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BEIJING, Dec. 9 (Xinhua) -- Chinese police have cracked a serious criminal case involving 10 suspects who gathered crowds for illegal demonstrations and assaulting the police in early October in the eastern province of Shandong.
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RESULTS: Low- and high-glucose-stimulated insulin release in the control group was significantly higher than in groups II and III (62.33 ± 9.67 μIU vs 47.75 ± 8.47 μIU, 39.67 ± 6.18 μIU and 125.5 ± 22.04 μIU vs 96.17 ± 14.17 μIU, 75.17 ± 13.57 μIU, respectively, P < 0.01) and was lowest in group III (P < 0.01). After adding 1 μg/mL naloxone, insulin release in groups II and III was not different from the control group. Electron microscopy studies showed that the islets were damaged by 30 ng/mL fentanyl.
The minimum effective plasma concentration of fentanyl is 0.63 ng/mL after intravenous administration and the therapeutic plasma concentration is 1-2 ng/mL. However, the plasma concentration often exceeds 3 ng/mL because many practitioners prefer to administer high doses of fentanyl[4,5]. In most cancer cases secondary to disease progression, the initial median transdermal fentanyl dose is generally 60-70 μg/h (release rate), which increases to about 170 μg/h over time. Furthermore, a small proportion of patients require doses of between 400 and 1000 μg/h in the latter stages of therapy and the mean treatment period is often longer than 50 d. These large doses are associated with high plasma concentrations (up to 14.5 ng/mL) which are linearly related to the dose[7,8]. Furthermore, fentanyl has been commonly used for patients undergoing cardiac operations because high doses of fentanyl can stabilize the cardiovascular circulatory system during operations. After administration of 50-100 μg/kg fentanyl, the plasma concentration of fentanyl in these patients is commonly above 20-30 ng/mL. However, high plasma concentrations of fentanyl are associated with clinical side effects such as nausea and vomiting, constipation, skin itching and respiratory depression. So far, the potential effects of fentanyl on pancreatic islet β-cells remain unknown.
The procedure of islets preparation. A: The islets were stained red by DTZ in digested pancreatic tissue; B: Pure islets isolated from digested pancreatic tissue; C: Pure islets stained by DTZ; D: The dye AO-PI stained living cells green and dead cells red in minimal background fluorescence (× 100).
The cell viability after co-culture with fentanyl. The viability measured by MTT was 100% in the control group. The viability of islets exposed to 0.3, 3 and 30 ng/mL fentanyl was 94.3%, 91.3% and 96.9%, respectively. There was no difference between groups. The data represent means ± SE.
Electron micrographs of β-cells in rat pancreatic islets of control group. N: Nucleus; SG: Secretory granule; V: Vesicle; E: Endoplasmic reticulum. The typical β-cells had an abundance of cytoplasmic granules and endoplasmic reticulum. The electron density of the granules increased when the granules were maturating in the vesicles. The mature secretory granules displayed a highly electron-dense core surrounded by a wide electron-lucent halo. The granules had a space between the core and the membrane. The vesicles showed a normal round outline (A, × 6000). There were many nascent granules in the β-cells; subsequent maturation involved further condensation of the matrix constituents and a reduction in granule diameter (B, × 8000).
Over the last two decades, despite the development of more potent, safer, faster onset, and shorter- and longer-lasting opioids, fentanyl has remained the mainstay of anesthesiologists and Certified Registered Nurse Anesthetists in the perioperative period, and for physicians involved in pain management. Because diabetic patients undergo higher risk procedures during the period of operation and anesthesia, anesthetists and surgeons should protect islet function and try to minimize any harmful medical effects on islets during the procedure. Although some studies have suggested that some opiates inhibit insulin secretion, it was unknown whether fentanyl has a similar effect.
Our results clearly demonstrate that fentanyl inhibited glucose-stimulated insulin release from islets in vitro. Electron microscopy studies showed that the cells in the control group exhibited good viability but, after the cells were exposed to 30 ng/mL fentanyl for 48 h, chromatin margination and severe cytoplasmic vacuolization were observed, indicating that the cells were in a poor condition. Thus, our test suggests that the islets were injured by exposure to fentanyl at the concentrations tested.
There are certain limitations in our experiment. The pharmacology of the mu receptor signaling pathway involves G-protein coupling which, when activated, closes Ca2+ channels and opens K+ channels, resulting in a decline in intracellular Ca2+ levels and hyperpolarization; all of which are short-term effects. The magnitude of the insulin response to glucose is related not only to the absolute level of glucose but also to the rate of change in the glucose level. There are two phases of insulin release. An acute increase in glucose level elicits a rapid and transient secretion of insulin, called the first or acute-phase response, which subsides within 10 min. The second phase response begins when glucose levels increase slowly and progressively for up to 4 h. As in many other studies, we measured the insulin release over 60 min in static culture after incubating in low (2.8 mmol/L) and then high (16.7 mmol/L) glucose concentrations[19,20,36]. Therefore, the effect of fentanyl on glucose-stimulated insulin release in rat islets in dynamic culture also needs to be investigated. In addition, perfusion of islets with glucose provides a dynamic profile of the characteristics of glucose-stimulated insulin release, which could be used to fully determine the effect of fentanyl on the inhibition of insulin release, and the ability of the cells to down-regulate insulin secretion after a fentanyl challenge are a focus of our future studies.
Non-inflamed rat islet and insulitis islet with T cell infiltration (white). Red indicates the inflammation signal. Green shows insulin-producing beta cells. Images by Adediwura Arowosegbe, PhD Candidate, UMass Chan Morningside Graduate School of Biomedical Sciences, Translational Science Program
They were also interested to determine if it was only a few islets that were getting inflamed, or if there was low-level inflammation occurring in all the islets throughout the pancreas. Additional experiments revealed that only a subset of islets expressed inflammation signals, with genes being turned on to alert the immune system that the body was under attack.
In most cases, the symptoms of interstitial lung disease develop slowly over time. Patients with CGD will usually have a more acute onset as they have a persistent infection causing the lung inflammation. Patients may notice a decrease in their endurance with everyday activities. They may find themselves having to cut back on exercise such as biking or running. These changes are often attributed to other causes, which may delay the diagnosis of the lung disease itself. Patients often complain of a cough, which is usually non-productive. Enlargement and rounding of the toenails and fingernails can be seen and is termed clubbing. Clubbing is not specific to primary immunodeficiency diseases or to lung damage but is a clue that the lungs should be evaluated. In some cases, the lung damage can lead to a severe lowering of blood oxygen causing patients to have a bluish tint to their skin or mucous membranes known as cyanosis. Fever is not a typical finding, unless infection is also present. On the lung exam, a practitioner may hear abnormal breath sounds such as crackles, wheezes or a decrease in the amount of air moving in and out of the lung with breathing. Often these symptoms lead to the incorrect diagnosis of asthma or a lung infection by physicians not familiar with autoimmune lung diseases in primary immunodeficiency diseases. 2b1af7f3a8