姜黄素对前列腺癌细胞核转录因子抑制蛋白表达的影响

目的观察姜黄素对前列腺癌细胞核转录因子抑制蛋白(IkBα)表达的影响,探讨姜黄素抑制前列腺癌细胞增殖的作用机制。方法分别用10、25、50、75和100μmol/L 浓度的姜黄素对雄激素依赖性及雄激素非依赖性前列腺癌细胞株 LNCaP 和 PC3进行干预,5、12和24 h 后采用噻唑蓝(MTT)比色法观察细胞增殖情况;采用流式细胞术测定24 h 后细胞周期变化;5 h 后 Western 印迹法检测细胞中 IkBα的表达。结果姜黄素显著抑制 LNCaP 及 PC3细胞的生长,呈剂量和时间依赖性;姜黄素将两种前列腺癌细胞阻滞于 G_2、M 期[LNCaP 与 PC3细胞,空白对照分别为(11.4±1.3)%与(17.3±1.7)%,100μmol/L 姜黄素作用后分别为(27.3±2.8)%与(33.4±4.0)%],从而诱导肿瘤细胞凋亡;姜黄素作用于 LNCaP 细胞后,细胞中 IkBα表达无变化(F=0.129,P>0.05);但作用于 PC3细胞后,细胞中 IkBα的表达明显增强,呈现出显著的剂量依赖性(F=31.618,P<0.05)。结论姜黄素通过活化 IkBα在 PC3细胞中的表达发挥抑制 PC3细胞增殖的作用。对于 LNCaP 细胞,姜黄素可能通过抗氧化、抑制细胞内代谢产物形成等方式抑制 LNCaP 细胞增殖。     

姜黄素对雄激素依赖性前列腺癌细胞的诱导凋亡作用

目的:探讨姜黄素对雄激素依赖性前列腺癌细胞株(LNCaP)的诱导凋亡作用。方法:分别用10、25、50、75、100μmol/L浓度的姜黄素作用于LNCaP细胞,5、12、24 h后MTT法检测细胞生长活性;24 h后流式细胞仪测定细胞周期及细胞凋亡的变化,透射电镜观察细胞超微结构变化;5 h后W estern印迹法检测细胞内IκBα的表达。结果:姜黄素能显著抑制LNCaP细胞的生长,呈剂量与时间依赖性,不同浓度姜黄素组之间与不同作用时间组之间的差异均有显著性意义(P均<0.05)。姜黄素诱导LNCaP细胞出现剂量依赖性G2/M期阻滞(P<0.01),各浓度组凋亡细胞比例均显著高于空白对照组(P均<0.05),差异有显著性意义;姜黄素作用24 h后LNCaP细胞出现凋亡的形态学改变;不同浓度姜黄素作用后,LNCaP细胞内IκBα的表达无变化。结论:姜黄素能显著抑制LNCaP细胞的体外生长,并促进其凋亡。     

姜黄素对雄激素非依赖性前列腺癌抑制效应及其机制

目的 检测姜黄素在体外对雄激素非依赖性前列腺癌细胞(PC-3)生物学行为的影响,并探讨其机制.方法 分别采用CFSE染色、Annexin V-PI染色和PI染色法,使用流式细胞仪分析姜黄素对PC-3细胞增殖、凋亡和细胞周期的影响.然后采用荧光素酶报告基因系统检测姜黄素在体外对核因子-κB(NF-κB)、激活蛋白-1(AP-1)和p53三个信号通路的影响.结果 50μmol/L的姜黄素作用后,PC-3细胞的增殖指数从7.08±0.20降到4.38±0.19(P＜0.05);凋亡率从(5.34±0.96)%提高到(21.53±2.87)%(P＜0.05);G2/M期细胞比例由(34.27±1.87)%上升到(57.29±1.91)%(P＜0.05).荧光素酶活性检测结果显示,姜黄素能在体外抑制NF-κB和AP-1信号通路活性(P＜0.05).结论 姜黄素能在体外显著抑制雄激素非依赖性前列腺癌细胞的增殖,诱导细胞凋亡并导致细胞周期的阻滞.姜黄素可能通过抑制NF-κB和AP-1信号通路发挥抑癌效应.     

姜黄素对雄激素非依赖性前列腺癌细胞PC-3及血管内皮生长因子的影响

目的:研究姜黄素对雄激素非依赖性前列腺癌细胞株PC-3细胞体外作用及其对血管内皮生长因子(VEGF)表达的影响,探讨其抗肿瘤的作用机制。方法:分别用0、6.25、12.5、25、50μmol/L浓度的姜黄素作用于PC-3细胞,12、24、36、48、72、96h后台盼蓝拒染法、四甲基偶氮唑蓝(MTT)法检测细胞生长活性;24h后流式细胞仪测定细胞周期及凋亡的变化,透射电镜观察细胞超微结构变化;半定量RT-PCR法检测PC-3细胞内VEGFmRNA的表达;ELISA检测细胞上清液中VEGF浓度。结果:姜黄素能显著抑制PC-3细胞的增殖,呈剂量与时间依赖性,不同浓度姜黄素组之间及不同时间组之间差异均有统计学意义(P<0.01)。不同浓度姜黄素诱导PC-3细胞出现剂量依赖性G2/M期阻滞(P<0.01),且各浓度组凋亡细胞比例均显著高于空白对照组(P<0.01),差异有统计学意义;姜黄素作用24h后PC-3细胞出现凋亡的形态学改变;PC-3细胞内VEGF mRNA的表达和细胞上清液中VEGF呈剂量依赖性降低。结论:姜黄素能显著抑制体外PC-3细胞的生长,并促进其G2/M期阻滞和凋亡,VEGFmRNA及蛋白的表达也明显降低,可能是其抑制肿瘤和血管生长的机制之一。     

双氢青蒿素对前列腺癌细胞PC-3M生长的影响及其机制探讨

目的:观察双氢青蒿素对雄激素非依赖性前列腺癌细胞株PC-3M细胞凋亡和血管内皮生长因子(VEGF)表达的影响。方法:不同浓度(0、25、50、100μmol/L)的双氢青蒿素分别作用于PC-3M细胞48 h,MTT法检测细胞生长活性;流式细胞仪测定细胞凋亡率;分光光度法检测细胞凋亡过程中caspase-3、caspase-8活性变化;半定量RT-PCR法检测PC-3M细胞内VEGF mRNA的表达;Western印迹法检测细胞VEGF蛋白表达。结果:双氢青蒿素能显著抑制PC-3M细胞的增殖,与对照组(0μmol/L)的细胞凋亡率(2.92±0.45)%相比,各剂量组(25、50、100μmol/L)的细胞凋亡率[(8.85±0.74)%,(12.83±0.84)%,(18.65±1.24)%]显著增加,caspase-8[(0.47±0.05)U/μg vs(1.22±0.15)U/μg,(1.76±0.07)U/μg,(2.91±0.24)U/μg]、caspase-3[(0.44±0.07)U/μg vs(0.95±0.08)U/μg,(1.48±0.14)U/μg,(2.92±0.45)U/μg]活性显著增加,呈剂量依赖性(P<0.01)。PC-3M细胞内VEGF mRNA的表达和蛋白表达呈剂量依赖性降低。结论:双氢青蒿素能显著抑制体外PC-3M细胞的生长,并促进其凋亡,机制可能与增加凋亡蛋白酶和抑制VEGF表达有关。     

地高辛联合姜黄素对雄激素非依赖性前列腺癌细胞PC3生长的影响

目的 观察地高辛联合姜黄素对雄激素非依赖性前列腺癌细胞PC3生长作用的影响及可能机制.方法 地高辛、姜黄素及两药联合作用PC3细胞,MTT法测定细胞增殖,流式细胞术测定细胞凋亡,Western Blot法检测PC3细胞中抑制低氧诱导因子-1(hypoxia-induc-ible factor-1α,HIF-1α)、血管生成因子(VEGF)蛋白的表达水平.结果 与对照组相比,联合用药组显著抑制PC3细胞的增殖(P＜0.05);地高辛、姜黄素联合较单独用药可升高PC3细胞凋亡率(P＜0.05);蛋白印迹法检测提示地高辛组、姜黄素组、联合用药组中HIF-1α、VEGF表达明显下调,联合用药组效果更显著(P＜0.05).结论 地高辛联合姜黄素可显著抑制雄激素非依赖性前列腺癌细胞PC3的增长并诱导其凋亡,并可能与下调HIF-1α、VEGF表达有关.     

姜黄素雷公藤内酯醇对前列腺癌细胞PC3及血管内皮生长因子影响的比较

目的研究姜黄素（curcumin,Cur）、雷公藤内酯醇（triptolide,TL）对非雄激素依赖性前列腺癌细胞株PC3细胞体外作用及其血管内皮生长因子（vascular endothelial growth factor,VEGF）表达的影响。方法分别用梯度浓度的Cur和TL作用于PC3细胞,MTT法检测细胞生长活性;流式细胞仪测定细胞周期及凋亡的变化;半定量RT-PCR法检测PC3细胞内VEGF mR-NA的表达;ELISA检测细胞上清液中分泌VEGF蛋白的浓度。结果Cur及TL都能呈剂量与时间依赖性显著抑制PC3细胞的生长,不同浓度组之间及不同作用时间组之间的差异均有统计学意义（P〈0.01）。Cur、TL诱导PC3细胞分别出现剂量依赖性G2/M、S期阻滞（P〈0.01）,且各浓度组凋亡细胞比例差异有统计学意义（P〈0.01）;PC3细胞内VEGF mRNA的表达和细胞上清液中分泌VEGF蛋白亦呈剂量依赖性降低。结论Cur、TL能显著抑制体外PC3细胞的生长,分别促进细胞周期阻滞于不同时期,增加凋亡,并且VEGF mRNA及蛋白的表达明显降低,两药抑制肿瘤和血管生长机制不同。     

索拉非尼对前列腺癌PC3细胞的抑制作用的研究

目的 观察索拉非尼(Sorafenib)对雄激素非依赖性前列腺癌PC3细胞的抑制作用.方法 用不同浓度Sorafenib处理前列腺癌PC3细胞24h、48h和72h后,用MTT法检测Sorafenib对PC3细胞的抑制作用,流式细胞仪检测细胞凋亡变化,Western blot检测不同浓度Sorafenib处理72h后PC3细胞内ERK和Bcl-2的表达.结果 Sorafenib能显著抑制PC3细胞的体外生长,呈时间与剂量依赖性.PC3细胞凋亡率随着Sorafenib剂量的增加而增大,具有良好的量效关系(P<0.01);Sorafenib处理PC3细胞72h后,ERK和Bcl-2蛋白的表达明显下调(P<0.01).结论 Sorafenib抑制PC3细胞增殖、诱导细胞凋亡,可显著抑制雄激素非依赖性前列腺癌细胞的体外生长.     

iNOS基因转染对雄激素非依赖性前列腺癌细胞DU145生长的影响

目的:观察诱导型一氧化氮合酶(iNOS)基因转染对雄激素非依赖性前列腺癌细胞DU145生物学行为的影响。方法:将iNOS基因转染到DU145细胞并筛选出阳性细胞进行扩增,并设空载体组和对照组。观察细胞的形态变化,MTT法绘制生长曲线;流式细胞术检测细胞凋亡率;了解NOS抑制剂对转染细胞的影响。结果:转染iNOS后,DU145细胞分泌的NO[(272.50±15.82)μmol/L]显著高于空载体组[(122.00±18.93)μmol/L]和对照组[(121.00±6.98)μmol/L](P<0.05)。流式细胞术检测结果提示转染iNOS组细胞凋亡率[(42.78±2.01)%]明显高于空载体组[(30.65±1.46)%]和对照组[(28.96±1.50)%](P<0.05)。MTT测定结果提示转染组细胞生长较空载体组和对照组减慢(P<0.05),NOS抑制剂可以加快其生长,但无显著性差异(P>0.05)。结论:iNOS基因转染可以使DU145细胞分泌较高浓度的NO,诱导细胞凋亡,抑制细胞生长,为晚期雄激素非依赖性前列腺癌的基因治疗提供一个有效的靶点。     

姜黄素对雄激素非依赖性前列腺癌细胞PC-3及血管内皮生长因子的影响

目的：研究姜黄素对雄激素非依赖性前列腺癌细胞株PC-3细胞体外作用及其对血管内皮生长因子（VEGF）表达的影响，探讨其抗肿瘤的作用机制。方法：分别用0、6．25、12．5、25、50μmol／L浓度的姜黄素作用于PC-3细胞，12、24、36、48、72、96h后台盼蓝拒染法、四甲基偶氮唑蓝（MTT）法检测细胞生长活性；24h后流式细胞仪测定细胞周期及凋亡的变化，透射电镜观察细胞超微结构变化；半定量RT-PCR法检测PC-3细胞内VEGF mRNA的表达；ELISA检测细胞上清液中VEGF浓度。结果：姜黄素能显著抑制PC-3细胞的增殖，呈剂量与时间依赖性，不同浓度姜黄素组之间及不同时间组之间差异均有统计学意义（P〈0．01）。不同浓度姜黄素诱导PC-3细胞出现剂量依赖性G2／M期阻滞（P〈0．01），且各浓度组凋亡细胞比例均显著高于空白对照组（P〈0．01），差异有统计学意义；姜黄素作用24h后PC-3细胞出现凋亡的形态学改变；PC-3细胞内VEGF mRNA的表达和细胞上清液中VEGF呈剂量依赖性降低。结论：姜黄素能显著抑制体外PC-3细胞的生长，并促进其G2／M期阻滞和凋亡，VEGF mRNA及蛋白的表达也明显降低，可能是其抑制肿瘤和血管生长的机制之一。     

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.     

Dilemma of Membrane Biocompatibility and Reuse

Abstract: Numerous articles have been published on the multiple use of dialyzers and on the effect of different reprocessing chemicals and techniques on the dialyzer biocompatibility and performance. The results often appear contradictory, especially those comparing standard biocompatibility parameters. Despite this confusion, a discerning review of the published works allows certain limited conclusions to be drawn. Reprocessing of used hemodialyzers changes the biocompatibility profile of a dialyzer as defined by the parameters complement activation. leukopenia, and cytokine release. The effect of reprocessing depends on the chemicals and reprocessing technique applied and also on the type of membrane polymer being subjected to the reprocessing procedure. Reports of pyrogenic reactions indicate that the flux of the membrane also influences how suitable it is for safe reuse. An increased risk of allergic and pyrogenic reactions appears to be associated with dialyzer reuse. Furthermore, there has been a lack of investigations into the immunologic effect of the layer of adsorbed and chemically altered proteins that remains on the inner surface of reprocessed dialyzers. We conclude that the clinical benefit of dialyzer reuse cannot be generally accepted from a biocompatibility point of view.     

The analgesic effect of racemic ketamine in patients with chronic ischemic pain due to lower extremity arteriosclerosis obliterans

Background : Ketamine in sub-dissociative doses has been shown to have analgesic and phantom-Limb pain, where conventional treatment has often failed. Chronic ischemic pain due to lower extremity arteriosclerosis obliterans often responds poorly to analgesics, and the pain-generating mechanisms are not well understood.
Methods : Eight patients with rest pain in the lower extremity due to arteriosclerosis obliterans were given sub-dissociative doses of 0.15, 0.30, or 0.45 mg/kg racemic ketamine and morphine 10 mg as a 5-min infusion on four separate days in a cross-over, double-blind, randomised protocol. Plasma levels of (S)- and (R)-ketamine and their nor-metabolites were analysed with an enantioselective high-performance liquid chromatography (HPLC) method. Pain levels were evaluated with a visual analogue scale (VAS).
Results : Individual pain levels were highly variable during and after all the infusions but the pooled pain levels showed a dose-dependent analgesic effect of ketamine with a transient but complete pain relief in all patients at the highest dose (0.45 mg/ kg). Side-effects, mainly disturbed cognition and perception, were pronounced and dose-dependent. Morphine 10 mg had an analgesic peak at 20 min and 5/8 patients had complete pain relief. The remaining 3 patients also had high baseline pain scores, indicating a higher analgesic potency for the 0.30 and 0.45 mg/ kg ketamine doses than for morphine 10 mg.
Conclusion : We have demonstrated a potent dose-dependent analgesic effect of racemic ketamine in clinical ischemic pain. Due to a narrow therapeutic window, this analgesic effect is probably best utilised in combination with other analgesics.     

Intravenous endotoxin does not increase tissue extravasation of albumin in rats

Background : It is unclear whether activation of the inducible nitric oxide synthase (iNOS) increases or decreases the extravasation of plasma.
Methods : Chloralose anaesthetised male Wistar rats received E. coli lipopolysacharide (LPS), 3 mg kg^-1 i.v., or the corresponding volume of saline, 3 or 5 h before the end of the experiment. Mean arterial pressure (MAP) and heart rate (HR) were recorded. Tissue clearance of radio-labelled albumin, during the last 2 h of each experiment, was determined by a double-isotope method. In separate animals, the serum concentration of nitrite and nitrate was determined, 5 h after LPS or the solvent.
Main Results : LPS initially decreased MAP and lastingly increased HR. In the 3-h LPS animals (n=8), tissue plasma clearance was lower in the heart and calf muscle and increased only in diaphragm, compared to corresponding control animals (n=8). In the 5-h LPS rats, clearance was lowered (n=8) in the entire gastrointestinal tract and in testes, compared to controls (n=8). The serum nitrite/nitrate concentration was higher in animals given LPS (n=6) than in controls (n=6).
Conclusion : After LPS, tissue clearance of albumin was not increased in any major tissue, in spite of increased serum levels of NO end products. Apparently, after activation of iNOS, the augmented release of NO is not necessarily associated with increased albumin extravasation.     

Adrenaline markedly improves thoracic epidural analgesia produced by a low-dose infusion of bupivacaine, fentanyl and adrenaline after major surgery: A randomised, double-blind, cross-over study with and without adrenaline

Background: Basic pharmacological research indicates that there are synergistic antinociceptive effects at the spinal cord level between adrenaline, fentanyl and bupivacaine. Our clinical experience with such a mixture in a thoracic epidural infusion after major surgery confirms this. The objectives of the present study were to evaluate the effects on postoperative pain intensity, pain relief and side effects when removing adrenaline from this triple epidural mixture. Methods: A prospective, randomised, double-blind, cross-over study was carried out in 24 patients after major thoracic or abdominal surgery. Patients with only mild pain when coughing during a titrated thoracic epidural infusion of about 10 ml · h^?1 of bupivacaine 1 mg · ml^?1, fentanyl 2 μg · ml^?1, and adrenaline 2 μg · ml^?1 were included. On the 1^st and 2^nd postoperative days each patient was given a double-blind epidural infusion, at the same rate, with or without adrenaline. The effect was observed for 4 h or until pain when coughing became unacceptable in spite of a rescue analgesic procedure. Rescue analgesia consisted of up to two epidural bolus injections per hour and i.v. morphine if necessary. All patients received rectal paracetamol 1 g, every 8 h. Fentanyl serum concentrations were measured with a radioimmunoassay technique at the start and end of each study period. Main outcome measures were extent of sensory blockade and pain intensity at rest and when coughing, evaluated by a visual analogue scale, a verbal categorical rating scale, the Prince Henry Hospital pain score, and an overall quality of pain relief score. Results: The number of hypaesthetic dermatomal segments decreased (P <0.001) and pain intensity at rest and when coughing increased (P <0.001) when adrenaline was omitted from the triple epidural mixture. This change started within the first hour after removing adrenaline. After 3 h pain intensity when coughing had increased to unacceptable levels in spite of rescue analgesia (epidural bolus injections and i.v. morphine). Within 15–20 min after restarting the triple epidural mixture with adrenaline, pain intensity was again reduced to mild pain when coughing. Serum concentration of fentanyl doubled from 0.22 to 0.45 ng · ml^?1 (P <0.01), and there was more sedation during the period without adrenaline. Conclusions: Adrenaline increases sensory block and improves the pain-relieving effect of a mixture of bupivacaine and fentanyl infused epidurally at a thoracic level after major thoracic or abdominal surgery. Serum fentanyl concentrations doubled and sedation increased when adrenaline was removed from the epidural infusion, indicating more rapid vascular absorption and systemic effects of fentanyl.     

Reduction of Plasma Fibrinogen, Immunoglobulin G, and Immunoglobulin M Concentrations by Immunoadsorption Therapy with Tryptophan and Phenylalanine Adsorbents

Abstract Immunoadsorption (1A) therapy with tryptophan (TR-350) or phenylalanine (PH-350) adsorbents has been used to reduce the concentration of serum antibodies in human lymphocyte antigen (HLA)-immunized patients. Other forms of plasma purification have been reported to reduce the level of fibrinogen, which affects the blood properties. In this study we investigated the effects of IA therapy using both adsorbents on plasma fibrinogen and immunoglobulins G and M in 13 patients (8 patients were treated with TR-350, and 5 patients were treated with PH-350). During each session 1 plasma volume (2.8 ± 0.4 L of plasma) was processed through the immunocolumn and then returned to the patient together with the blood cells. Compared with the pretreatment values, the plasma fibrinogen, IgG, and IgM concentrations were significantly reduced after IA therapy (p < 0.01 for TR-350; p < 0.04 for PH-350). There was a positive correlation between the degree of reduction of plasma proteins and the number of IA treatments given. A nonpara-metric test (Wilcoxon's signed-rank test or the Mann-Whitney test) was used for statistical analysis. We conclude from our study that IA therapy effectively lowers the plasma levels of fibrinogen, IgG, and IgM and thus can be considered a valuable alternative to other blood purification methods.     

Utilisation des médicaments prokinétiques en réanimation : indications et limites ?

Enteral feeding is often limited by gastric and intestinal motility disturbances in critically ill patients, particularly in patients with shock. So, promotility agents are frequently used to improve tolerance to enteral nutrition. This review summaries the pathophysiology, presents the available pharmacological strategies, the clinical data, the counter-indications and the principal limits. The clinical data are poor. No study demonstrates a positive effect on clinical outcomes. Metoclopramide and erythromycin seems to be the more effective. Considering the risk of antibiotic resistance, the first line use of erythromycin should be avoided in favor of metoclopramide.     

Anesthésie générale chez l’enfant : quid des pratiques en 2010 ?

Introduction

The practice of pediatric anesthesia requires a regular update of scientific knowledge and technical skills. To provide the most adequate Continuing Medical Education programs, it is necessary to assess the practices of pediatric anesthesiologists. Thus, the objective of this survey was to draw a picture of the current clinical practices of general anesthesia in children, in France.

Material and methods

One thousand one hundred and fifty questionnaires were given to anesthesiologists involved in pediatric cases. These questionnaires collected information on various aspects of clinical practice relative to induction, maintenance, recovery from general anaesthesia and also classical debated points such as children with Upper Respiratory Infection (URI), emergence agitation, epileptoid signs or anaesthetic management of adenoidectomy. Differences in practices between CHG (general hospital), CHU (teaching hospital), LIBERAL (private) and PSPH (semi-private) hospitals were investigated.

Results

There were 1025 questionnaires completed. Fifty-five percent of responders worked in public hospitals (CHG and CHU); 77% had a practice that was 25% or less of pediatric cases. In children from 3 to 10 years: 72% of respondents used always premedication and two thirds performed inhalation induction in more than 50% of cases. For induction, 53% used sevoflurane (SEVO) at 7 or 8%. Respondents from LIBERAL used higher SEVO concentrations. Tracheal intubation was performed with SEVO alone (37%), SEVO and propofol (55%) and SEVO with myorelaxant (8%), 93% of respondents used a bolus of opioid. For maintenance, the majority of respondents used SEVO associated with sufentanil; desflurane and remifentanil were more frequently used in CHU. Two thirds of respondents used N₂O. Depth of anesthesia was commonly assessed by hemodynamic changes (52%), end tidal concentration of halogenated (38%) or automated devices based on EEG (7%). In children with URI, 98% of respondents used SEVO for anesthesia. To control the airway 42% used a tracheal tube, 30% a laryngeal mask and 20% a facial mask. Emergence agitation was an important concern for two thirds of respondents, while epileptoid signs were considered as important by only 20%. Eighty-nine percent of respondents practiced anesthesia for adenoidectomy. Anesthesia was induced by inhalation of SEVO 7–8% (41%), 6% (39%) or 4% (12%), 66% put an intravenous line (less frequently in LIBERAL). 67% of the responders managed adenoidectomy without any device to control the airway (more frequently in LIBERAL), 32% administrated a bolus of opioid (less frequently in LIBERAL).

Discussion

This survey demonstrated that the practices regarding general anesthesia in children are relatively homogenous. Most of the differences appeared between LIBERAL and the others structures; the anaesthetic management for adenoidectomy illustrates these findings.     

Intérêt d’une rééducation précoce pour les patients neurologiques

Rehabilitation improves the functional prognosis of patients after a neurologic lesion, and tendency is to begin rehabilitation as soon as possible. This review focuses on the interest and the feasibility of very early rehabilitation, initiated from critical care units. It is necessary to precisely assess patients’ impairments and disabilities in order to define rehabilitation objectives. Valid and simple tools must support this evaluation. Rehabilitation will be directed to preventing decubitus complications and active rehabilitation. The sooner rehabilitation is started; the better functional prognosis seems to be.