Cyclodextrins and the emergence of sugammadex

Summary Residual paralysis, with its subsequent postoperative pulmonary sequelae, is one of the major complications of anaesthesia, and was recognised shortly after the introduction of neuromuscular blocking drugs into routine clinical practice. Although its incidence decreased with the introduction of intermediate duration drugs, and further diminished with routine neuromuscular monitoring and reversal with cholinesterase inhibitors, residual paralysis still remained a problem. In the search for alternatives to stop the effect of neuromuscular blocking drugs and to match their duration of action to clinical need, chelation of the non-depolarising neuromuscular blocking drugs was considered. It was recognised that cyclodextrins could encapsulate steroidal molecules and thereby inactivate the aminosteroidal neuromuscular blocking drugs. In order to improve the binding of rocuronium to the cyclodextrin and to increase the compound's water solubility

Activation of sp3-CH Bonds in a Mono(pentamethylcyclopentadienyl)yttrium Complex. X-ray Crystal Structures and Dynamic Behavior of Cp*Y(o-C6H4CH2NMe2)2 and Cp*Y[o-C6H4CH2NMe(CH2-μ)][μ-o-C6H4CH2NMe(CH2-μ)]YCp*[THF]

Reaction of Y(o-C6H4CH2NMe2)3 (1) with Cp*H gives Cp*Y(o-C6H4CH2NMe2)2 (2), which crystallizes in the monoclinic space group P21/n (No. 14) with a = 18.607 (4) Å, b = 15.633 (3) Å, c = 8.861 (3) Å, β = 102.73 (3)°, and Z = 4. Least-squares refinement with 3006 independent reflections (F > 4.0σ(F)) led to a final RF (wR) of 0.053 (0.068). The molecular structure consists of monomeric Cp*Y(o-C6H4CH2NMe2)2 units with a regularly bonded Cp* ligand (Y-Ct = 2.367 (3) Å), equal Y-C(aryl) distances (2.479 (6) and 2.471 (6) Å), and both nitrogen atoms coordinated to yttrium (Y-N distances = 2.568 (5) and 2.506 (6) Å). Short intramolecular Y···H distances (Y···H(181) = 3.00 (6) Å, Y···H(183) = 3.13 (9) Å) indicate agostic interactions. The long N(2)-C(18) bond (1.55 (1) Å) and the short Y···C(18) distance (3.202 (8) Å) indicate an Y···C-N agostic interaction. Thermolysis of 2 in THF gives Cp*Y[o-C6H4CH2NMe(CH2-μ)][μ-o-C6H4CH2NMe(CH2-μ)]YCp*[THF] (3) and N,N-dimethylbenzylamine. Compound 3 crystallizes in the monoclinic space group P21/c (No. 14) with a = 17.004 (1) Å, b = 13.962 (1) Å, c = 20.129 (3) Å, β = 92.94 (1)°, and Z = 4. Least-squares refinement with 4578 independent reflections (F > 5.0σ(F)) led to a final RF (wR) of 0.065 (0.070). The molecule consists of two Cp*Y fragments (Y(1)-Ct(1) = 2.420 (6) Å, Y(2)-Ct(2) = 2.414 (5) Å), bridged by two methylene carbon atoms (Y(1)-C(9) = 2.591 (10) Å, Y(2)-C(9) = 2.527 (9) Å, Y(1)-C(18) = 2.622 (10) Å, Y(2)-C(18) = 2.532 (10) Å) and one aryl carbon atom (Y(1)-C(1) = 2.702 (8) Å, Y(2)-C(1) = 2.547 (9) Å). The remaining aryl group is not bridging (Y(1)-C(10) = 2.441 (8) Å). Asymmetry in 3 is caused by THF coordination (Y(2)-O = 2.446 (5) Å). Thermolysis of 2 can be explained by dissociation of an Y-N dative bond followed by activation of an agostic C-H bond

AMPT-induced monoamine depletion in humans: evaluation of two alternative [123I]IBZM SPECT procedures

Purpose Acute monoamine depletion paradigms using alpha-methyl-para-tyrosine (AMPT) combined with single photon emission computed tomography (SPECT) have been used successfully to evaluate disturbances in central dopaminergic neurotransmission. However, severe side effects due to relatively high doses (4,500 to 8,000 mg) of AMPT have been reasons for study withdrawal. Thus, we assessed the effectiveness and tolerability of two alternative procedures, using lower doses of AMPT. Methods Six healthy subjects underwent three measurements of striatal dopamine D2 receptor (D2R)-binding potential (BPND) with SPECT and the selective radiolabeled D2R antagonist [123I]IBZM. All subjects were scanned in the absence of pharmacological intervention (baseline) and after two different depletion procedures. In the first depletion session, over 6 h, subjects were administered 1,500 mg of AMPT before scanning. In the second depletion session, over 25 h, subjects were administered 40 mg AMPT/kg body weight. We also administered the Subjective Well-being Under Neuroleptic Treatment Scale, a self-report instrument designed to measure the subjective experience of patients on neuroleptic medication. Results We found no change of mean D2R BPND after the first and short AMPT challenge compared to the baseline. However, we found a significant increase in striatal D2R BPND binding after the AMPT challenge adjusted for bodyweight compared to both other regimen. Although subjective well-being worsened after the prolonged AMPT challenge, no severe side effects were reported. Conclusions Our results imply a low-dosage, suitable alternative to the common AMPT procedure. The probability of side effects and study withdrawal can be reduced by this procedure

Affective regulation of cognitive-control adjustments in remitted depressive patients after acute tryptophan depletion

Negative affect in healthy populations regulates the appraisal of demanding situations, which tunes subsequent effort mobilization and adjustments in cognitive control. In the present study, we hypothesized that dysphoria in depressed individuals similarly modulates this adaptation, possibly through a neural mechanism involving serotonergic regulation. We tested the effect of dysphoria induced by acute tryptophan depletion (ATD) in remitted depressed patients on conflict adaptation in a Simon task. ATD temporarily lowers the availability of the serotonin precursor L-Tryptophan and is known to increase depressive symptoms in approximately half of remitted depressed participants. We found that depressive symptoms induced by ATD were associated with increased conflict adaptation. Our finding extends recent observations implying an important role of affect in regulating conflict-driven cognitive control

The Neuroscience of Sadness: A Multidisciplinary Synthesis and Collaborative Review for the Human Affectome Project

Sadness is typically characterized by raised inner eyebrows, lowered corners of the mouth, reduced walking speed, and slumped posture. Ancient subcortical circuitry provides a neuroanatomical foundation, extending from dorsal periaqueductal grey to subgenual anterior cingulate, the latter of which is now a treatment target in disorders of sadness. Electrophysiological studies further emphasize a role for reduced left relative to right frontal asymmetry in sadness, underpinning interest in the transcranial stimulation of left dorsolateral prefrontal cortex as an antidepressant target. Neuroimaging studies – including meta-analyses – indicate that sadness is associated with reduced cortical activation, which may contribute to reduced parasympathetic inhibitory control over medullary cardioacceleratory circuits. Reduced cardiac control may – in part – contribute to epidemiological reports of reduced life expectancy in affective disorders, effects equivalent to heavy smoking. We suggest that the field may be moving toward a theoretical consensus, in which different models relating to basic emotion theory and psychological constructionism may be considered as complementary, working at different levels of the phylogenetic hierarchy

Unlocking the potential of photon counting detector CT for paediatric imaging: a pictorial essay

Recent advancements in CT technology have introduced a revolutionary innovation to practice known as the Photon-Counting detector (PCD) CT imaging. The pivotal hardware enhancement of the PCD-CT scanner lies in its detectors, which consist of smaller pixels than standard detectors and allow direct conversion of individual X-rays to electrical signals. As a result, CT images are reconstructed at higher spatial resolution (as low as 0.2 mm) and reduced overall noise, at no expense of an increased radiation dose. These features are crucial for paediatric imaging, especially for infants and young children, where anatomical structures are notably smaller than in adults and in whom keeping dose as low as possible is especially relevant. Since January 2022, our hospital has had the opportunity to work with PCD-CT technology for paediatric imaging. This pictorial review will showcase clinical examples of PCD-CT imaging in children. The aim of this pictorial review is to outline the potential paediatric applications of PCD-CT across different anatomical regions, as well as to discuss the benefits in utilizing PCD-CT in comparison to conventional standard energy integrating detector CT

Rapid Eye Movement Sleep Behavior Disorder:Abnormal Cardiac Image and Progressive Abnormal Metabolic Brain Pattern

BACKGROUND: Isolated rapid eye movement sleep behavior disorder (iRBD) is prodromal for α-synucleinopathies. OBJECTIVE: The aim of this study was to determine whether pathological cardiac [123 I]meta-iodobenzylguanidine scintigraphy ([123 I]MIBG) is associated with progression of [18 F]fluorodeoxyglucose-positron emission tomography-based Parkinson's disease (PD)-related brain pattern (PDRP) expression in iRBD. METHODS: Seventeen subjects with iRBD underwent [18 F]fluorodeoxyglucose-positron emission tomography brain imaging twice ~3.6 years apart. In addition, [123 I]MIBG and [123 I]N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl)nortropane single-photon emission computed tomography ([123 I]FP-CIT-SPECT) at baseline were performed. Olfactory, cognitive, and motor functions were tested annually. RESULTS: Twelve of 17 subjects had pathological [123 I]MIBG. At baseline, 6 of 12 of these expressed the PDRP (suprathreshold PDRP z score). At follow-up, 12 of 17 subjects had suprathreshold PDRP z scores, associated with pathological [123 I]MIBG in 92% and with pathological [123 I]FP-CIT-SPECT in 75%. Subjects with pathological [123 I]MIBG had higher PDRP z score change per year (P = 0.027). Three subjects phenoconverted to PD; all had pathological [123 I]MIBG and [123 I]FP-CIT-SPECT, suprathreshold baseline PDRP z scores, and hyposmia. CONCLUSIONS: Pathological [123 I]MIBG was associated with progressive and suprathreshold PDRP z scores at follow-up. Abnormal [123 I]MIBG likely identifies iRBD as prodromal PD earlier than pathological [123 I]FP-CIT-SPECT. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society