术前罗哌卡因联合右美托咪定和地塞米松髂筋膜间隙阻滞在高龄患者半髋关节置换术中的应用及对患者应激反应的影响

目的 探讨术前罗哌卡因联合右美托咪定和地塞米松行髂筋膜间隙阻滞对高龄患者半髋关节置换术后镇痛效果和应激反应的影响。方法 选取2020年01月至2021年10月入住中国人民解放军总医院第六医学中心拟行半髋关节置换术的高龄患者90例并随机分成两组,每组患者均于术前24 h及手术当日麻醉前30 min行骨折侧超声引导下腹股沟韧带上髂筋膜间隙阻滞,对照组患者使用0.375%罗哌卡因30 mL,观察组患者使用0.375%罗哌卡因联合0.5 μg/kg右美托咪定和0.1mg/kg地塞米松共30 mL,术后两组患者均连接静脉自控镇痛泵。比较两组患者入院后即刻（T0）、术前实施神经阻滞后12 h（T1）、入室时（T2）、术后12 h（T3）、24 h（T4）和48 h（T5）的静息视觉模拟评分（visual analogue scores, VAS）及T3~T5时刻的运动VAS评分;并记录两组患者术后镇痛泵的首次按压时间,镇痛药的使用剂量和不良反应的发生率;同时比较两组患者术前和术后1 d血清白细胞介素-6（interleukin-6, IL-6）、C反应蛋白（c reactive protein, CRP）、皮质醇（cortisol, Cor）、去甲肾上腺素（norepinephrine, NE）和肾上腺素（epinephrine, E）水平。结果 与对照组比较,观察组患者T2和T4时刻的静息VAS评分以及T3~T5时刻的运动VAS评分均降低（P<0.05）,且术后镇痛泵的首次使用时间推迟,镇痛药的使用剂量减少（P<0.05）。术后1 d,观察组血清IL-6、CRP、Cor、NE和E的水平明显低于对照组（P<0.05）,但两组患者术后并发症和不良反应的发生率比较,差异无统计学意义（P>0.05）。结论 术前罗哌卡因联合右美托咪定和地塞米松行髂筋膜间隙阻滞可有效减轻高龄患者半髋关节置换术后的疼痛程度、延长镇痛时间、减轻术后炎症和应激反应,且安全可靠。     

Dietary Lipids Alter the Effect of Steroids on the Transport of Fructose Following Intestinal Resection in Rats

BACKGROUND: Glucocorticosteroids alter intestinal morphology and transport. We tested the hypothesis that the desired intestinal adaptive response following intestinal resection may be enhanced further by the locally active steroid budesonide, and by feeding a saturated as compared with a polyunsaturated fatty acid diet. METHODS: An in-vitro uptake method was used to assess intestinal fructose uptake by rats of semisynthetic diets enriched in saturated or polyunsaturated fatty acids, and injected with budesonide or control solution. RESULTS: Budesonide increased ileal fructose uptake in chow and PUFA-fed animals, but reduced jejunal fructose uptake in rats fed SFA. GLUT5 and GLUT2 protein and mRNA did not correlate with changes in fructose uptake. Steroids reduced jejunal proglucagon expression in animals fed chow. Animals fed SFA and given budesonide had a reduction in jejunal ODC mRNA compared with those fed PUFA or chow. CONCLUSIONS: (1) budesonide increases ileal fructose uptake following intestinal resection, and this beneficial effect is prevented by feeding SFA rather than PUFA; (2) fructose uptake does not correlate with GLUT5 and GLUT2 protein and mRNA; (3) ODC and proglucagon may be involved in this adaptive response.     

A comparative study of adverse reactions occurring after administration of glycosylated granulocyte colony stimulating factor and/or dexamethasone for mobilization of neutrophils in healthy donors

Both granulocyte colony-stimulating factor (G-CSF) and dexamethasone (DXM) are used for neutrophil (PMN) mobilization and collection. This prospective study was aimed to evaluate and compare the rate, severity and clinical significance of adverse reactions of these drugs alone and in combination in healthy donors. PMN mobilization was carried out using dexamethasone alone (8 mg orally; n=25) or glycosylated G-CSF alone (Lenograstim, 5 g/kg subcutaneously, n=24) or in combination (n=23) prior to a standard granulocyte apheresis on the Spectra cell separator. The number of PMNs counted in the mobilized peripheral blood of the donors was 7.0 (3.6–20.4) ×10⁹/L (DXM), 25.2 (15.5–49.7) ×10⁹/L (G-CSF), and 31.6 (20.0–43.0) ×10⁹/L (G-CSF+DXM), corresponding to PMN apheresis yields of 13 (8–43) ×10⁹/U, 56 (34–118) ×10⁹/U, and 83 (33–117) ×10⁹/U, respectively. The three groups had comparable percentages of donors with at least one adverse effect (ranging from 75 to 80%), but the G-CSF-containing regimens were generally more toxic, as was reflected by higher percentages of donors with moderate to severe adverse reactions and higher overall severity scores of 2.28 (G-CSF) and 2.08 (G-CSF+DXM) compared with 1.33 in the DXM group (p0.001). With G-CSF alone, pain symptom complexes were more frequent, more severe, and more often triggered requests for analgesics (9/47 donors; 19%) and unwillingness to give further neutrophil donations (2/47 donors; 4%). The addition of DXM to G-CSF diminished some symptoms, particularly bone pain, headache and the frequency of requests for analgesics. The predominant symptoms in the DXM alone group were mild gastrointestinal complaints. We conclude that G-CSF stimulation improved neutrophil mobilization and apheresis yields at the expense of donor tolerability. Compared with G-CSF alone, the combination G-CSF and DXM did not increase the quantity or the severity of donor symptoms.Abbreviations AP Alkaline phosphatase - LDH Lactic dehydrogenase - DBV Donor blood volume - DXM Dexamethasone - G-CSF Granulocyte colony-stimulating factor - HCT Hematocrit - PMN Polymorphonuclear neutrophil leukocytes - OSS Overall severity score - p.o. Orally - s.c. Subcutaneously - WBC White blood cells     

Effect of operation-synchronizing transfusion of apoptotic spleen cells from donor rats on acute rejection of recipient rats after liver transplantation

AIM: To study effect of operation-synchronizing transfusion of apoptotic spleen cells from donor rats on acute rejection of recipient rats after liver transplantation. METHODS: Two of Wistar rats were chosen randomly for normal liver pathology control and ten of SD rats chosen randomly for liver function control as blank group (no operation). The rest of Wistar and SD rats were divided into four groups: control group (only liver transplantation), Dex group (donors receiving intraperitoneal injection of dexamethasone), SpC group (recipients receiving infusion of spleen cells of donors), Dex-SpC group (recipients receiving infusion of apoptotic spleen cells of donors), with each group except blank group, containing 10 SD rats and 10 Wistar rats, respectively. Wistar rats received liver transplantation from SD rats, in the meantime they received infusion of spleen cells of donors, which were induced by an intraperitoneal injection of dexamethasone (3 mg/(d.kg)·b.w) for three days before liver transplantation. The serum alanine transaminase (ALT), total bilirubin (T bili), liver pathological changes and survival time were analysed. Statistical analysis was carried out using SPSS 10.0 for Windows. Differences of the parametric data of ALT in means were examined by one-way ANOVA. Differences of ALT between two groups were examined by LSD. Differences of the nonparametric data of T bili in means and scores of pathology classification for acute rejection were examined by Kruskal-Willis H test. The correlations between ALT and T bili were analysed by Bivariate. Kaplan-Meier curves were used to demonstrate survival distribution. The log-rank test was used to compare the survival data. RESULTS: There were significant differences in ALT of the five groups (F= 23.164 P= 0.000), and ALT in Dex-SpC group was significantly higher than that in blank control, control, Dex, and SpC groups (P = 0.000), and ALT in SpC group was significantly higher than that in blank control (P= 0.000), control (P= 0.004), and Dex groups (P= 0.02). Results of nonparametric analysis of T bill showed that there were differences in T bill of the five groups (X2= 33.265 P= 0.000). T bili in Dex-SpC group was significantly higher than that in blank control, control, Dex, and SpC groups. T bili in SpC group was higher than that in blank control, control, and Dex groups. There were significant differences in scores of pathology classification for acute rejection in each of the groups (X2= 25.933, P= 0.000). The pathologically more serious acute rejection was found in Dex-SPC group than in other groups. No sign of acute rejection was observed in the blank control group. Slight acute rejection was observed in the control group. Slight-moderate acute rejection was observed in the Dex group. Moderate-acute rejection was observed in the SpC group. Severe-acute rejection was observed in the Dex-SpC group. The survival time in Dex-SpC group was shorter than in other groups (statistic = 11.13, P= 0.011). ALT and T bili were positively correlated (r= 0.747, P= 0.000, two-tailed). CONCLUSION: In order to reduce quantity of blood loss from rats after liver transplantation, only one of ALT or T bili is needed for liver function measurement of rats. Simultaneous injection of apoptotic spleen cells from donors induced by dexamethasone to liver transplantation rats aggravates acute rejection. One important mechanism of aggravation of acute rejection may be that apoptotic cells are not removed in time and that dead cells including apoptotic cells release inflammatory factors.     

地塞米松治疗与细菌性脑膜炎脑源性神经营养因子及其受体基因表达的关系

目的 探讨地塞米松(DEX)治疗与细菌性脑膜炎脑源性神经营养因子(BDNF)及其受体TrkB基因表达的关系。方法 建立细菌性脑膜炎模型，分别用抗菌药物及抗菌药物加DEX治疗，用原位杂交检测脑组织BDNF mRNA和TrkB mRNA的表达。结果 单独使用抗菌药物治疗后BDNF mRNA和TrkB mRNA表达均低于感染后5d组的水平(P＜0．05)，并以BDNF mRNA下降更明显(P＜0．01)，而使用DEX与抗菌药物联合治疗后，BDNF mRNA和TrkB mRNA表达回到较高水平(P＜0．01)，BDNFmRNA达到感染后5d组水平(P＞0．05)，TrkB mRNA则超过感染后5d组水平(P＜0．05)。结论 DEX则可能通过上调内源性BDNF mRNA和TrkB mRNA表达，有利于抵御细菌性脑膜炎脑损伤。     

Establishment of a Rat Long-Term Culture Expressing the Osteogenic Phenotype: Dependence on Dexamethasone and FGF-2

Rat stromal bone-marrow cells cultured in the presence of dexamethasone, ascorbic acid, &#103 -glycerophosphate, and fibroblast growth factor-2 (FGF-2) express the osteogenic phenotype (Pitaru et al., J. Bone Miner. Res . 8:919-929, 1993). The purpose of this study was to establish a long-term homogeneous culture expressing the osteogenic phenotype. The cultures were routinely passaged every 5 days in the absence or presence of either or both dexamethasone and FGF-2, and the cumulative doubling number and the expression of the osteogenic phenotype were determined. Cultures treated with dexamethasone (10 &#109 7 M) ceased proliferation and only upon addition of FGF-2 (3 ng/ml) was a spontaneous immortalization achieved, as expressed by sustained proliferation for about 1 year, with a doubling time of 22 h and more than 300 doublings in 72 passages. Both FGF-2 and dexamethasone are required and act synergistically to maintain cell propagation, alkaline phosphatase expression, and osteocalcin secretion; however, protein content was FGF-2 dependent and the mineralization was dexamethasone dependent. Repetitive single-cell cloning tested the homogeneity and stability of the cells expressing the osteogenic phenotype in these long-term cultures. It was shown that 25% to 50% of subclones derived from clones with an osteogenic phenotype do not further express the osteogenic phenotype. In conclusion, we have established a spontaneously immortalized dexamethasone- and FGF-2-dependent rat stromal bone-marrow-derived long-term culture expressing the osteogenic phenotype. The cultures tend to lose the osteogenic phenotype, and dexamethasone supports the long-term preservation of the osteogenic phenotype.     

地塞米松溶液预处理外周静脉置入中心静脉导管预防早产儿静脉炎随机双盲对照试验

目的探讨地塞米松溶液预处理导管在预防早产儿经外周静脉置人中心静脉导管（PICC）所致静脉炎中的可行性及安全性。方法186例需行PICC置管术的低出生体重儿随机分为两组。两组均采用标准操作规范置入PICC,地塞米松组92例置管前使用地塞米松0．08mg·mL。稀释液50mL浸泡PICC导管,生理盐水组94例使用生理盐水50mL浸泡PICC导管,浸泡时间均为5min。比较两组患儿置管术后静脉炎的发生率、出现时间、严重程度及其他导管相关并发症发生情况。结果地塞米松组静脉炎发生率14．1％（13／92）,平均出现时间为（4．4±1．0）d,生理盐水组分别为33．O％（31／94）和（2．8±0．8）d,地塞米松组静脉炎严重程度低于生理盐水组,两组间差异均有统计学意义（P〈0．05）。两组其他置管相关并发症发生率差异无统计学意义（P〉0．05）。结论在早产儿PICC置管前,使用地塞米松溶液预处理导管,能降低PICC所致静脉炎发生率及其严重程度,且能延缓静脉炎出现时间,未增加其他导管相关并发症。     

Melatonin prevents dexamethasone‐induced testicular oxidative stress and germ cell apoptosis in golden hamster,Mesocricetus auratus

This study investigated the protective effect of melatonin on dexamethasone (Dex), an extensively used anti‐inflammatory and immunosuppressive synthetic glucocorticoid, induced testicular oxidative stress and germ cell apoptosis in golden hamster. Hamsters were randomly divided into four groups (n = 7): group I – control; group II – melatonin treated (10 mg kg^?1 day^?1); group III – Dex treated (7 mg kg^?1 day^?1) and group IV – combination of Dex and melatonin. All the injections were administered intraperitoneally for seven consecutive days. The histopathological changes, specific biochemical markers, including antioxidative enzymes, plasma melatonin level and the markers for germ cell apoptosis were evaluated. Dex administration decreased antioxidant enzyme activities (SOD, CAT, GSH‐P_X), plasma melatonin level and melatonin receptor (MT1) expression with a concomitant increase in lipid peroxidation (TBARS) and altered testicular histopathology which might culminate into increased germ cell apoptosis as evident from increased Bax/Bcl‐2 ratio and caspase‐3 expression. However, melatonin pre‐treatment enhanced enzyme activities for SOD, CAT, GSH‐P_X with a simultaneous decrease in Bax/Bcl‐2 ratio and caspase‐3 expression. Our findings clearly suggest that melatonin improved defence against Dex‐induced testicular oxidative stress and prevented germ cell apoptosis, suggesting a novel combination therapeutic approach for management of male reproductive health.     

糖皮质激素对大鼠肾上腺嗜铬细胞分泌儿茶酚胺的急性效应

利用全细胞膜片钳技术,观察不同浓度地塞米松急性灌洗大鼠肾上腺嗜铬细胞(AMCC)后钙通道电流和烟碱受体通道电流(INIC)的变化,地塞米松对大鼠AMCC的急性作用为明显抑制INIC而对电刺激所诱发的钙通道电流无明显影响,提示糖皮质激素对大鼠AMCC分泌儿茶酚胺的急性效应可能与烟碱受体直接相关。