膝关节滑膜间质干细胞分离、培养及其多向分化潜能特性的研究

目的 探讨晚期骨关节炎患者膝关节滑膜间质干细胞(synovium-derived mesenchymalstem cells,SMSCs)体外分离、培养的可行性及其在体外向脂肪细胞、成骨细胞和软骨细胞定向分化的特性.方法 取膝关节滑膜组织,胶原酶消化获得有核细胞.挑选单细胞克隆,筛选获得SMSCs.流式细胞技术检测细胞表面特异性抗原标志.培养至第三代,分别向脂肪细胞、成骨细胞和软骨细胞诱导分化.油红O染色鉴定向脂肪细胞分化;碱性磷酸酶染色、茜素红染色鉴定向成骨细胞分化;甲苯胺蓝染色鉴定向软骨细胞分化.RT-PCR检测脂肪细胞、成骨细胞标志基因.Ⅱ型胶原免疫组化染色检测软骨细胞Ⅱ型胶原的表达.结果 原代SMSCs体外培养呈葵花样细胞集落,传代后可见圆形巨噬样细胞和纺锤形成纤维样细胞,融合后呈成纤维细胞样生长.CD44、CD90呈阳性,CD34、CD71和CD45呈阴性.向脂肪细胞诱导21d,油红O染色阳性;RT-PCR检测有脂蛋白酶、乙二腈及PPARγ2表达;向成骨细胞诱导7、28 d,ALP,茜素红染色阳性,有ALP、Osteopontin及Osteocalcin表达;向软骨细胞诱导21d,甲苯胺蓝染色阳性,Ⅱ型胶原免疫组化染色阳性.结论 晚期骨关节炎患者膝关节滑膜组织可以分离、培养获得SMSCs. SMSCs具有向脂肪细胞、成骨细胞和软骨细胞发生定向分化的潜能.     

微小RNA-564基因下调对滑膜间充质干细胞成软骨分化的影响

目的探究下调微小RNA-564(miR-564)基因对滑膜间充质干细胞成软骨分化的作用。 方法取第3代的人滑膜间充质干细胞(SMSCs)作为实验细胞,实验设计为3组：SMSCs空白对照组(空白组);miRNA抑制剂转染SMSCs对照组(对照组);miR-564抑制剂转染SMSCs实验组(实验组)。将3组SMSCs同时成软骨诱导培养,观察诱导后软骨细胞的组织形态,并检测诱导前7 d内的3组细胞增殖曲线,和软骨分化特异性基因和蛋白[Ⅱ型胶原、蛋白聚糖、性别决定区Y框蛋白9(Sox9)、母亲DPP同源物4(Smad4)];本次实验所有数据均采用单因素方差分析(one-way ANOVA)检验。 结果甲苯胺蓝染色观察细胞形态与特点基本符合软骨细胞,实验组细胞数量更多,蓝染更明显;细胞增殖曲线表明实验组细胞增殖速度明显快于对照组(F＝0.842, P <0.01);RT-PCR检测与Western Blotting检测表明实验组软骨细胞分化特异基因和蛋白表达较对照组明显升高(F＝2274.75, F＝447.31, F＝30476.22; P <0.01),并且实验组TGF-BMP关键基因及蛋白Smad 4有所升高(F＝457.02, P <0.01)。 结论下调miR-564基因的表达可促进滑膜间充质干细胞向软骨细胞增殖与分化,并且有可能是通过作用于TGF-BMP通路实现。     

CD204阴性人脂肪来源细胞体外成软骨潜能的初步研究

目的比较CD204+和CD204-两种人脂肪来源细胞的干细胞特性和体外诱导成软骨的能力。方法分离培养人脂肪来源细胞并进行流式细胞分选,分别获得CD204+和CD204-两种细胞。将这两种细胞培养扩增至第2代,观察其形态学特点;成脂、成骨定向诱导分化,油红O染色、茜素红染色定性;同时将两种细胞进行pellet成软骨诱导分化,比较体外诱导成软骨的能力,并以HE、Safranin O和Ⅱ型胶原免疫组化染色等进行鉴定。结果经流式细胞分选,脂肪来源细胞中CD204表达阳性率约为10%。分选后的CD204+和CD204-细胞均呈成纤维细胞样贴壁生长,但CD204-细胞具有更强的增殖能力。成脂诱导10 d后,两组细胞油红O染色均可见胞浆内有大量红染脂滴,但CD204+细胞具有更强的成脂潜能。成骨诱导2周后,两组细胞茜素红染色均可见钙结节红染,而CD204-细胞具有更强的成骨潜能。同时,细胞pellet成软骨诱导4周后,大体观可见CD204-细胞组pellet形成白色透明样软骨成分,而CD204+细胞组pellet外观微黄。HE和Ⅱ型胶原免疫组化染色均显示CD204-组pellet可见成熟软骨陷窝形成,Safranin O染色显示CD204-组软骨特异性细胞外基质沉积;而CD204+细胞组pellet则呈纤维化改变。结论脂肪组织来源的CD204-细胞具有干细胞的生物学特点,且有良好的成软骨潜能,可以成为软骨组织工程良好的种子细胞来源。     

CDMP-1促进成人骨髓间充质干细胞成软骨分化的研究

目的 探讨软骨源性形态发生蛋白1(CDMP-1)诱导成人骨髓间充质干细胞(BMSCs)向软骨细胞分化的可行性及最佳诱导浓度.方法 分离培养BMSCs,免疫荧光法检测BMSCs表面CD34,CD45,CD105表达.采用含0、10、50、100ng/ml CDMP-1的软骨诱导液诱导培养BMSCs 21 d,倒置显微镜观察细胞形态变化;RT-PCR检测不同浓度CDMP-1组细胞Ⅱ型胶原和Aggrccan表达:免疫组化检测Ⅱ型胶原表达;番红O和阿利新蓝染色检测蛋白多糖表达.结果 成人BMSCs呈梭形漩涡状生长,CD44、CD105表达阳性,CD34呈阴性表达.CDMP-1诱导7 d后细胞形态逐渐由长梭形向多边形、多角形转化.不同浓度CDMP-1诱导21 d,Ⅱ型胶原表达量各组间差异均具有统计学意义(P<0.05);Aggrecan的表达CM组和10 ng组之间差异无统计学意义(P>0.05),其他各组间差异均具有统计学意义(P<0.05).免疫组化检测Ⅱ型胶原表达阳性,阿利新蓝和番红O染色均为阳性.结论 含100 ng/mJ CDMP-1软骨诱导液能有效促进成人BMSCs向软骨表型分化.     

膝骨关节炎滑膜间充质干细胞多向分化及免疫抑制能力

目的观察骨关节炎(OA)患者膝关节滑膜来源的间充质干细胞(SMSCs)多向分化能力以及免疫抑制能力。方法无菌环境下通过关节镜取出中山大学孙逸仙纪念医院10例OA患者膝关节滑膜组织,分离培养出SMSCs,采用CCK-8法检测细胞增殖能力,通过成骨、成软骨和成脂肪诱导分化培养基对SMSCs诱导分化,于诱导第21天分别行茜素红、甲苯胺蓝和油红O染色。将SMSCs和CD3、CD28抗体刺激后的人外周血单核细胞(PBMC)进行共培养,通过流式细胞术对PBMC的增殖率进行检测,组间比较通过方差分析总体差异后再通过Bonferroni法进行组间两两比较。结果OA患者SMSCs第3天开始进入对数增长期,第7天细胞增殖进入平台期。SMSCs经过成骨、成软骨和成脂肪诱导分化后,茜素红、甲苯胺蓝和油红O染色均为阳性。SMSCs和CD3、CD28抗体刺激后的PBMC进行共培养5 d后,阴性对照组PBMC增殖率为(3.8±0.4)%,几乎不增殖,阳性对照组PBMC增殖率为(80.9±8.1)%,实验组PBMC的增殖率为(52.3±5.1)%,实验组与阳性对照组的差异具有统计学意义(t=8.97,P0.01)。结论 OA患者SMSCs同样具有多向分化能力和免疫抑制能力,可作为组织工程理想的种子细胞来源。     

Kartogenin与TGF-β3/BMP-2/DEX对兔滑膜间充质干细胞增殖及成软骨分化的对比研究

目的：比较Kartogenin（KGN）与转化生长因子β3（TGF?β3）/骨形态发生蛋白2（BMP?2）/地塞米松（DEX）对兔滑膜间充质干细胞（synovial?derived mesenchymal stem cells, SMSCs）增殖及成软骨分化的作用。方法于6~10月龄新西兰大白兔膝关节处滑膜中分离培养SMSCs,并进行鉴定。设置KGN组（采用KGN干预）、T/B/D组（TGF?β3/BMP?2/DEX联合干预）及空白对照组,采用PELLET系统培养法分别培养各组细胞。通过比较各组细胞的增殖速度、软骨微球的直径和重量、Ⅱ型胶原（Col?Ⅱ）表达情况、成软骨分化相关标志基因表达及蛋白质合成量等指标来评价KGN对SMSCs增殖及成软骨能力的影响。结果成功从兔膝关节滑膜分离出SMSCs;KGN组的SMSCs增殖能力弱于T/B/D组,但KGN组软骨微球直径最大,重量最重,Ⅱ型胶原合成量最多,且均显著高于其他组;PCR及Western Blot结果表明KGN组成软骨分化相关基因的表达最强,蛋白质合成量最多。结论 KGN不能明显增强SMSCs的增殖能力,但对SMSCs的成软骨分化能力强于TGF?β3/BMP?2/DEX,将来可能应用于修复软骨损伤。     

骨骺干细胞复合壳聚糖/纳米羟基磷灰石支架体外培养的实验研究

目的 探讨免疫磁珠分选的骨骺干细胞(PSCs)经诱导后向软骨细胞方向分化的性能,及其与壳聚糖/纳米羟基磷灰石(CS/nHA)支架材料复合培养构建组织工程化软骨的可行性.方法 用显微手术器械剪取新生24 h内的清洁级SD大鼠股骨下端骺板两端的La Croix环处组织,应用免疫磁珠分选系统分离纯化PSCs,免疫荧光染色观察PSCs成纤维细胞生长因子受体-3(FGFR-3)的表达情况.体外培养并诱导PSCs向软骨细胞特性方向分化,免疫细胞化学、甲苯胺兰及番红O染色检测诱导后细胞Ⅱ型胶原及软骨基质的表达情况.以诱导后接种于CS/nHA支架培养的PSCs为实验组,以诱导后未接种支架的细胞为对照组.扫描电镜观察细胞的黏附及形态学改变,MTT法检测细胞增殖情况,阿辛蓝法测定细胞合成的糖胺多糖(GAG)情况.对两组间不同培养时间的吸光度值及GAG进行比较.结果 免疫磁珠分选的PSCs体外培养增殖迅速,免疫荧光染色显示FGFR-3阳性表达.诱导后的PSCsⅡ型胶原免疫细胞化学染色、甲苯胺兰染色及番红O染色均旱阳性.细胞接种CS/nHA支架后1、4 d,实验组与对照组吸光度值比较差异无统计学意义(P>0.05),而7 d实验组与对照组吸光度值比较筹异有统计学意义(t=-2.786,P=0.024).培养14 d后培养液GAG含量为(89.66±6.52)μg/106个细胞,高于对照组[(78.62±4.63)μg/106个细胞)],差异有统计学意义(t=-3.084,P<0.05).结论 免疫磁珠分选的PSCs经诱导后可向软骨细胞功能方向分化,诱导后的PSCs与CS/nHA分层支架复合有望构建组织工程化软骨.     

猪滑膜源性MSCs体外多向分化潜能的研究

目的 体外分离培养猪滑膜源性MSCs(synovium-derived MSCs,SMSCs),探讨其在体外多向分化潜能.方法 2月龄长枫杂交猪3头,雌雄不限,体重8～10kg.取猪膝关节滑膜组织分离SMSCs并行原代及传代培养,待第3代SMSCs长满培养皿后,吸去基础培养液,分别加入特定培养液进行成软骨、成骨、成脂诱导分化,作为实验组;以基础培养液培养作为对照组.成软骨诱导21 d后行甲苯胺蓝染色、免疫组织化学染色和实时荧光定量PCR检测;成骨诱导10 d后行ALP染色检测,21 d后行茜素红染色检测;成脂诱导21 d后行油红O染色检测.结果 SMSCs培养24 h后细胞形态细长或呈多角形;48 h后细胞数量增多;72 h后可见大量纺锤形细胞,其间散在分布少许小圆形细胞.实验组成软骨诱导21 d后甲苯胺蓝染色早阳性,细胞外有蛋白多糖(Aggrecan)形成;免疫组织化学染色示特异软骨基质ColⅡ表达;实时荧光定量PCR检测示Col Ⅱ A1、Aggrecan、SOX9 mRNA表达量与对照组比较,差异有统计学意义(P＜0.05).成骨诱导10 d后ALP染色阳性,21d后茜素红染色阳性,有钙结节形成.成脂诱导21 d后油红O染色示细胞内有脂滴形成.对照组除ALP染色观察呈弱阳性外,余染色均呈阴性.结论 猪膝关节滑膜组织可分离获取SMSCs,其在体外具有向成软骨、成骨、成脂多向分化潜能,有望成为组织工程种子细胞来源.     

不同相对分子质量透明质酸对兔骨髓来源间充质干细胞成软骨分化的影响

目的 观察不同相对分子质量透明质酸(HA)对兔骨髓来源间充质干细胞(MSCs)向软骨方向定向分化的影响.方法 取P3代未诱导的骨髓来源间充质干细胞,培养液中分别添加不同相对分子质量透明质酸做诱导剂,分为3个实验组,A组:相对低分子质量组(基础培养基+ HA 0.1 g/L,相对分子质量约1000×103),B组:相对中分子质量组(基础培养基+HA0.1 g/L,相对分子质量约1800×103),C组:相对高分子质量组(基础培养基+HA 0.1 g/L,相对分子质量约2000×103).同时设立阳性对照组[基础培养基+ 10 μg/L转化生长因子-β3( TGF-β3)]及空白对照组(基础培养基),观察细胞形态及增殖情况,分别于诱导后第7、14、21天行甲苯胺蓝染色检测蛋白聚糖表达,另外采用免疫组织化学染色及逆转录-聚合酶链反应(RT-PCR)方法检测细胞Ⅱ型胶原表达.结果 经添加软骨诱导剂后,干细胞细胞增殖速度放缓,形态逐渐改变,细胞外基质呈甲苯胺蓝异染性,Ⅱ型胶原免疫组织化学染色阳性.RT-PCR检测示实验组Ⅱ型胶原mRNA表达阳性,诱导至21 d可见各实验组Ⅱ型胶原基因相对表达量分别为0.64±0.06、0.72±0.03、0.75±0.01,与阴性对照组(0.09±0.03)、阳性对照组(0.96±0.15)比较差异均有统计学意义,但B、C组间Ⅱ型胶原表达相似.结论 不同相对分子质量外源性HA诱导兔MSCs向软骨细胞分化的能力存在差异,相对高分子质量的HA的诱导能力较相对低分子质量HA的诱导能力强.证明透明质酸的相对分子质量与MSCs的软骨分化有关联性,但均比TGF-β3的诱导能力弱.     

CD105、CD133在人肝癌细胞株HepG-2的表达情况及生物学性状的体外研究

目的 观察人肝癌细胞株HepG-2中CD105、CD133的表达情况并对不同亚群的生物学性状进行体外研究.方法 采用含10％胎牛血清的DMEM培养HepG-2.流式细胞分选仪检测CD105、CD133表达情况并分选出CD105+ CD133+、CD105-CD133+、CD105+ CD133-、CD105-CD133-亚群.CCK-8和Transwell侵袭实验分别检测各细胞亚群增殖及侵袭能力;软琼脂培养试验检测细胞成球能力.结果 四种不同细胞亚群的比例分别为99.57％,0.2％,0.2％和0.03％.CD133阳性亚群增值能力和成球能力较CD133-及未分选细胞强;而CD105+亚群侵袭能力较CD105-及未分选细胞强.结论 CD105在人肝癌细胞株HepG-2的表达与其侵袭能力有关,CD133与其增殖成球能力有关.CD105+ CD133+亚群在人肝癌细胞株HepG-2中具有干细胞特性.     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.