Sam Sze Wing. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2000. / Includes bibliographical references (leaves 156-184). / Abstracts in English and Chinese. / Publications based on work in this thesis --- p.ii / Abstract --- p.iii / Acknowledgements --- p.vii / Chapter 1 --- INTRODUCTION --- p.1 / Chapter 1.1 --- Corticosteroids --- p.2 / Chapter 1.1.1 --- Chemical Structure of Steroids --- p.3 / Chapter 1.1.2 --- Biosynthesis of Endogenous Corticosteroids --- p.3 / Chapter 1.1.2.1 --- Regulation of Cortisol synthesis and negative feedback system --- p.4 / Chapter 1.1.3 --- Biological Significance of Corticosteroids --- p.5 / Chapter 1.1.3.1 --- Involvement of corticosteroids as anti-inflammatory drugs --- p.6 / Chapter 1.1.3.2 --- Eicosanoid biosynthesis --- p.7 / Chapter 1.1.3.3 --- Lipoxygenase pathway --- p.9 / Chapter 1.1.3.4 --- Side-effects of prolonged use of corticosteroids --- p.9 / Chapter 1.2 --- Organisation of the Emetic Reflex --- p.11 / Chapter 1.2.1 --- Motor Pathway of Emetic Reflex --- p.12 / Chapter 1.2.1.1 --- Retching and vomiting --- p.12 / Chapter 1.2.1.2 --- Nausea --- p.13 / Chapter 1.2.2 --- Components of the Emetic Reflex --- p.14 / Chapter 1.2.2.1 --- The vomiting centre (VC) --- p.15 / Chapter 1.2.2.2 --- Area postrema (AP) / Chemoreceptor trigger zone (CTZ) --- p.15 / Chapter 1.2.2.3 --- The nucleus tractus solitarius (NTS) --- p.17 / Chapter 1.2.2.4 --- Gastrointestinal tract and vagus nerves --- p.17 / Chapter 1.2.2.5 --- Neurotransmitter receptors --- p.18 / Chapter 1.3 --- Chemotherapy-Induced Emesis --- p.19 / Chapter 1.3.1 --- Cancer as a cause of mortality in Man --- p.20 / Chapter 1.3.2 --- Chemotherapeutic Agents --- p.20 / Chapter 1.3.2.1 --- Different classes --- p.20 / Chapter 1.3.2.2 --- Emetogenic potential --- p.21 / Chapter 1.3.3 --- Cisplatin-Induced Emesis --- p.23 / Chapter 1.3.3.1 --- Unfavourable effects associated with chemotherapy-induced nausea and emesis --- p.24 / Chapter 1.3.3.2 --- Anticipatory nausea and vomiting --- p.24 / Chapter 1.3.3.3 --- Profile of cisplatin-induced emesis --- p.25 / Chapter 1.3.4 --- Animal Models of Cisplatin-Induced Acute and Delayed Emesis --- p.26 / Chapter 1.3.5 --- Mechanisms and Pathways Involves in Chemotherapy-Induced Emesis --- p.28 / Chapter 1.3.6 --- Anti-Emetic Drugs for the Treatment of Chemotherapy-Induced Emesis --- p.31 / Chapter 1.3.6.1 --- 5-HT3 receptor antagonists --- p.31 / Chapter 1.3.6.2 --- Dopamine receptor antagonists --- p.33 / Chapter 1.3.6.3 --- Benzodiazepines --- p.35 / Chapter 1.3.6.4 --- Cannabinoids --- p.35 / Chapter 1.3.6.5 --- Antihistamines and anticholinergics --- p.35 / Chapter 1.3.6.6 --- NK1 receptor antagonists --- p.37 / Chapter 1.3.6.7 --- Corticosteroids --- p.38 / Chapter 1.3.6.8 --- Multi-agent anti-emetic regimens --- p.39 / Chapter 1.4 --- Motion-Induced Emesis --- p.41 / Chapter 1.4.1 --- Incidence --- p.42 / Chapter 1.4.2 --- Mechanisms and Pathways Involved in Motion Sickness --- p.43 / Chapter 1.4.2.1 --- Importance of the vestibular apparatus --- p.44 / Chapter 1.4.2.2 --- Importance of the area postrema --- p.45 / Chapter 1.4.2.3 --- The nucleus tractus solitarius --- p.46 / Chapter 1.4.2.4 --- Hormone and neurotransmitters --- p.46 / Chapter 1.4.3 --- Animal models in Motion-Induced Emesis --- p.47 / Chapter 1.4.4 --- Anti-Emetic Drugs for the Treatment of Motion Sickness --- p.48 / Chapter 1.4.4.1 --- Anticholinergics --- p.49 / Chapter 1.4.4.2 --- Antihistamines --- p.49 / Chapter 1.4.4.3 --- Non-selective muscarinic and histamine receptor antagonists --- p.51 / Chapter 1.4.4.4 --- Sympathomimetics --- p.51 / Chapter 1.4.4.5 --- NK1i receptor antagonists --- p.51 / Chapter 1.4.4.6 --- 5-HT1A agonists --- p.52 / Chapter 1.4.4.7 --- 5-HT2 receptor agonist --- p.52 / Chapter 1.4.4.8 --- Arginine vasopressin (AVP) antagonists --- p.53 / Chapter 1.4.4.9 --- Opioid receptor agonists --- p.53 / Chapter 1.4.4.10 --- Dexamethasone and hormone levels --- p.54 / Chapter 1.4.4.11 --- Other anti-emetic drugs --- p.55 / Chapter 1.5 --- Aims of the Studies --- p.56 / Chapter 2 --- Methods --- p.59 / Chapter 2.1 --- Cisplatin-Induced Emesis Studies --- p.60 / Chapter 2.1.1 --- Animals --- p.60 / Chapter 2.1.2 --- Induction and Measurement of Emesis --- p.60 / Chapter 2.1.3 --- The Effects of Corticosteroids on Cisplatin-Induced Acute and Delayed Retching and Vomiting --- p.63 / Chapter 2.1.4 --- "The Effects of Dexamethasone (1 mg/kg, i.p.) Administered as an Intervention Treatment on an Established Delayed Retching and Vomiting Response Induced by Cisplatin" --- p.63 / Chapter 2.1.5 --- The Effects of Cortrosyn Depot (Tetracosactrin) on Cisplatin-Induced Acute and Delayed Retching and Vomiting --- p.63 / Chapter 2.1.6 --- The Effects of Metyrapone on Cisplatin-Induced Acute and Delayed Retching and Vomiting --- p.64 / Chapter 2.1.7 --- The Effects of Indomethacin on Cisplatin-Induced Acute and Delayed Retching and Vomiting --- p.64 / Chapter 2.1.8 --- "The Effects of DFU and L-745,337 Administered as an Intervention Treatments on an Established Delayed Retching and Vomiting Response Induced by Cisplatin" --- p.64 / Chapter 2.1.9 --- "The Effects of MK-886 (L-663,536) on Cisplatin-Induced Acute and Delayed Retching and Vomiting" --- p.65 / Chapter 2.1.10 --- The Effects of a Combination of Indomethacin and MK-886 on Cisplatin- Induced Acute and Delayed Retching and Vomiting --- p.65 / Chapter 2.1.11 --- Statistical Analysis --- p.66 / Chapter 2.2 --- Motion-Induced Emesis Studies --- p.67 / Chapter 2.2.1 --- Animals --- p.67 / Chapter 2.2.2 --- Measurement of Emesis --- p.67 / Chapter 2.2.3 --- Induction of Emesis in Motion-Naive Suncus murinus: Effects of Glucocorticoids --- p.68 / Chapter 2.2.4 --- Induction of Emesis in Motion-Sensitive Suncus murinus: Effects of Dexamethasone --- p.70 / Chapter 2.2.5 --- Preparation of Serum --- p.72 / Chapter 2.2.6 --- Measurement of Serum Cortisol by Enzyme-Linked Immunoassay (ELISA) --- p.72 / Chapter 2.2.6.1 --- Immunoassay kit --- p.72 / Chapter 2.2.6.2 --- Assay procedures --- p.73 / Chapter 2.2.7 --- Measurement of Serum Adrenocorticotrophin (ACTH) by Radioimmunoassay (RIA) --- p.75 / Chapter 2.2.7.1 --- Immunoassay kit --- p.75 / Chapter 2.2.7.2 --- Assay procedures --- p.76 / Chapter 2.2.8 --- Statistical Analysis --- p.79 / Chapter 3 --- Results --- p.81 / Chapter 3.1 --- Cisplatin-Induced Emesis --- p.82 / Chapter 3.1.1 --- General Profile of Emesis Induced by Cisplatin --- p.82 / Chapter 3.1.2 --- Antagonism of Cisplatin-Induced Emesis by Corticosteroids --- p.82 / Chapter 3.1.3 --- "The Effect of Dexamethasone (1 mg/kg, i.p.) Administered as an Intervention Treatment on an Established Delayed Retching and Vomiting Response Induced by Cisplatin" --- p.84 / Chapter 3.1.4 --- The Effect of Cortrosyn Depot (Tetracosactrin) on Cisplatin-Induced Acute and Delayed Retching and Vomiting --- p.85 / Chapter 3.1.5 --- The Effect of Metyrapone on Cisplatin-Induced Acute and Delayed Retching and Vomiting --- p.85 / Chapter 3.1.6 --- "The Effect of Indomethacin, DFU and L-745,337 on Cisplatin-Induced Acute and Delayed Retching and Vomiting" --- p.86 / Chapter 3.1.7 --- The Effect of MK-886 on Cisplatin-Induced Acute and Delayed Retching and Vomiting --- p.88 / Chapter 3.1.8 --- The Effect of Combination of Indomethacin and MK-886 on Cisplatin- Induced Acute and Delayed Retching and Vomiting --- p.89 / Chapter 3.2 --- Motion-Induced Emesis --- p.91 / Chapter 3.2.1 --- General Effect of Motion on Serum Cortisol and ACTH Levelsin Motion Naive Suncus murinus --- p.91 / Chapter 3.2.2 --- The Effect of Glucocorticoids on Motion-Induced Emesis and Cortisol and ACTH Levels in Motion-Naive Male Suncus murinus --- p.92 / Chapter 3.2.2.1 --- Effect of dexamethasone --- p.92 / Chapter 3.2.2.2 --- Effect of betamethasone --- p.93 / Chapter 3.2.2.3 --- Effect of methylprednisolone --- p.93 / Chapter 3.2.3 --- The Effect of Glucocorticoids on Motion-Induced Emesis and Cortisol and ACTH Levels in Motion Naive Female Suncus murinus --- p.94 / Chapter 3.2.3.1 --- Effect of dexamethasone --- p.94 / Chapter 3.2.3.2 --- Effect of betamethasone --- p.95 / Chapter 3.2.3.3 --- Effect of methylprednisolone --- p.95 / Chapter 3.2.4 --- The Effect of Dexamethasone on Motion-Induced Emesis and Cortisol and ACTH Levels in Motion-Sensitive Suncus murinus --- p.96 / Chapter 3.2.4.1 --- Effect of dexamethasone on male motion-sensitive animals --- p.97 / Chapter 3.2.4.2 --- Effect of dexamethasone on female motion-sensitive animals --- p.97 / Chapter 4 --- Discussion --- p.131 / Chapter 4.1 --- "Cisplatin (5 mg/kg, i.p.)-Induced Emesis in Control Animals" --- p.132 / Chapter 4.2 --- Anti-Emetic Action of Corticosteroids in the Ferret --- p.133 / Chapter 4.3 --- Metyrapone Study --- p.138 / Chapter 4.4 --- Cortrosyn Depot Study --- p.139 / Chapter 4.5 --- Role of Cycloxygenase --- p.141 / Chapter 4.6 --- Role of 5-Lipoxygenase --- p.143 / Chapter 4.7 --- Duel Inhibition of Cycloxygenase and 5-Lipoxygenase --- p.144 / Chapter 4.8 --- Anti-Emetic Potential of Glucocorticoids in Suncus murinus --- p.145 / Chapter 4.9 --- General Summary --- p.149 / Appendix I --- p.152 / Appendix II --- p.154 / References --- p.156

Em 32 pacientes com Distrofia Muscular de Duchenne, em corticoterapia, avaliou-se a evolução da força muscular, ao longo de 14 meses, mensalmente no primeiro semestre e a cada dois meses no segundo e terceiro semestre. Testes empregados: escala "Medical Research Council", Hammersmith "motor ability score", levantamento de peso cronometragem do tempo para manobra de Gowers e para percorrer 9 metros. O estudo revelou tendência de estabilidade da força muscular durante o acompanhamento e que para avaliar objetivamente a força muscular são suficientes intervalos de três meses no primeiro semestre de corticoterapia e, posteriormente, de seis meses enquanto durar o tratamento / In 32 patients with Duchenne muscular dystrophy and receiving steroid therapy we assessed muscle strength along a follow-up of 14 months using Medical Research Council scale, Hammersmith functional motor scale, timed testing for rising from the floor and walking 9 meters, as well as rising weights. The tests were repeated monthly along the first 6 months and every two months by the rest of the follow-up. The study revealed a trend to functional stability and that the muscle strength can be evaluated at 3 and 6 months of treatment and then every 6 months while the steroid therapy is maintained

Em 32 pacientes com Distrofia Muscular de Duchenne, em corticoterapia, avaliou-se a evolução da força muscular, ao longo de 14 meses, mensalmente no primeiro semestre e a cada dois meses no segundo e terceiro semestre. Testes empregados: escala "Medical Research Council", Hammersmith "motor ability score", levantamento de peso cronometragem do tempo para manobra de Gowers e para percorrer 9 metros. O estudo revelou tendência de estabilidade da força muscular durante o acompanhamento e que para avaliar objetivamente a força muscular são suficientes intervalos de três meses no primeiro semestre de corticoterapia e, posteriormente, de seis meses enquanto durar o tratamento / In 32 patients with Duchenne muscular dystrophy and receiving steroid therapy we assessed muscle strength along a follow-up of 14 months using Medical Research Council scale, Hammersmith functional motor scale, timed testing for rising from the floor and walking 9 meters, as well as rising weights. The tests were repeated monthly along the first 6 months and every two months by the rest of the follow-up. The study revealed a trend to functional stability and that the muscle strength can be evaluated at 3 and 6 months of treatment and then every 6 months while the steroid therapy is maintained

Embora a utilização do corticóide oral não seja indicada no tratamento de manutenção na doença pulmonar obstrutiva crônica, identificamos em nosso ambulatório, um grupo de pacientes que fazem uso desta medicação de forma continuada e, nos quais, todas as tentativas anteriores de retirada da medicação, havia resultado em exacerbação dos sintomas. O objetivo deste estudo foi o de analisar os fenômenos inflamatórios associados à tentativa de redução progressiva do corticóide oral nesses doentes. Avaliamos o escarro induzido de 14 pacientes usuários crônicos de corticóide. Após a avaliação basal, realizada enquanto os pacientes faziam uso de sua dose habitual da medicação (V0), procedemos ao aumento da prednisona a 40 mg por dia, por duas semanas (V1). A seguir, reduzimos progressivamente a dose até que ocorresse uma exacerbação (EXAC), quando a dose de 40 mg de prednisona foi re-introduzida por duas semanas (APÓS). Comparamos os resultados deste grupo aos de um grupo de pacientes portadores de DPOC não-usuários de corticóide oral. Esses pacientes foram avaliados na condição basal (V0), quando exacerbaram (EXAC) e após o tratamento com 40 mg de prednisona, por duas semanas (APÓS). As variáveis analisadas no escarro foram: % de neutrófilos, % de eosinófilos, % de macrófagos, número total de células, interleucinas 4, 6 e 8. Constatamos que o grupo corticóide apresentou um aumento significativo na porcentagem de eosinófilos na exacerbação em relação a V0, e uma redução significativa em APÓS, em relação a EXAC. Isto não ocorreu no grupo não-corticóide. Ao compararmos os dois grupos, observamos que a concentração das interleucinas 4, 6 e 8, foi significativamente mais alta no grupo corticóide em V0 e na exacerbação em relação ao grupo não-corticóide. Quando analisamos o comportamento das interleucinas nas avaliações seqüenciais, dentro de cada grupo, observamos que a interleucina 4 tendeu à elevação na exacerbação, no grupo corticóide, sem atingir, entretanto, significância estatística. As interleucinas 6 e 8 aumentaram significativamente no grupo corticóide na visita APÓS. Concluímos que a retirada progressiva de corticóide oral induz a exacerbação em pacientes com DPOC corticóide-dependentes com um processo inflamatório eosinofílico, que tende à reversão após o aumento da dose do corticóide / Although in chronic obstructive lung disease the use of oral corticoid is not indicated in the maintenance treatment, we identified a group of patients that make use of this medication continuously. The objective of this study was to analyze the inflammatory phenomena associated to the attempt of progressive reduction of oral corticoids in these patients. We evaluated induced sputum of 14 patients on long-term use of oral corticoids. After the basal evaluation, accomplished while the patients made use of their habitual dose of the medication (V0), we increased the dose of prednisone to 40 mg daily for two weeks (V1). To proceed we reduced the dose progressively until an exacerbation occurred (EXAC), when the dose of prednisone 40 mg daily was reintroduced for two weeks (AFTER). We compared the results to a group of patients with COPD not on use of oral corticoids, that were appraised in the basal condition (V0), when they exacerbated (EXAC) and after the treatment with prednisone 40 mg daily for two weeks (AFTER). The variables analyzed in the sputum were:, % of neutrophils, % of eosinophils, % of macrophages, total number of cells, interleukins 4, 6 and 8. We verified that the corticoid group presented a significant increase in the percentage of eosinophils at the exacerbation in relation to V0, and a significant reduction in AFTER in relation to EXAC. This didn\'t happen in the non corticoid group. When we compared the two groups we observed that the concentration of the interleukins was significantly higher in corticoid group in V0 and at the exacerbation in relation to the non corticoid group. When we analyzed the behavior of the interleukins along the evaluations in each group we observed that interleukin 4 tended to an elevation at the exacerbation in the corticoid group, without reaching statistical significance. Interleukins 6 and 8 increased significantly in the corticoid group in the visit AFTER. We concluded that the progressive reduction of oral corticoid induces exacerbation in patients with COPD on long-term use of prednisone with an eosinophilic inflammatory process that tends to reverse after the increase of the dose of the corticoid

Embora a utilização do corticóide oral não seja indicada no tratamento de manutenção na doença pulmonar obstrutiva crônica, identificamos em nosso ambulatório, um grupo de pacientes que fazem uso desta medicação de forma continuada e, nos quais, todas as tentativas anteriores de retirada da medicação, havia resultado em exacerbação dos sintomas. O objetivo deste estudo foi o de analisar os fenômenos inflamatórios associados à tentativa de redução progressiva do corticóide oral nesses doentes. Avaliamos o escarro induzido de 14 pacientes usuários crônicos de corticóide. Após a avaliação basal, realizada enquanto os pacientes faziam uso de sua dose habitual da medicação (V0), procedemos ao aumento da prednisona a 40 mg por dia, por duas semanas (V1). A seguir, reduzimos progressivamente a dose até que ocorresse uma exacerbação (EXAC), quando a dose de 40 mg de prednisona foi re-introduzida por duas semanas (APÓS). Comparamos os resultados deste grupo aos de um grupo de pacientes portadores de DPOC não-usuários de corticóide oral. Esses pacientes foram avaliados na condição basal (V0), quando exacerbaram (EXAC) e após o tratamento com 40 mg de prednisona, por duas semanas (APÓS). As variáveis analisadas no escarro foram: % de neutrófilos, % de eosinófilos, % de macrófagos, número total de células, interleucinas 4, 6 e 8. Constatamos que o grupo corticóide apresentou um aumento significativo na porcentagem de eosinófilos na exacerbação em relação a V0, e uma redução significativa em APÓS, em relação a EXAC. Isto não ocorreu no grupo não-corticóide. Ao compararmos os dois grupos, observamos que a concentração das interleucinas 4, 6 e 8, foi significativamente mais alta no grupo corticóide em V0 e na exacerbação em relação ao grupo não-corticóide. Quando analisamos o comportamento das interleucinas nas avaliações seqüenciais, dentro de cada grupo, observamos que a interleucina 4 tendeu à elevação na exacerbação, no grupo corticóide, sem atingir, entretanto, significância estatística. As interleucinas 6 e 8 aumentaram significativamente no grupo corticóide na visita APÓS. Concluímos que a retirada progressiva de corticóide oral induz a exacerbação em pacientes com DPOC corticóide-dependentes com um processo inflamatório eosinofílico, que tende à reversão após o aumento da dose do corticóide / Although in chronic obstructive lung disease the use of oral corticoid is not indicated in the maintenance treatment, we identified a group of patients that make use of this medication continuously. The objective of this study was to analyze the inflammatory phenomena associated to the attempt of progressive reduction of oral corticoids in these patients. We evaluated induced sputum of 14 patients on long-term use of oral corticoids. After the basal evaluation, accomplished while the patients made use of their habitual dose of the medication (V0), we increased the dose of prednisone to 40 mg daily for two weeks (V1). To proceed we reduced the dose progressively until an exacerbation occurred (EXAC), when the dose of prednisone 40 mg daily was reintroduced for two weeks (AFTER). We compared the results to a group of patients with COPD not on use of oral corticoids, that were appraised in the basal condition (V0), when they exacerbated (EXAC) and after the treatment with prednisone 40 mg daily for two weeks (AFTER). The variables analyzed in the sputum were:, % of neutrophils, % of eosinophils, % of macrophages, total number of cells, interleukins 4, 6 and 8. We verified that the corticoid group presented a significant increase in the percentage of eosinophils at the exacerbation in relation to V0, and a significant reduction in AFTER in relation to EXAC. This didn\'t happen in the non corticoid group. When we compared the two groups we observed that the concentration of the interleukins was significantly higher in corticoid group in V0 and at the exacerbation in relation to the non corticoid group. When we analyzed the behavior of the interleukins along the evaluations in each group we observed that interleukin 4 tended to an elevation at the exacerbation in the corticoid group, without reaching statistical significance. Interleukins 6 and 8 increased significantly in the corticoid group in the visit AFTER. We concluded that the progressive reduction of oral corticoid induces exacerbation in patients with COPD on long-term use of prednisone with an eosinophilic inflammatory process that tends to reverse after the increase of the dose of the corticoid