used in the treatment of Mycoplasma pneumoniae pneumonia (MPP) in children with impaired pulmonary function, but previous randomized controlled trials (RCTs) showed inconsistent efficacy and safety. This study is aimed to firstly provide a systematic review of the combined therapy. Methods: This study was registered at the International Prospective Register of Systematic Reviews (PROSPERO CRD42023452139). A PRISMA-compliant systematic review and meta-analysis was performed. Six English and four Chinese databases were comprehensively searched up to June, 2023. RCTs of azithromycin sequential therapy plus inhaled terbutaline were selected. The revised Cochrane risk of bias tool for randomized trials (RoB2) was used to evaluate the methodological quality of all studies, and meta-analysis was performed using Stata 15.0 with planned subgroup and sensitivity analyses. Publication bias was evaluated by a funnel plot and the Harbord' test. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation recommendations. Results: A total of 1,938 pediatric patients from 20 RCTs were eventually included. The results of meta-analysis showed that combined therapy was able to significantly increase total effectiveness rate (RR = 1.20, 95%CI 1.15 to 1.25), forced expiratory volume in one second (SMD = 1.14, 95%CIs, 0.98 to 1.29), the ratio of forced expiratory volume in one second/forced vital capacity (SMD = 2.16, 95%CIs, 1.46 to 2.86), peak expiratory flow (SMD = 1.17, 95%CIs, 0.91 to 1.43). The combined therapy was associated with a 23% increased risk of adverse reactions compared to azithromycin therapy alone, but no significant differences were found. Harbord regression showed no publication bias (P = 0.148). The overall quality of the evidence ranged from moderate to very low. Conclusions: This first systematic review and meta-analysis suggested that azithromycin sequential therapy plus inhaled terbutaline was safe and beneficial for children with MPP. In addition, the combined therapy represented significant improvement of PVF. Due to lack of high-quality evidence, our results should be confirmed by adequately powered RCTs in the future. [ABSTRACT FROM AUTHOR]

A spectrophotometric method has been developed for the determination of certain amine-phenol-containing drugs, namely, adrenaline, phenylephrine hydrochloride, and terbutaline sulfate. The method depends on the formation of new products by the reaction of drugs with the Gibbs reagent (2,6-dichloroquinone-4-chloroamide) in a basic borate buffer medium with a pH value of 11. The products were measured at 475, 652.5, and 547 nm for the aforementioned drugs, respectively. Beer–Lambert law was obeyed in the ranges of 0.3–9.5, 0.5–17, and 0.5–55 µg/mL with average recovery of 101.10, 99.13, and 99.78% and a relative standard deviation of ≤3.31%, respectively. The method was free from excipient interferences and applied successfully for the assay of the studied drugs in their pharmaceutical formulations. The resulting products were found in the ratio of 1 : 1. [ABSTRACT FROM AUTHOR]

BACKGROUND: Terbutaline is the drug of choice for asthma patients but it exists in racemic mixture. (R)‐(−)‐terbutaline is 200 times more active than (S)‐(+)‐terbutaline yet it is not advisable to prescribe racemic mixture due to certain adverse effects of (S)‐(+)‐terbutaline. Therefore, a fast, effective and reproducible separation method is necessary. RESULTS: Chiral separation was achieved on Chiralpak‐IE and Chiralpak‐IG columns (250 × 4.6 mm, 5 μm) using carbon dioxide‐methanol (CO2‐MeOH, 60:40) with a 0.2% triethylamine mobile phase. The flow was 1.0 mL min−1 with detection at 223 nm using a photodiode array (PDA) detector. The values of retention, separation and resolution factors were in the ranges 1.88–2.38, 1.14–1.26 and 0.91–1.17, respectively; with best separation with Chiralpak‐IE. The tailing factors and number of theoretical plates were in the range of 1.0–1.23 and 487–3699. The purity of the separated peaks was determined by ultra‐performance liquid chromatography–mass spectrometry (UPLC–MS); indicating 100% purity of the peaks. The chiral recognition was determined by modeling with binding affinities −5.0 and −6.0 for S‐ and R‐enantiomers, respectively; indicating S‐enantiomer elution first followed by R‐enantiomers. The major forces responsible for the chiral resolution were hydrogen bonding and π‐π interactions. CONCLUSION: Owing to the great demand for optically active pure drugs and high economic pressure on analytical techniques, the chiral separation of terbutaline was achieved via inexpensive supercritical fluid chromatography. The reported method may be used to prepare optically active pure terbutaline drugs (R‐enantiomers) at a pilot scale. © 2024 Society of Chemical Industry (SCI). [ABSTRACT FROM AUTHOR]

Lung cancer is a type of cancer that is mostly diagnosed at an advanced stage and has a short survival time despite standard chemotherapy and targeted therapies. Terbutaline and Orciprenaline are bronchodilator agents that are potent and selective β2 receptor agonists. The purpose of this study was to investigate to evaluate the effects of Terbutaline and Orciprenaline on A549 human lung carcinoma cell line and Beas-2b human bronchial epithelial cell line. Cells were treated with 1, 10, 100, 200, 400 μM concentrations of Terbutaline and Orciprenaline. 3- (4,5-Dimethylthiazol-2-yl)-2,5-Diphenyltetrazolium Bromide (MTT) assay and xCELLigence real-time cell analyzer were used to determine their effects on cell viability. The cell index was monitored continuously by visualizing the impedance of the E-plate wells. Because of the roles of Glycogen Synthase Kinase 3β (GSK3β) in a diverse range of cellular processes like metabolism, cell proliferation, differentiation and survival and its key position at several signaling pathways, GSK3β inhibition by Terbutaline and Orciprenaline was also investigated. The results showed that Terbutaline and Orciprenaline inhibits GSK-3β. The overall results led to the conclusion that Terbutaline and especially Orciprenaline may have potential therapeutic effects in lung carcinoma. [ABSTRACT FROM AUTHOR]

The study investigated the formation of cobalt, nickel, and copper metal complexes by reacting metal chloride with the ligand pregabalin and the medication terbutaline. The complexes had the formula C20H40N2O7MCl2, where M=Co(II), Ni(II), and Cu(II). The analysis used elemental data, molar mass, and infrared (IR) spectrum studies. The IR frequencies of the ligand bands showed changes, indicating coordination with the metal ion. The study found that the ligands pregabalin and terbutaline exhibited bidentate properties of metal complexes. The research focused on how metal complexation affected the functionality of terbutaline and pregabalin complexes about Alzheimer's Disease and Parkinson's Disease. The results demonstrated strong interactions with amino acids in the binding region of the targeted protein. The study suggested that zinc metal carboxylates with antioxidant and anticholinesterase properties could be beneficial in treating Alzheimer's diseases. [ABSTRACT FROM AUTHOR]

Abstract Quantitative 1H-NMR became an increasingly important issue in pharmaceutical analytical chemistry. This study used NMR spectroscopy to assay the bronchodilator drug terbutaline sulfate and its pro-drug bambuterol hydrochloride in pure form and pharmaceutical preparations. The technique proceeded using deuterium oxide (D2O) as an 1H-NMR solvent and phloroglucinol anhydrous as an internal standard (IS). Comparatively, to the phloroglucinol signal at 5.9 ppm, the resulting quantitative signals of the studied drugs were corrected. The terbutaline singlet signal at 6.3 ppm was chosen for quantification, while the bambuterol quantitative singlet signal was at 2.9 ppm. The two drugs were rectilinear over the concentration range of 1.0–16.0 mg/mL. LOD values were 0.19 and 0.21 mg/mL while LOQ values were 0.58 and 0.64 mg/mL for terbutaline and bambuterol respectively. The developed method has been validated according to the International Conference of Harmonization (ICH) regarding linearity, accuracy, precision, specificity, and robustness. A greenness profile assessment was applied, and the method proved to be green. The method enables the assay of the two drugs in pure drug and pharmaceutical preparations. The method also enables the assay of the two drugs in the presence of each other; thus, it is considered a stability-indicating method where terbutaline is an acid degradation product of bambuterol.

Background Before the advent of antenatal steroids, early non-invasive respiratory support (NIV), and intratracheal surfactant, antenatal terbutaline was also used to improve lung compliance and reduce the incidence of respiratory distress syndrome (RDS). Objectives The objective of this paper was to study the association between antenatal terbutaline and endotracheal intubation (ET) within the first 24 hours of life, RDS, bronchopulmonary dysplasia (BPD), and intraventricular hemorrhage (IVH) in infants with the gestational age (GA) of <32 weeks, and to study the association between antenatal terbutaline, and ET or NIV within the first 24 hours of life, and RDS in infants with the GA of 32 to 36 weeks. Method This was a retrospective medical record review of preterm infants delivered at a single tertiary care center from October 2016 to December 2020. Multivariable logistic regression was used to explore the association between antenatal terbutaline and neonatal respiratory support. Result 1,794 infants were included, 234 (13.0%) had the GA of <32 weeks and 1,560 (86.9%) had the GA of 32 to 36 weeks. Antenatal terbutaline, corticosteroid, or both agents were administered in 561 (31.3%), 1,461 (81.4%), and 555 (30.9%), respectively. Antenatal terbutaline was significantly associated with a reduction in ET (adjusted odds ratio [aOR] = 0.40, 95% confident interval [CI] 0.19–0.82, p = 0.012) in infants with the GA of <32 weeks, but not in infants with the GA of 32–36 weeks. Antenatal terbutaline was not associated with RDS or BPD but was significantly associated with a reduction in grade III-IV IVH (aOR 0.11, CI 0.01–0.98; p = 0.048), in infants with the GA of <32 weeks. Conclusion In a state-of-the-art neonatal care setting, antenatal terbutaline was associated with a reduction in ET during the first 24 hours in infants with the GA of <32 weeks. The use of antenatal terbutaline to improve acute neonatal respiratory outcomes merits reconsideration. Key Points The neonatal respiratory benefits of antenatal terbutaline in the era of antenatal corticosteroids were uncertain. Terbutaline is associated with a reduction in endotracheal intubation in a modern care setting. The role of terbutaline, and potentially other betamimetics, to improve neonatal respiratory outcomes merits reconsideration. [ABSTRACT FROM AUTHOR]

An 8-year-old neutered male Persian breed cat presented at the private practice for investigation of seizure-like episodes. An echocardiography revealed mild enlargement of the left atrium (La/AO: 1.73) with spontaneous echo contrast and mitral regurgitation. A left anterior fascicular block was also detected in the electrocardiogram. The cat had no response to the atropine response test. Aminophylline, pimobendan, clopidogrel, and furosemide were initially prescribed at the private clinic, and then the cat was referred to Prasu Arthon Animal Hospital, Faculty of Veterinary Science, Mahidol University, Thailand. Repeated echocardiogram and electrocardiogram demonstrated left atrium enlargement (La/AO: 1.85) and sinus arrest, respectively. The cat was diagnosed with feline nonspecific phenotype cardiomyopathy. As the cat has no improvement after aminophylline administration and the owners declined further management with pacemaker implantation, therefore, terbutaline at 0.625 mg/cat PO ql2h was given to replace aminophylline. The cat responded well to this prescription. The mean interval of each syncope episode was markedly increased. Terbutaline increased the mean syncopal episode interval from 8.4 days of aminophylline treatment to 15.5 days. In this case, terbutaline could increase the mean heart rate (MHR) to 190 bpm, which might be an advantage over aminophylline, which increased the MHR to 165 bpm. Unfortunately, the cat died 62 days after starting a new medication. The objective of this case report is to describe medical management in a cat with sinus arrest without atropine responsiveness by using oral terbutaline. [ABSTRACT FROM AUTHOR]

Background: Myelomeningocele (MMC) is a neural tube defect disease. Antenatal repair of fetal MMC is an alternative to postnatal repair. Many agents can be used as tocolytics during the in utero fetal repair such as β2-agonists and oxytocin receptor antagonists, with possible maternal and fetal repercussions. This study aims to compare maternal arterial blood gas analysis between terbutaline or atosiban, as tocolytic agents, during intrauterine MMC repair. Methods: Retrospective cohort study. Patients were divided into two groups depending on the main tocolytic agent used during intrauterine MMC repair: atosiban (16) or terbutaline (9). Maternal arterial blood gas samples were analyzed on three moments: post induction (baseline, before the start of tocolysis), before extubation, and two hours after the end of the surgery. Results: Twenty-five patients were included and assessed. Before extubation, the terbutaline group showed lower arterial pH (7.347 ± 0.05 vs. 7.396 ± 0.02 for atosiban, p = 0.006) and higher arterial lactate (28.33 ± 12.76 mg.dL−1 vs. 13.06 ± 6.35 mg.dL−1, for atosiban, p = 0.001) levels. Conclusions: Patients who received terbutaline had more acidosis and higher levels of lactate, compared to those who received atosiban, during intrauterine fetal MMC repair.

The utility of ambulatory electrocardiography (AECG) to evaluate cats with subclinical hypertrophic cardiomyopathy (HCM) for arrhythmias and heart rate variability (HRV) is not well defined but may provide information regarding risk stratification. This prospective study used AECG to evaluate ectopy and HRV in subclinical HCM cats compared to healthy controls and is the first to implement a pharmacologic cardiac stress test. Twenty-three purpose-bred, Maine coon cross cats (16 HCM, 7 control) underwent 48-h of continuous AECG. Terbutaline (0.2-0.3 mg/kg) was administered orally at 24 and 36 h. Heart rate, ectopy frequency and complexity and HRV parameters, including standard deviation of normal R-R intervals (SDNN), were compared pre-terbutaline and post-terbutaline and across phenotype, genotype and sex. Genotype for an HCM-causative mutation was significantly associated with the frequency of supraventricular (P = 0.033) and ventricular (P = 0.026) ectopy across all cats. Seven HCM cats and zero healthy cats had a sinus arrhythmia. Mean heart rate was significantly higher post-terbutaline (p

Meng-qin Wang,1,&ast; Ying Zhuang,1,&ast; Ya-ning Zheng2 1Department of Obstetrics, Nanjing Drum Tower Hospital, Nanjing, People’s Republic of China; 2Department of Gynecology Otolaryngology, Nanjing Drum Tower Hospital, Nanjing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Ya-ning Zheng, Email zhengyaqinzyq@126.comBackground: Neonatal hypoglycemia (NH) is a common clinical symptom that can occur in both normal and critically ill neonates. The placenta is the site of material exchange between the mother and the fetus, a special organ shared by the mother and the fetus during pregnancy, and one of its important functions is to transfer nutrients from the mother to the fetus. Terbutaline is used to relax frequent uterine contractions before delivery, and it can penetrate the placental barrier and affect the normal decomposition of neonatal glycogen. The situation is neonatal hypoglycemia if not timely detection and interventions in time, the neonate may have recurrent hypoglycemia, leading to irreversible nervous system damage, such as neonatal hypoglycemic encephalopathy, and visual and cognitive impairment.Case Report: The male neonate was a single fetus, with a birth weight of 3660 g and a length of 50 cm. The blood glucose at birth was 5 mmol/L, Apgar score was 9– 10, and body temperature was normal. The mother was healthy, was not diabetic, and had no other risk factors for neonatal hypoglycemia. She was injected with 0.25 mg of terbutaline 6 hours before delivery due to frequent uterine contractions. However, it was found that recurrent hypoglycemia occurred in the neonate even after adequate oral feeding.Conclusion: We included evidence-based use of terbutaline 48 hours before delivery as a high-risk factor for hypoglycemia in the rooming-in neonatal hypoglycemia care program, and formulate the corresponding nursing process, with good effect.Keywords: hypoglycemia, neonatal recurrent hypoglycemia, neonate, terbutaline

This case report describes events that occurred under general anaesthesia of a dog undergoing transvenous pacemaker implantation for third‐degree atrioventricular block. Following premedication with acepromazine and buprenorphine, general anaesthesia was induced with alfaxalone, and maintained with isoflurane in oxygen. The dog developed severe hypotension during the procedure with concurrent bradycardia before commencement of pacing. In order to increase the heart rate, terbutaline was administered intravenously. This was followed by a worsening of the hypotension, with only a small increase in heart rate. Blood pressure improved following noradrenaline infusion. The animal recovered uneventfully in intensive care, and was sedated due to its anxious temperament to avoid dislodgement of the pacemaker device in the postoperative period. [ABSTRACT FROM AUTHOR]

Objective To systematically evaluate the clinical efficacy and safety of terbutaline combined with budesonide aerosol inhalation in the treatment of acute attack of asthma in children, and to provide evidence-based medical basis for clinical medication.Methods By searching China National Knowledge Infrastructure, China Biology Medicine, Wanfang, VIP, PubMed, Cochrane Library, Web of Science and EM-Base databases, the retrieval time was from the database construction to December 1, 2022.The literatures of randomized controlled trials (RCT) of terbutaline combined with budesonide aerosol inhalation in the treatment of acute attack of asthma in children were collected. The quality evaluation and data extraction of the included research were strictly carried out by two researchers independently.RevMan5.3 software was used for meta-analysis and TSA0.9 software was used for trial sequential analysis. Results A total of 59 RCT articles were included, including 5 179 patients, which 2 610 patients were in the experimental group and 2 569 patients were in the control group. Meta-analysis results showed that the total clinical effective rate [odds ratio (OR) =5.70, 95%CI (4.64, 7.00), Z=16.64, P＜0.000 01], time to disappearance of dyspnea [standardized mean difference (SMD) =-1.44, 95%CI (-1.83, -1.06), Z=7.42, P＜0.000 01], cough disappearance time [SMD=-1.68, 95%CI (-2.03, -1.34), Z=9.67, P＜0.000 01], forced vital capacity (FVC) [SMD=1.02, 95%CI (0.69, 1.36), Z=5.93, P＜0.000 01], forced expiratory volume in the first second (FEV1) [SMD=0.97, 95%CI (0.71, 1.23), Z=7.22, P＜0.000 01], adverse reactions [OR=0.44, 95%CI (0.30, 0.65), P＜0.001], and the trial sequential analysis further confirmed the results of meta-analysis of clinical efficacy and adverse reactions. Conclusion Terbutaline combined with budesonide aerosol inhalation in the treatment of acute attack of asthma in children can significantly improve the clinical efficacy, relieve the clinical symptoms, improve lung function and reduce adverse reactions in children with acute asthma. [ABSTRACT FROM AUTHOR]

T helper 17 (Th17) cells produce IL-17A cytokine and can exacerbate autoimmune diseases and asthma. The β2 adrenergic receptor is a g protein-coupled receptor that induces cAMP second messenger pathways. We tested the hypothesis that terbutaline, a β2-adrenergic receptor-specific agonist, promotes IL-17 secretion by memory Th17 cells in a cAMP and PKA-dependent manner. Venous peripheral blood mononuclear cells (PBMC) from healthy human participants were activated with anti-CD3 and anti-CD28 antibodies. Secreted IL-17A was measured by enzyme linked immunosorbent assay, intracellular IL-17A, and RORγ were measured using flow cytometry, and RORC by qPCR. Memory CD3+CD4+CD45RA-CD45RO+ T cells were obtained by immunomagnetic negative selection and activated with tri-antibody complex CD3/CD28/CD2. Secreted IL-17A, intracellular IL-17A, RORC were measured, and phosphorylated-serine133-CREB was measured by western blotting memory Th cells. Terbutaline increased IL-17A (p < 0.001), IL-17A+ cells (p < 0.05), and RORC in activated PBMC and memory Th cells. The PKA inhibitors H89 (p < 0.001) and Rp-cAMP (p < 0.01) abrogated the effects of terbutaline on IL-17A secretion in PBMC and memory T cells. Rolipram increased IL-17A (p < 0.01) to a similar extent as terbutaline. P-Ser133-CREB was increased by terbutaline (p < 0.05) in memory T cells. Terbutaline augments memory Th17 cells in lymphocytes from healthy participants. This could exacerbate autoimmune diseases or asthma, in cases where Th17 cells are considered to be pro-inflammatory. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the therapeutic benefits of terbutaline sulfate aerosol inhalation combined with budesonide, and its influence on pulmonary function in pregnant women suffering from acute bronchial asthma attacks. Methods: A total of 100 pregnant patients diagnosed with acute bronchial asthma in PLA Strategic Support Force Characteristic Medical Center, Beijing, China were divided into control and study groups (n = 50 each). Control group received aerosol inhalation of normal saline along with standard treatments, viz, oxygen inhalation, sputum aspiration, anti-infection measures, and maintenance of water-electrolyte balance. Study group received combined terbutaline sulfate and budesonide aerosol inhalation in addition to standard treatment. Both groups underwent a 7-day treatment course, with inhalation therapy twice daily. Results: Study group showed significantly shorter relief times for cough, wheezing, and chest tightness compared to control group (p < 0.05). After treatment, 92.0 % of patients in study group exhibited improvement or relief from their symptoms, compared to 80.0 % in control group (p < 0.05). Pulmonary function indices, including first vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow (PEF), and FEV1/FVC, improved in both groups after treatment. Study group exhibited significantly lower laboratory indices, including immunoglobulin E (IgE), C-reactive protein (CRP), and eosinophils (EOS) compared to control group (p < 0.05). Conclusion: The combination of inhalation therapy of terbutaline sulfate with budesonide in pregnant women experiencing acute bronchial asthma demonstrates significant enhancements in clinical effectiveness, pulmonary function, and laboratory parameters. Clinical trials of this combined therapy should be carried out in other locations to ascertain the effect of population variation on treatment efficacy. [ABSTRACT FROM AUTHOR]

ABSTRACT Advances in prenatal diagnostic techniques have enabled early detection of potentially correctable foetal anomalies. Here, we summarise recent developments in anaesthesia for foetal surgery. Types of foetal surgery include minimally invasive, open mid-gestational and ex-utero intrapartum treatment (EXIT) procedures. Foetoscopic surgery avoids hysterotomy, with risk of uterine dehiscence, preserving the possibility of subsequent vaginal delivery. Minimally invasive procedures are performed under local or regional anaesthesia; open or EXIT procedures are usually done under general anaesthesia. Requirements include maintenance of uteroplacental blood flow, and uterine relaxation to prevent placental separation and premature labour. Foetal requirements include monitoring of well-being, providing analgesia and immobility. EXIT procedures require maintenance of placental circulation till the airway is secured, requiring multidisciplinary involvement. Here, the uterine tone must return after baby delivery to prevent major maternal haemorrhage. The anaesthesiologist plays a crucial role in maintaining maternal and foetal homeostasis and optimising surgical conditions. Keywords: EXIT procedure, foetal resuscitation, foetal surgery, foetal therapy, maternal anaesthesia, uteroplacental perfusion, Author(s): Gita Nath (corresponding author) [1]; M Subrahmanyam [1]; R Jayanthi [2]; Ranju Singh [3]; S Ramesh [2]; Vanita Ahuja [4] INTRODUCTION Progressive technological advances in prenatal diagnostic techniques have [...]

Silver nanoparticles (AgNPs) were found to significantly quench the fluorescence of bambuterol hydrochloride (BAM) and its active metabolite terbutaline sulfate (TER). The intrinsic fluorescence intensity of each of BAM (at 264/292 nm) and TER (at 276/306 nm) decreased by the gradual addition of AgNPs. Quenching of the steady state fluorescence of BAM and TER probably resulted from the energy transfer to the photo-excited state of AgNPs. The estimated Stern–Volmer quenching constant at several temperature settings proved that the quenching mechanism of the two drugs was dynamic quenching in case of BAM while it was static quenching in case of TER. The number of binding sites, binding constants, and corresponding thermodynamic parameters depending on the interaction system were estimated at 293, 313, and 333 °K and the results obtained were interpreted. [ABSTRACT FROM AUTHOR]

Background: Recent research in our laboratory shows that CD4+ T cells express the β2 adrenergic receptor (β2-AR), and the sympathetic neurotransmitter norepinephrine regulates the function of T cells via β2-AR signaling. However, the immunoregulatory effect of β2-AR and its related mechanisms on rheumatoid arthritis is unknown.Objective: To explore the effects of β2-AR in collagen-induced arthritis (CIA) on the imbalance of T helper (Th) 17/ regulatory T (Treg) cells.Methods: In DBA1/J mice, collagen type II was injected intradermally at the tail base to prepare the CIA model. The specific β2-AR agonist, terbutaline (TBL), was administered intraperitoneally beginning on day 31 and continuing until day 47 after primary vaccination, twice a day. Magnetic beads were used to sort CD3+ T cells subsets from spleen tissues.Results: In vivo, β2-AR agonist TBL alleviated arthritis symptoms in the CIA mice including histopathology of the ankle joints, four limbs’ arthritis score, the thickness of ankle joints, and rear paws. After TBL treatment, in the ankle joints, the levels of proinflammatory factors (IL-17/22) notably decreased and the levels of immunosuppressive factors (IL-10/TGF-β) significantly increased. In vitro, ROR-γt protein expression, Th17 cell number, mRNA expression and the releasing of IL-17/22 from CD3+ T cells reduced following TBL administration. Moreover, TBL enhanced the anti-inflammatory responses of Treg cells.Conclusion: These results suggest that β2-AR activation exerts anti-inflammatory effects through the amelioration of Th17/Treg imbalance in the CIA disease.

We developed unmodified and modified solid-contact potentiometric sensors (tubular and screen-printed) for determining some cephalosporin antibiotics in aqueous media, biological fluids, and pharmaceutical preparations. Tetraalkylammonium compounds with silver(I)-[beta]-lac [Ag([beta]-lac).sub.2] complex compounds were used as active membrane components; carbon nanotubes, polyaniline, and copper oxide and NiZnFeO nanoparticles were used as modifiers. The main electroanalytical and operational characteristics of the studied sensors in aqueous solutions of antibiotics and oral fluid were determined. The sensors ensure the determination of antibiotics in a wide analytical range of 1 x 10.sup.-4 (1 x 10.sup.-5)-1 x 10.sup.-2 (0.1) M; the values of c.sub.min = n x 10.sup.-5 (1 x 10.sup.-6) M. The modifiers stabilize the electrode potential and act as electron transfer mediators, improving the electroanalytical characteristics of the sensors. Solid-contact sensors can be used to determine the main substances in drugs from various manufacturers and model aqueous solutions and oral fluid with added antibiotics and as consistuents of 'electronic tongue' multisensor systems for the separate determination of cephalosporin antibiotics in two-component mixtures., Author(s): E. G. Kulapina [sup.1], O. I. Kulapina [sup.2], E. N. Cherdakova [sup.1], V. D. Ankina [sup.2] Author Affiliations: (1) Chernyshevsky Saratov National Research State University, , 410012, Saratov, Russia [...]

Extravasation is the leakage of intravenous solutions into surrounding tissues, which can be influenced by drug properties, infusion techniques, and patient‐related risk factors. Although peripheral administration of vesicants may increase the risk of extravasation injuries, the time and resources required for central venous catheter placement may delay administration of time‐sensitive therapies. Recent literature gathered from the growing use of peripheral vasopressors and hypertonic sodium suggests low risk of harm for initiating these emergent therapies peripherally, which may prevent delays and improve patient outcomes. Physiochemical causes of tissue injury include vasoconstriction, pH‐mediated, osmolar‐mediated, and cytotoxic mechanisms of extravasation injuries. Acidic agents, such as promethazine, amiodarone, and vancomycin, may cause edema, sloughing, and necrosis secondary to cellular desiccation. Alternatively, basic agents, such as phenytoin and acyclovir, may be more caustic due to deeper tissue penetration of the dissociated hydroxide ions. Osmotically active agents cause cellular damage as a result of osmotic shifts across cellular membranes in addition to agent‐specific toxicities, such as calcium‐induced vasoconstriction and calcifications or arginine‐induced leakage of potassium causing apoptosis. A new category has been proposed to identify absorption‐refractory mechanisms of injury in which agents such as propofol and lipids may persist in the extravasated space and cause necrosis or compartment syndrome. Pharmacological antidotes may be useful in select extravasations but requires prompt recognition and frequently complex administration strategies. Historically, intradermal phentolamine has been the preferred agent for vasopressor extravasations, but frequent supply shortages have led to the emergence of terbutaline, a β2‐agonist, as an acceptable alternative treatment option. For hyperosmolar and pH‐related mechanisms of injuries, hyaluronidase is most commonly used to facilitate absorption and dispersion of injected agents. However, extravasation management is largely supportive and requires a protocolized multidisciplinary approach for early detection, treatment, and timely surgical referral when required to minimize adverse events. [ABSTRACT FROM AUTHOR]

Introduction: Preterm delivery and its complications are among the biggest challenges and health risks in obstetrical practice. Several tocolytic agents are used in clinical practice, although the efficacy and side effect profiles of these drugs are not satisfying. The aim of this study was to investigate the uterus relaxant effect of the coadministration of β2‐mimetic terbutaline and magnesium sulfate (MgSO4) in an isolated organ bath and to perform in vivo smooth muscle electromyographic (SMEMG) studies in pregnant rats. In addition, we also investigated whether the tachycardia‐inducing effect of terbutaline can be reduced by the presence of magnesium, due to the opposite heart rate modifying effects of the two agents. Material and methods: In the isolated organ bath studies, rhythmic contractions of 22‐day‐ pregnant Sprague–Dawley rats were stimulated with KCl, and cumulative dose–response curves were constructed in the presence of MgSO4 or terbutaline. The uterus‐relaxing effects of terbutaline were also investigated in the presence of MgSO4 in both normal buffer and Ca2+‐poor buffer. The in vivo SMEMG studies were carried out under anesthesia with the subcutaneous implantation of an electrode pair. The animals were treated with MgSO4 or terbutaline alone or in combination in a cumulative bolus injection. The implanted electrode pair also detected the heart rate. Results: Both MgSO4 and terbutaline reduced uterine contractions in vitro and in vivo, furthermore, the administration of a small dose of MgSO4 significantly enhanced the relaxant effect of terbutaline, especially in the lower range. However, in Ca2+‐poor environment, MgSO4 was not able to increase the effect of terbutaline, indicating the role of MgSO4 as a Ca2+ channel blocker. In the cardiovascular studies, MgSO4 significantly decreased the tachycardia‐inducing effect of terbutaline in late pregnant rats. Conclusions: The combined application of MgSO4 and terbutaline may have clinical significance in tocolysis, which must be confirmed in clinical trials. Furthermore, MgSO4 could substantially reduce the tachycardia‐inducing side effect of terbutaline. [ABSTRACT FROM AUTHOR]

Terbutaline is a prohibited drug except for athletes with a therapeutic use exemption certificate; terbutaline's effects on endurance performance are relatively unknown. Purpose: To investigate the effects of 2 therapeutic (2 and 4 mg) inhaled doses of terbutaline on 3-km running time-trial performance. Methods: A total of 8 men (age 24.3 [2.4] y; weight 77.6 [8] kg; and height 179.5 [4.3] cm) and 8 women (age 22.4 [3] y; weight 58.6 [6] kg; and height 163 [9.2] cm) free from respiratory disease and illness provided written informed consent. Participants completed 3-km running time trials on a nonmotorized treadmill on 3 separate occasions following placebo and 2- and 4-mg inhaled terbutaline in a single-blind, repeated-measures design. Urine samples (15 min postexercise) were analyzed for terbutaline concentration. Data were analyzed using 1-way repeated-measures analysis of variance, and significance was set at P < .05 for all analyses. Results: No differences were observed for completion times (1103 [201] s, 1106 [195] s, 1098 [165] s; P = .913) for the placebo or 2- and 4-mg inhaled trials, respectively. Lactate values were higher (P = .02) after 4 mg terbutaline (10.7 [2.3] mmol⋅L-1) vs placebo (8.9 [1.8] mmol⋅L-1). Values of forced expiratory volume in the first second of expiration (FEV1) were greater after inhalation of 2 mg (5.08 [0.2]; P = .01) and 4 mg terbutaline (5.07 [0.2]; P = .02) compared with placebo (4.83 [0.5] L) postinhalalion. Urinary terbutaline concentrations were mean 306 (288) ng⋅mL-1 and 435 (410) ng⋅mL-1 (P = .2) and peak 956 ng⋅mL-1 and 1244 ng⋅mL-1 after 2 and 4 mg inhaled terbutaline, respectively. No differences were observed between the male and female participants. Conclusions: Therapeutic dosing of terbutaline does not lead to an improvement in 3-km running performance despite significantly increased FEV1. The findings suggest that athletes using inhaled terbutaline at high therapeutic doses to treat asthma will not gain an ergogenic advantage during 3-km running performance. [ABSTRACT FROM AUTHOR]