p38丝裂原活化蛋白激酶在罗哌卡因致SH-SY5Y细胞凋亡中的作用

目的 评价p38丝裂原活化蛋白激酶(p38MAPK)在罗哌卡因致SH-SY5Y细胞凋亡中的作用,以探讨罗哌卡因诱发神经毒性的机制.方法 采用随机数字表法,将SH-SY5Y细胞随机分为4组(n=18):正常对照组(C组)、10 μmol/L p38MAPK特异性抑制剂SB203580组(SB组)、3 mmol/L罗哌卡因组(R组)、10 μmol/L SB203580+3 mmol/L罗哌卡因组(SB+R组).C组在细胞培养液中继续培养；SB组在含10 μmol/L SB203580培养液中孵育；R组在含3 mmol/L罗哌卡因的培养液中孵育；SB+R组在含10 μmol/L SB203580的培养液中孵育30 min后,用含3mmol/L罗哌卡因的培养液继续孵育.各组细胞培养或罗哌卡因孵育4 h后采用流式细胞仪检测细胞内活性氧(ROS)水平和细胞凋亡率,采用Western blot法检测p38MAPK和磷酸化p38MAPK(p-p38MAPK)的表达,采用MTT法检测细胞活力.结果 与C组比较,R组和SB+R组ROS水平升高,p-p38MAPK表达上调,细胞活力降低,细胞凋亡率升高(P＜0.01),SB组上述指标差异无统计学意义(P＞0.05)；与R组比较,SB组p-p38MAPK表达下调,细胞活力升高,细胞凋亡率降低(P＜0.01).四组p38MAPK表达水平差异无统计学意义(P＞0.05).结论 罗哌卡因致SH-SY5Y细胞凋亡作用的机制部分与p38MAPK的激活有关.     

异丙酚对布比卡因致PC12细胞毒性时细胞Ca2+浓度和一氧化氮合酶活性的影响

目的 评价异丙酚对布比卡因致PC12细胞毒性时细胞Ca2+浓度和一氧化氮合酶(NOS)活性的影响.方法 PC12细胞悬液(105/ml)随机分成4组:对照组(C组)、异丙酚组(P组)、布比卡因组(B组)和异丙酚+布比卡因组(PB组),每组PC12细胞分别接种于36孔板(每孔1 ml,每组9孔)、激光共聚焦显微镜专用培养皿(每皿1 ml,每组6皿)和24孔板(每孔 1 ml,每组6孔).C组加入D-Hank液500 μl;P组加入异丙酚至终浓度为2 mmol/L;B组加入布比卡因至终浓度为0.09 mmol/L;PB组同时加入异丙酚和布比卡因,终浓度分别为2 mmol/L和0.09 mmol/L.于36孔板中孵育24 h后测定PC12细胞凋亡率;于激光共聚焦显微镜专用培养皿中孵育6、24 h时,测定PC12细胞游离Ca2+浓度;于24孔板中孵育6、24 h时测定细胞NOS活性.结果 与C组相比,B组和PB组PC12细胞游离Ca2+浓度、NOS活性和凋亡率均升高(P<0.01),P组上述指标差异无统计学意义(P>0.05);与B组相比,PB组PC12细胞游离Ca2+浓度、NOS活性和凋亡率均降低(P<0.05).结论 在细胞水平,异祆丙酚可能通过抑制NOS活性和钙超载,减轻布比卡因诱导的神经毒性.     

乙酰左旋肉碱预处理对低氧低糖诱导PC12细胞凋亡的影响

目的 评价乙酰左旋肉碱预处理对低氧低糖诱导PC12细胞凋亡的影响.方法 PC12细胞接种于96孔板中,采用随机数字表法,将细胞随机分为5组(n=6):对照组(C组)、细胞损伤组(Ⅰ组)和不同浓度乙酰左旋肉碱预处理组(A1-3组).C组加入含葡萄糖4.5 g/L的DMEM溶液孵育3h;Ⅰ组加入含葡萄糖0.5 g/L和Na2SO4 3 mmol/L的DMEM溶液孵育3h;A1-3组分别加入0.2、0.4和0.6 mmol/L乙酰左旋肉碱孵育24h,然后加入含葡萄糖0.5 g/L和Na2S2O4 3mmol/L的DMEM溶液孵育3h.采用MTT法检测细胞活力,采用TUNEL法检测细胞凋亡率,测定细胞SOD和ATP酶的活性和MDA含量.结果 与C组比较,Ⅰ组细胞活力降低,细胞凋亡率升高,SOD和ATP酶的活性降低,MDA含量增加(P＜0.05),A1-3组细胞活力、细胞凋亡率、SOD和ATP酶的活性和MDA含量差异无统计学意义(P＞0.05);与Ⅰ组比较,A1-3组细胞活力升高,细胞凋亡率降低,SOD和ATP酶的活性升高,MDA含量下降(P＜ 0.05);A1-3组间细胞活力、细胞凋亡率、SOD和ATP酶的活性和MDA含量比较差异无统计学意义(P＞0.05).结论 乙酰左旋肉碱预处理可通过抑制细胞凋亡,减轻低氧低糖诱导PC12细胞损伤.     

丙泊酚对布比卡因诱导的PC12细胞毒性、活性氧和过氧化氢酶的影响

目的探讨丙泊酚对布比卡因诱导的PC12细胞毒性的保护作用及活性氧(ROS)和过氧化氢酶(CAT)在其中的作用。方法培养的PC12细胞分成四组:正常对照组(C组);丙泊酚组(P组),在细胞培养基中加入2mmol/L丙泊酚;布比卡因组(B组),在细胞培养基中加入0.09mmol/L布比卡因;丙泊酚加布比卡因组(PB组),在细胞培养基中同时加入2mmol/L丙泊酚和0.09mmol/L布比卡因;每组6孔。培养6h和24h后,用倒置相差显微镜观察细胞形态、MTT比色微量分析细胞活性,测定上清液乳酸脱氢酶(LDH)活性和细胞内CAT、ROS活性。结果与C组相比,B组PC12细胞活性和细胞内CAT活性显著降低(P<0.01),LDH活性和细胞内ROS活性显著增加(P<0.01);P组PC12细胞活性及其它指标无显著变化;与B组相比,PB组PC12细胞活性和细胞内CAT活性显著增加(P<0.05),LDH活性和细胞内ROS活性显著降低(P<0.01)。结论布比卡因对PC12细胞具有毒性作用,可能与降低细胞内CAT活性、增加ROS活性有关;丙泊酚通过保护细胞内CAT活性和清除ROS而减轻布比卡因诱导的PC12细胞毒性。     

不同浓度罗哌卡因对乳腺癌MCF-7细胞增殖和细胞周期的作用研究

目的观察不同浓度罗哌卡因对乳腺癌MCF-7细胞增殖和细胞周期的影响并探讨其机制。方法人乳腺癌细胞MCF-7接种于培养板培养24h,随机分为四组:对照组(C组)、罗哌卡因100μg/ml组(R1组)、罗哌卡因200μg/ml组(R2组)和罗哌卡因400μg/ml组(R3组)处理乳腺癌MCF-7细胞48h后,检测其细胞增殖能力(细胞活力)和细胞周期。检测R3组作用于MCF-7细胞48h后TCF-4、beta-catenin的蛋白表达水平。结果 R2、R3组MCF-7细胞活力明显低于C组(P0.05);R1、R2、R3组MCF-7细胞G0/G1期细胞明显少于C组,S期和G2/M期细胞明显多于C组(P0.05);R3组TCF-4和beta-catenin蛋白表达水平明显低于C组(P0.05)。结论罗哌卡因可能通过下调TCF-4和beta-catenin蛋白表达水平抑制人乳腺癌MCF-7细胞增殖。     

异丙酚对布比卡因诱导的PC12细胞毒性的作用

目的 探讨异丙酚对布比卡因诱导的PC12细胞毒性的作用及其可能机制。方法PCI2细胞接种于96孔培养板中培养，随机分为4组：对照组、布比卡因组、异丙酚组和布比卡因＋异丙酚组，分别加入Hanks液、布比卡因（终浓度为0．03、0．06、0．09、0．12、0．15mmol／L）、异丙酚（终浓度为1、2,4、8mmol／L）以及同时加入布比卡因（终浓度为0．09mmol／L）和异丙酚（终浓度为1、2,4、8mmol／L）。培养24h时，采用二甲基噻唑二甲基四唑溴盐比色微量分析法测定各孔的细胞活力和上清液乳酸脱氢酶（LDH）的活性，应用流式细胞仪检测硫氧还蛋白-1（Trx-1）和硫氧还蛋白还原酶-1（TrxR-1）表达率。结果 与对照组比较，布比卡因组PC12细胞活力降低（P〈0．01），且呈浓度依赖性；异丙酚组PC12细胞活力差异无统计学意义（P〉0．05）。与布比卡因组的0．09mmol／L亚组比较，布比卡因＋异丙酚组的2—8mmol／L亚组PC12细胞活力增加（P〈0．05）。与对照组比较，布比卡因组和布比卡因＋异丙酚组LDH活性升高，Trx-1和TrxR-1表达率降低（P〈0．01）；与布比卡因组比较，异丙酚组和布比卡因＋异丙酚组LDH活性降低，Trx-1和TrxR-1表达率升高（P〈0．01）。结论 布比卡因对PC12细胞具有浓度依赖性的细胞毒性作用。异丙酚可通过保护内源性硫氧还蛋白系统减轻布比卡因诱导的PCI2细胞的毒性。     

染料木黄酮对去势小鼠脾细胞凋亡及雌激素受体表达的影响

目的探讨染料木黄酮(GEN)对去势(OVX)小鼠脾细胞凋亡、凋亡基因Fas、FasL及雌激素受体(ER)亚型表达的影响。方法流式细胞仪检测不同浓度GEN对OVX小鼠脾细胞的凋亡率,采用逆转录聚合酶链反应(RT-PCR)方法检测细胞内Fas、FasL及ERα、ERβ mRNA的表达。结果OVX+GEN组与青年组相比,脾细胞凋亡率在GEN两个高浓度(37.0、92.5μmol/L)时都显著增高(P均<0.05);而Fas基因表达在GEN 92.5μmol/L时显著增高(P<0.05),FasL基因表达在GEN两个高浓度均显著高于青年组(P均<0.05);与OVX空白组相比,GEN最高浓度(92.5μmol/L)时凋亡率显著增高(P<0.01),Fas、FasL基因的表达均显著增高(P均<0.05)。ERα、ERβ基因的表达随GEN浓度增加而呈增加趋势,在GEN最高浓度(92.5μmol/L)时显著高于OVX空白组(ERα:P<0.05;ERβ:P<0.01)。结论高浓度GEN致脾细胞凋亡,与上调凋亡促进基因Fas、FasL基因表达有关。低浓度GEN可能逆转OVX小鼠脾细胞凋亡。高浓度GEN增加ERα、ERβ基因表达。GEN对脾细胞凋亡、ERs表达的调节可能不完全通过ER途径。     

Fas/FasL蛋白在不同浓度葡萄糖小鼠囊胚中的表达及意义

目的:探讨Fas/FasL蛋白在不同浓度葡萄糖小鼠囊胚中的表达及意义.方法:通过促超排卵,获取妊娠3.5d小鼠囊胚,随机分成三组,即对照组(空白)、低糖组(葡萄糖浓度为7.5mmol/L和高糖组(葡萄糖浓度为28.0mmol/L),分别培养在含0、7.5mmol/L和28.0mmol/L萄萄糖的M199培养基中,培养24h后,然后再吸出囊胚.每组随机吸取30个囊胚用免疫组织化学S-P法,检测不同浓度葡萄糖对小鼠囊胚Fas/FasL蛋白表达状况,利用HPIAS-1000图像分析系统测定Fas/FasL蛋白在以上三组中表达的平均光密度和平均阳性面积率.结果:Fas/FasL蛋白表达结果:空白组中囊胚细胞胞浆中可见少量浅棕黄色颗粒,Fas/FasL蛋白表达呈弱阳性.低糖组中囊胚细胞胞浆未见着色,Fas/FasL蛋白表述呈阴性.高糖组囊胚细胞胞浆中可见较多的棕黄色颗粒,Fas/FasL蛋白表达呈强阳性.空白组与低糖组囊胚Fas/FasL蛋白表述的阳性面积率及平均光密度无显著性差异(P＞0.05),高糖组与空白组和低糖组相比均存在显著性差异(P＜0.01).结论:Fas/FasL蛋白通过执行细胞凋亡的功能,在高浓度葡萄糖中过度表达,导致囊胚细胞数目过度减少,从而影响囊胚的正常发育和着床.     

Fas/FasL在乳头状甲状腺癌组织中的表达

目的：探讨凋亡相关基因Fas/FasL在甲状腺癌组织中的表达与细胞凋亡的关系。方法：采用流式细胞技术检测43例乳头状甲状腺癌癌细胞凋亡及相关基因Fas及FasL表达。同时检测Fas及FasL在甲状腺癌组织肿瘤浸润淋巴细胞（TIL）中的表达。结果：43例乳头状甲状腺癌细胞中Fas低表达者19例,细胞凋亡率为3．71％,高表达者24例,细胞凋亡率为7．26％,高表达组癌细胞凋亡率明显高于低表达组（P＜0．05）,癌细胞中FasL表达明显高于甲状腺腺瘤组织（P＜0．01）,乳头状甲状腺癌组织TLL表达Fas及FasL的水平明显高于甲状腺腺瘤组织（P＜0．01）。结论：Fas系统参与乳头状甲状腺癌细胞中细胞凋亡的调节,Fas/FasL表达异常使甲状腺癌癌细胞逃避免疫监视,诱导Fas敏感的TIL凋亡,有助于癌细胞发生浸润及转移。     

罗哌卡因致大鼠脊髓神经毒性时Bax和Bcl-2表达的变化

目的 评价罗哌卡因致大鼠脊髓神经毒性时Bax和Bcl-2表达的变化,以探讨罗哌卡因脊髓神经毒性的机制.方法 清洁级雄性SD大鼠,体重260～300 g,按改良Yaksh法鞘内置入脊髓微导管,取鞘内置管成功的大鼠54只,随机分为3组(n=18):生理盐水组(NS组)、0.5%罗哌卡因组(R1组)和1%罗哌卡因组(R2组).R1组和R2组于置管后第7天经脊髓微导管分别注射0.5%、1%罗哌卡因0.12μl/g,注药速率10 μl/15 s,每隔1.5小时给药1次,给药期24 h,共注药16次,NS组注射等容量生理盐水.于最后1次鞘内注射罗哌卡因或生理盐水后,每隔10分钟行双下肢运动阻滞评分1次,共5次(T1-5),以评价运动阻滞效果;于鞘内注射罗哌卡因或生理盐水后6、12和24 h(T6-8)时随机取6只大鼠,处死后取脊髓,光镜和电镜下观察病理学结构,并测定脊髓组织Bax和Bcl-2的表达水平.结果 与NS组比较,R1组T1,2时、R2组,T1-3时大鼠双下肢运动阻滞评分升高,R1组脊髓组织Bax、Bcl-2表达均上调(P<0.05),Bcl-2/Bax比值差异无统计学意义(P>0.05),R2组脊髓组织Bax表达上调(P<0.05),Bcl-2表达差异无统计学意义(P>0.05),Bcl-2/Bax比值降低(P<0.05).R1组超微结构改变主要为线粒体和内质网轻度肿胀,而神经细胞未发生凋亡;R2组脊髓神经细胞出现了核固缩等早期凋亡改变.结论 罗哌卡因的脊髓神经毒性可能与激活神经细胞线粒体凋亡途径有关.     

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.