Clinical analysis of patients of cirrhosis complicated with adrenal insufficiency.

OBJECTIVE: To evaluate the level of cortisol and adrenocorticotrophic hormone (ACTH) in patients with cirrhosis and to investigate the clinical significance and characteristics of cirrhosis with adrenal insufficiency (AI). PATIENTS AND METHODS: A total of 118 patients that were hospitalized in the Department of Gastroenterology of Xiangyang Hospital affiliated to Hubei University due to cirrhosis were selected and chemiluminescence assay was used to measure the basal level of cortisol and ACTH in their blood. All the 118 patients with cirrhosis were divided into two groups, cirrhosis with AI group and cirrhosis without AI group and comparison and analysis of the clinical characteristics and prognosis of the two groups were undertaken. About 39 patients with gastrointestinal polyps were used as control group. RESULTS: The basal level of cortisol of the patient group 329.67±136.1 nmol/l was significantly lower than that of the normal control 460.7±165.48 nmol/l (p<0.05). Of the 118 patients with cirrhosis, 32 patients had AI (32/118). Compared with the cirrhosis without AI group, cirrhosis with AI group had significantly increased spontaneous bacterial peritonitis (SBP), Child classes, Child scores, MELD scores and case fatality and the difference was statistically significant (p<0.05). The level of albumin and high-density lipoprotein-cholesterol (HDL-C) in 32 patients with cirrhosis and AI was significantly reduced and the prevalence rate of facial pigmentation and ascites were significantly higher (p<0.05). But, there was no statistically significant difference between cirrhosis with AI and cirrhosis without AI (p>0.05) in other clinical characteristics and laboratory parameters studied. CONCLUSIONS: The basal level of cortisol in patients with cirrhosis was significantly reduced and about 27% of cirrhosis patients had AI. Patients of the later kind had a higher prevalence rate of SBP, worse hepatic impairment and higher mortality, thus resulting in poor prognosis.

The distribution of substance P receptor (NK1)-like immunoreactive neurons in the newborn and adult human spinal cord.

Substance P receptor (i.e. NK1)-like immunoreactive (SPR-LI) neurons were observed in the newborn and adult human spinal cord. Substance P receptor-like immunoreactive neuronal cell bodies were seen most frequently in lamina I, and were scattered throughout the remaining laminae of the dorsal horn and the area around the central canal. Some neurons in the intermediolateral nucleus also showed weak immunoreactivity. The pattern of distribution of SPR-LI neurons in the adult spinal cord was essentially the same as that in the newborn spinal cord. However, SPR-LI neurons cell bodies were seen much more frequently in the newborn than in the adult dorsal horn, especially in lamina II.

Convergence of perianal cutaneous and pelvic visceral nociceptive inputs onto neurons of dorsal commissural nucleus in the cat sacral spinal cord.

The effects of somatic and visceral nociceptive stimulation on neurons of dorsal commissural nucleus in sacral spinal cord were studied in pentobarbitone anesthetized cats using extracellular recording techniques. The results indicated that all neurons deriving input from A delta fibers of the pelvic nerve were either nociceptive specific or wide dynamic range neurons, and could be activated by mechanical or intense electrical stimulation of the respective receptive fields including perianal region. The above results suggest that the A delta afferents innervation of the pelvic organ is important in nociception.

Direct projections from the lumbosacral spinal cord to Barrington's nucleus in the rat: a special reference to micturition reflex.

In the present study, direct projections from the lumbosacral cord to Barrington's nucleus in the rat were investigated by using retrograde and anterograde tracing techniques. After injection of cholera toxin B subunit (CTb) into Barrington's nucleus, a number of moderately CTb-labeled neurons were observed in the lumbosacral cord, with a slight ipsilateral dominance; most were located in the spinal parasympathetic and dorsal commissural nuclei of the lumbosacral cord. In addition, some retrogradely labeled neurons were found in the periaqueductal gray (PAG). These findings were confirmed by an anterograde labeling experiment. After biotinylated dextran amine (BDA) was injected into the lumbosacral cord, dense BDA-labeled axon terminals were found in Barrington's nucleus as well as in the PAG. Injection of BDA into the PAG resulted in many BDA-labeled terminals in Barrington's nucleus. The present results provided clear evidence for a direct projection from the spinal parasympathetic and dorsal commissural nuclei to Barrington's nucleus that could subserve conveying bladder-filling information from the lumbosacral cord to Barrington's nucleus in the micturition reflex of the rat.

GABAergic synapses on mu-opioid receptor-expressing neurons in the superficial dorsal horn: an electron microscope study in the cat spinal cord.

A double-immunocytochemical electron microscope study was performed in the cat to examine whether GABAergic axons might be in synaptic contact with spinal neurons expressing mu-opioid receptor (MOR) in laminae I and II of the spinal dorsal horn at the lumbar cord segments. Structures showing MOR-like immunoreactivity (-LI) and those showing GABA-LI were labeled, respectively, with diaminobenzidine/peroxidase-reaction products and immunogold particles. Approximately one-third of dendritic profiles with MOR-LI in laminae I and II were postsynaptic to axon terminals with GABA-LI; about one-fourth of somatic profiles with MOR-LI were also postsynaptic to axon terminals with GABA-LI. The results suggest that activation of MOR on postsynaptic neurons may modulate effects which are induced by GABA released from presynaptic neurons.

Coexistence of mu-opioid receptor-like and substance P-like immunoreactivities in the cat dorsal root ganglionic neurons.

Coexistence of mu-opioid receptor (MOR)-like immunoreactivity (LI) and substance P (SP)-LI in the neurons of the cat dorsal root ganglia (DRG) was examined by a double immunofluorescence histochemical method. Approximately 91% of SP-LI neurons in the DRG showed MOR-LI. However, SP-LI was exhibited in approximately 28% of the neurons labeled with MOR-LI. These morphological findings indicated that the MOR exist on most of the primary afferent SP-containing terminals, and suggest that MOR may regulate SP release from the primary afferent terminals in the cat dorsal horn.

Expression of c-fos protein in substance P receptor-like immunoreactive neurons in response to noxious stimuli on the urinary bladder: an observation in the lumbosacral cord segments of the rat.

Chemical irritation of the urinary bladder with formalin in the rat induced c-fos protein-like immunoreactivity in more than 80% of substance P receptor-like immunoreactive (SPR-LI) neurons of the dorsal commissural nucleus, sacral parasympathetic nucleus and lamina I in the 6th lumbar and 1st sacral cord segments. These neurons with SPR-LI may receive noxious information from the urinary bladder through the primary afferent fibers with substance P.

Induction of c-fos-like protein in the spinoparabrachial tract-neurons locating within the sacral parasympathetic nucleus in the rat.

Immunoreactivity against c-fos-like protein (FOS) was induced in many neuronal cell bodies within the sacral parasympathetic nucleus (SPN) in urethane-anesthetized rats by chemical irritation of the urinary bladder with formalin. More than half of these FOS-immunoreactive neurons were retrogradely labeled with Fluoro-Gold injected into the lateral parabrachial nucleus (PBN1). The results indicate that some neurons within the SPN may transmit noxious information from the urinary bladder to the PBN1.

[Distribution, content and action site of leucine-enkephalin in pulmonary artery wall of rat and rabbit].

Using immunohistochemical method to investigate the distribution of peptidergic fibers in the pulmonary artery wall of SD rat, L-enkephalin immunoreactive (L-ENK ir) fibers were easily demonstrated. The contents of L-ENK in pulmonary artery of rat and rabbit measured by radioimmunoassay were respectively 439.18 +/- 30.52 and 29.9 +/- 1.4 (pg/mg of wct tissue). Contraction of superfused strips of pulmonary artery of rabbit could be evoked by parameter I electric field stimulation. The response was blocked by alpha-receptor antagonist phentolamine. Alpha 2-receptor antagonist Yohimbine enhanced the response in small doses (0.06-0.12 mumol/L), while inhibited in large (3.2 mumol/L). The contraction could also be enhanced when the artery strips were preincubated with naloxone. After the alpha-receptors were blocked with phentolamine, stronger contraction could still be evoked by parameter II electric field stimulation and the response was not affected by naloxone. L-ENK had no effect on the contraction evoked by exogenous NE. The present experiments demonstrate that enkephalin presented in the pulmonary artery wall are released by electric field stimulation. Enkephalin may reduce the release of NE from sympathetic nerve endings via opioid receptors and inhibit the contraction response.

The distribution and origin of axon terminals with NADPH diaphorase activity in the nucleus of the solitary tract of the rat.

The distribution and origin of axon terminals containing nitric oxide synthase (NOS) were examined in the nucleus of the solitary tract (NST) of the rat by NADPH diaphorase histochemistry combined with nodose ganglionectomy. Axon terminals with NADPH diaphorase activity were densely distributed in the middle and caudal part of the NST. After removal of the nodose ganglion (NG), most of the axon terminals with NADPH activity in the NST were eliminated on the ipsilateral side. These results indicated that most of the axon terminals with NADPH diaphorase in the NST derive from the primary afferent neurons in the NG, and that NOS may be richly contained in the central terminals of NG neurons to produce nitric oxide as a transmitter.

The subdivisions of the intermediolateral nucleus in the sacral spinal cord of the cat.

The subdivisions of the sacral intermediolateral nucleus (IML) of the cat have been studied by using a double-labeling technique of retrograde Fluoro-gold (FG) and wheat germ agglutinin-conjugated horseradish peroxidase (WGA-HRP) tracing. The parasympathetic preganglionic neurons (PGNs) that were labeled by the FG injected into the pelvic nerve formed a 'V'-shaped column known as the sacral parasympathetic nucleus (SPN) in the sacral IML. The neurons that were labeled by the WGA-HRP applied to the lateral parabrachial nucleus (PBL) formed an elongated spindle-shaped column extending throughout the IML of the sacral segments. We designated it by the name of sacral visceral sensory nucleus (SVSN). These findings indicate that the sacral IML of the cat contain two distinct subdivisions, SPN and SVSN.

The major pelvic ganglion is the main source of nitric oxide synthase-containing nerve fibers in penile erectile tissue of the rat.

The possible implication of nitric oxide synthase (NOS) in penile erection was examined by utilizing NADPH histochemistry in the rat. NADPH histochemistry indicated that the major pelvic ganglion (MPG), a well-known origin of nerve fibers supplying the external genitalia, contained many NOS-positive neurons. On the other hand, NOS-positive nerve fibers in penile erectile tissue observed in the walls of both arteries and veins, as well as in intrinsic smooth muscles. The retrograde tracing study with Fluoro-Gold (FG) in combination with NADPH histochemistry revealed that almost all MPG neurons which were retrogradely labeled with FG injected into the penile crura were NOS-positive. Thus, the MPG was considered to be the main source of NOS-positive nerve fibers in penile erectile tissue.