原发性肝细胞癌以及近癌旁组织微血管密度CD105表达及其临床意义

目的 研究肝细胞癌(HCC)及其近癌旁组织微血管密度(MVD-CD105)分布,探讨MVD-CD105在HCC、近癌旁组织的分布规律、临床意义以及CD105标染HCC组织微血管的特异性.方法 采用免疫组织化学方法检测63例HCC组织、近癌旁组织MVD-CD105,比较HCC组织和近癌旁组织MVD-CD105分布特点及其与临床参数的关系.结果 63例HCC及其近癌旁组织血管CD105阳性表达率为100％,近癌旁组织表达强度高于癌组织(χ2=9.184,P＜0.01).HCC组织MVD-CD105为(58.37±21.45)/0.74mm2,近癌旁组织为(81.62±19.86)/0.74mm2,近癌旁组织MVD-CD105分布显著高于癌组织(t=2.438,P＜0.05).HCC组织中的MVD-CD105阳性表达分布与肿瘤转移及TNM分期有关(P＜0.01).近癌旁组织的MVD-CD105阳性表达分布与肿瘤TNM分期及2年存活时间有关(P＜0.05).结论 CD105标染HCC组织MVD未体现出肿瘤微血管标染特异性.HCC组织MVD-CD105高表达、分布意味着肿瘤的局部转移和进展.CD105分子不能作为抗肝癌肿瘤血管生成靶向治疗的靶标,但肝癌MVD-CD105的检测对于后续综合治疗有指导意义.     

骨膜蛋白与上皮-间质转化标志物在结直肠癌中表达相关性的研究

目的 探讨结直肠癌中骨膜蛋白与上皮间质转化标志物E-cadherin、N-cadherin和临床病理参数间的相关性.方法 通过免疫组织化学染色方法检测106例结直肠癌患者癌组织和对应癌旁正常组织中骨膜蛋白、E-cadherin和N-cadherin表达情况,并对其结果进行分析.结果 骨膜蛋白、E-cadherin和N-cadherin在结直肠癌组织中表达与对应癌旁正常组织相比差异有统计学意义(62/106 vs 21/106,x2=34.027,P＜0.05;43/106 vs 89/106,x2 =42.480,P＜0.05;66/106 vs 19/106,x2 =43.382,P＜0.05).结直肠癌组织中骨膜蛋白表达水平与肿瘤分化程度、肿瘤浸润程度、淋巴结转移及远处转移有关(x2=7.752,P =0.007; x2 =5.008,P=0.031; x2=10.227,P =0.002; x2 =8.001,P=0.006),与E-cadherin表达呈负相关(r=-0.435,P＜0.001),与N-cadherin表达呈正相关(r=0.213,P=0.028).结论 骨膜蛋白可能通过调节上皮间质转化过程参与结直肠癌的发生发展.     

肝动脉灌注化疗后肝细胞癌8-OHdG、p53和p21~(waf1/cip1)的表达研究

目的 探讨肝细胞癌(hepatocellular carcinoma,HCC)患者经导管肝动脉灌注化疗(transcathcter arterial chemotherapy,TAC)后肝组织8-羟基-2'脱氧鸟嘌呤核苷(8-hydroxy-2'-deoxyguanosine,8-OHdG)、p53和p21_(waf1/cip1)蛋白的表达.方法 HCC患者分为两组,术前行TAC治疗的HCC患者39例(TAC组),术前未行TAC治疗的HCC患者50例(非化疗组),肝血管瘤和肝内胆管结石患者15例为对照组.免疫组织化学法检测肝组织的8-OHdG、p53和p21~(waf1/cip1)蛋白表达水平.结果 8-OHdG表达在癌组织中表现为非化疗组高于TAC组(F=9.516,P＜0.05),对照组最低(F=9.516,P＜0.01);在TAC组与非化疗组均为癌组织高于痛旁组织(分别t=7.101,t=8.020,均P＜0.001);癌旁组织与对照组的8-OHdG水平差异尤统计学意义;TAC组与非化疗组巾的癌组织和癌旁组织的8-OHdG表达呈正相关(r=0.651,r=0.493,均P＜0.001).p53表达在TAC组和非化疗组差异无统计学意义.p21~(waf1/cip1)三组间有差异表达.在癌组织中和癌旁组织p21~(waf1/cip1)表达均为对照组最高(F=13.459,F=16.613,均P＜0.001),TAC组高于非化疗组(F=13.459,F=16.613,均P＜0.01),但癌组织和癌旁组织比较差异无统计学意义.21_(waf1/cip1)在非化疗组中癌组织和癌旁组织表达的水平呈正相关(r=0.872,P＜0.001).结论 HCC痛组织的8-OHdG、p53和p21~(waf1/cip1)的表达高于痛旁和非HCC肝组织;癌细胞可能经由增强的氧化应激修复机制逃脱介入化疗.     

NF-κBp65、VEGF在肝癌血管生成中的作用与相关性研究

目的 通过对肝细胞癌(HCC)组织、癌旁组织、肝硬化组织及正常肝组织中核转录因子-κBp65(NF-κBp65)、血管内皮生长因子(VEGF)的蛋白表达和微血管密度(MVD)的检测,探讨NF-κBp65、VEGF的蛋白表达与HCC新生血管生成的关系及相关性,阐述二者在HCC血管生成中的机制.方法 选用45例HCC组织和32例癌旁肝组织、15例肝硬化组织、10例正常肝组织标本作对照,采用免疫组化法(SABC)检测其NF-κBp65、VEGF的表达和计数MVD值,并结合患者的临床病理指标进行统计学分析.结果 HCC中NF-κBp65、VEGF的表达和MVD值显著高于癌旁肝组织、肝硬化组织和正常肝组织(P＜0.05);HCC组织中NF-κBp65、VEGF阳性表达组显著高于阴性表达组(P＜0.05);NF-κBp65、VEGF的表达在有血管侵犯组显著高于无血管侵犯组(P＜0.05);Spearman等级相关分析NF-κBp65与VEGF表达之间存在正相关性(r=0.72,P＜0.05).结论 HCC中NF-κBp65、VEGF的表达与肝癌血管生成有关;HCC组织中NF-κBp65的表达与VEGF存在相关性,它们之间在肝癌血管生成中可能存在调节关系.     

肿瘤坏死因子受体6在肝癌组织及肝癌细胞系中的表达研究

目的 探讨肿瘤坏死因子受体6(TR-6)蛋白在原发性肝细胞癌(HCC)组织芯片及肝癌细胞系中的表达及临床意义. 方法 利用125例HCC、48例癌旁、89例非癌肝组织构建组织微阵列.应用免疫组织化学法检测组织芯片和5种肝癌细胞系中TR-6蛋白的表达水平,并分析其与HCC临床病理特征的关系.结果 (1)组织微阵列利用率为96.56%(253/262);(2)HCC组织中的TR-6蛋白的阳性率为73.33%(88/120),明显高于癌旁的54.17%(26/48,)(χ2=5.755,P=0.016)及非癌组织的29.41%(25/85,χ2=38.801,P=0.000).癌旁组织中的TR-6蛋白阳性率明显高于非癌组织(χ2=7.952,P=0.005).5种肝癌细胞系均有TR-6蛋白的表达,而癌旁肝细胞系QSG-7701及正常肝细胞系HL-7702均无表达;(3)HCC中临床TNM分期Ⅰ、Ⅱ期TR-6阳性率61.76%(42/68)明显低于Ⅲ、Ⅳ期88.46%(46/52,χ2=10.739,P=0.001);(4)HCC中无转移组TR-6阳性率58.82%(20/34)明显低于转移组96.67%(29/30,χ2=19.858,P=0.000);(5)TR-6表达率在AFP≥400μg/L组为80.82%(59/73)、有门静脉癌栓组91.30%(42/46)、包膜浸润组84.34%(70/83)和多个肿瘤结节组89.13%(41/46)分别高于AFP＜400μg/L组的61.70%(29/47,χ2=5.345,P=0.021)、无门静脉癌栓组的62.16%(46/74,χ2=12.319,P=0.000)、无包膜浸润组的48.65%(18/37,χ2=16.668,P=0.000)及单个肿瘤结节组的63.51%(47/74,χ2=9.519,P=0.002).(6)TR-6表达与年龄、性别、肿瘤分化程度、有无肝硬化及肿瘤直径无关.结论检测TR-6蛋白指标有助于HCC的诊断和判断患者预后.     

Livin蛋白在原发性肝细胞癌组织中的表达和意义

目的 探讨凋亡抑制蛋白(inhibitor of apoptosis protein,IAP)Livin在人原发性肝癌(HCC)组织中的表达及其与HCC血管生成的关系.方法 应用免疫组织化学法检测42例HCC及对应癌旁组织和12例正常肝组织内Livin的表达情况,观察Livin蛋白与HCC病理学特点及微血管密度(microvessel density,MVD)之间的关系.结果 免疫组织化学(SP)染色结果显示,Livin蛋白在正常肝组织中均不表达,而在42例HCC中的阳性表达率(73.81%)显著高于癌旁组织(4.76%)和正常肝脏组织,有显著统计学意义(X2=39.13,P＜0.05;X2=17.89,P＜0.05);Livin蛋白在病理分级Ⅲ～Ⅳ组阳性表达率(85.12%)强度明显高于病理分级Ⅰ～Ⅱ组(53.33%),两者比较差异有显著统计学意义(X2=4.690,P＜0.05);Livin蛋白在有转移HCC中的阳性表达率(89.47%)明显高于无转移组(60.89%),有统计学意义(X2=4.404,P＜0.05);Livin蛋白阳性表达HCC中的MVD值明显高于Livin蛋白阴性表达HCC中MVD值(23.56±5.12/17.63±4.86;P＜0.05).结论 Livin蛋白基因在原发性肝癌组织中高表达,提示该基因可能参与了肝癌的发生发展过程;Livin蛋白在HCC组织中的表达明显上调且与血管生成和浸润转移有关.     

Abil在肝细胞癌中的表达及临床意义

目的 研究Abil在肝细胞癌(HCC)组织中的表达情况及其临床意义.方法 采用RT-PCR法检测40例HCC组织及相应癌旁肝组织标本中Abil mRNA的表达情况;免疫组织化学法检测加例HCC组织及相应癌旁肝组织标本中Abil蛋白的表达情况;结合临床病理及随访资料分析Abil表达水平与HCC侵袭转移及预后的关系.结果 Abil mRNA在HCC组织中的表达水平高于相应的癌旁组织(1.32±0.75比0.74±0.52,P<0.05);Abil mRNA在结节性肝癌组织中的表达水平亦明显高于孤立性大肝癌组织(1.72±0.83比1.14±0.57,P<0.05).Abil蛋白主要表达于HCC细胞的胞质内,其表达水平与肿瘤结节数目、是否有包膜、静脉癌栓及Edmondson-Steiner分级密切相关(P<0.05),而与HCC患者的性别、有无肝硬化及肿瘤直径无明显相关性(P>0.05).Abil蛋白高表达组HCC患者的复发转移率明显高于低表达组患者(P<0.05);生存率则明显低于低表达组患者(P<0.02).结论 Abil在HCC组织中的表达水平较癌旁组织高,其表达水平与HCC的结节数目、是否有包膜、静脉癌栓、Edmondson-Steiner分级及临床预后密切相关.     

细胞外基质蛋白-1在原发性肝癌中的表达及其临床意义

目的 检测细胞外基质蛋白-1(ECM1)在原发性肝癌中的表达,探讨其在肝癌转移中的临床意义.方法 收集2008年6月至2009年12月安徽医科大学附属省立医院手术切除的60例原发性肝癌患者的癌组织及癌旁组织标本和9例肝外伤患者的正常肝组织标本,采用免疫组织化学染色和Western blot法检测ECM1的表达,分析ECM1表达与肝癌临床病理特征之间的关系.率的比较采用x2检验和Fisher确切概率法,均数比较采用t检验.结果 免疫组织化学染色显示ECM1主要表达在细胞质中.肝癌组织中ECM1阳性表达率为73%,显著高于癌旁组织的20%和正常肝组织的22%(x2=34.286,7.044,P＜0.05).ECM1的表达水平与肝癌有无转移和TNM分期有关(x2=5.455,4.275,P＜0.05),而与患者性别、年龄、肿瘤大小、有无包膜、分化程度、血清AFP水平和HBsAg表达等无明显关系(x2=2.841,0.014,0.000,0.734,0.075,0.000,0.031,P＞0.05).Western b1ot检测结果显示肝癌组织中ECM1相对含量为25.49±4.61,显著高于癌旁组织的3.00±0.37和正常肝组织的2.94±0.21(t=31.962,31.699,P＜0.05).结论 ECM1在原发性肝癌组织中的表达高于癌旁和正常肝组织,且与肝癌有无转移和TNM分期有关,提示ECM1可能参与了肝癌的转移,可能是肝癌转移的预测指标之一.     

EphA2和E-cadherin在胃癌中的表达及其意义

目的:探讨EphA2与E-cadherin在胃癌组织中的表达及其意义。方法:采用免疫组织化学SP法检测EphA2与E-cadherin蛋白在胃癌组织、癌旁组织和远癌胃组织中的表达情况，分析它们与胃癌临床病理特征之间的关系及两种蛋白间的相关性。结果:EphA2在胃癌组织中呈高表达(P＜0.01)，其高表达与胃癌的浸润深度、肿瘤TNM分期以及淋巴结转移有关(P＜0.05);E-cadherin在胃癌组织中呈低表达(P＜0.01)，其低表达与胃癌的浸润深度、肿瘤分化程度、肿瘤TNM分期以及淋巴结转移有关(P＜0.05);胃癌组织中EphA2和E-cadherin蛋白表达呈负相关(r=-0.602，P＜0.001)。结论:EphA2的高表达和E-cadherin的低表达与胃癌的发展和转移密切相关，EphA2可望作为胃癌治疗的新靶点。     

肝细胞癌中MyD88和STAT3的表达及其意义

目的 探讨髓样分化因子88(MyD88)和转录激活因子3(STAT3)在肝细胞癌(HCC)组织中的表达及其生物学意义.方法 采用免疫组化方法 检测MyD88和STAT3在82例肝痛组织及其对应的癌旁肝组织中的表达水平.结合肝癌临床病理指标分析它们的相关性.结果 MyD88和STAT3蛋白在癌组织中的阳性表达率分别为67.1%(55/82)和69.5%(57/82),高于癌旁肝组织中的11.0%(9/82)和8.5%(7/82).差异均具有统计学意义(P＜0.05).在肝癌组织中MyD88与STAT3的阳性表达呈正相关(r=0.578,P=0.002).MyD88和STAT3表达与HCC患者的性别、癌的分化程度、有无HBV感染和肝硬化有关;上述4指标分组间差异具有显著性(P＜0.05).而与HCC肿瘤大小及有无静脉浸润无关;该2指标分组间差异无显著性(P＞0.05).结论 MyD88和STAT3表达上调,导致肝癌细胞增殖和免疫逃逸是肝癌发生发展的重要分子机制.     

Histochemical and contractile properties of striated muscles of urethra and levator ani of dogs and sheep

AIMS: To understand their possible importance in long- and short-term control of continence, some properties of the striated muscles of the urethra and pelvic floor (levator ani) of dogs and sheep were investigated, especially fiber types and contractile characteristics. MATERIALS AND METHODS: Striated muscles of urethra and levator ani of 29 male and 6 female dogs and 11 male and 6 female sheep were removed and cut into strips. Some strips were frozen and stained for ATPase at pH 9.4 and 4.3 for fiber typing; others were set up in an organ bath to study contractile responses to nerve stimulation. RESULTS: All muscles contained both type I (slow) and type II fibers, ranging from 97% type II in female greyhound urethra to 60% in female sheep levator ani. For each muscle, there were fewer type II muscles in sheep than in dog. The diameters of the urethral fibers were about 60% of the levator ani in dogs and 34% in sheep. Contraction of the urethral muscle was faster than for levator ani and declined to about 80% of the peak, 500 msec after the beginning of stimulation at 20 Hz. The levator ani contraction rose to a steady level as long as stimulation continued. CONCLUSIONS: Both the levator ani and urethral striated muscles contain slow and fast fiber types. The levator ani muscles are capable of sustained contraction with rapid onset which will produce long-term closure of the urethra. The circular urethral muscle contraction was faster but less well maintained.     

Incorporation and release of85Sr and14C-proline-hydroxyproline in mineral and collagen of bone and incisor teeth of growing rats

The extent to which exchange and reutilization processes of mineral tracers affect skeletal mineral accretion and resorption measurements was evaluated by comparing the rates of appearance and disappearance of⁸⁵Sr and¹⁴C-proline-hydroxyproline in bones and teeth in growing rats for 12 days following simultaneous parenteral injection of these tracers. Expressions for the relative rates of collagen synthesis and breakdown, which unlike mineral metabolism are considered not to be complicated by exchange phenomena, were based on¹⁴C-proline conversion to¹⁴C-hydroxyproline; the specific activity of the latter was determined. Both the mineral and the collagen specific activities reflected the rates and patterns of growth of the samples assayed; rapid growth and a short interval of time between formation and resorption of tissue in themetaphyseal bone which contains the cartilagineous growth plate, slow growth and an interval of time between formation and resorption of tissue indiaphyseal bone and incisor teeth which is longer than the 12 days of the experiment. However, in metaphyseal bone the specific activity collagen/mineral ratio dropped by one half during the 4–12 day interval in contrast to diaphyseal bone and incisor teeth in which no change in this ratio was observed during this period of time. The data indicate that collagen in the metaphyseal growth zone is removed by resorption before it has become fully mineralized, and that exchange is a relatively unimportant factor in the long term kinetics of bone mineral.

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Zusammenfassung Das Ausmaß, bis zu welchem Austausch- und Wiederverwendungsprozesse der mineralen Tracer die Messungen des mineralen Skelett-Auf- und Abbaues beeinflussen können, wurde ausgewertet; zu diesem Zweck wurde die Geschwindigkeit des Auftretens und Verschwindens von⁸⁵Sr und von¹⁴C-Prolin-Hydroxyprolin in Knochen und Zähnen von wachsenden Ratten während der 12 auf die simultane parenterale Injektion dieser Tracer folgenden Tage verglichen.Der Ausdruck für die relative Geschwindigkeit des Kollagen-Auf- und Abbaues, bei welchem im Gegensatz zum Mineralmetabolismus kein Mitwirken des Austauschphänomens vermutet wird, basiert auf der Umwandlung von¹⁴C-Prolin zu¹⁴C-Hydroxyprolin; die spezifische Aktivität des letzteren wurde bestimmt.Aus der spezifischen Aktivität des Minerals sowie jener des Kollagens konnten die Geschwindigkeit und die Art des Wachstums der untersuchten Proben ersehen werden, d.h.schnelles Wachstum und ein kurzes Zeitintervall zwischen Bildung und Resorption des Gewebes imKnochen der Metaphyse, die auch die knorpelige Wachstumsplatte enthält, und andererseitslangsames Wachstum und längeres Zeitintervall (länger als die 12 Tage des Experimentes) zwischen Bildung und Resorption des Gewebes imKnochen der Diaphyse und in den Schneidezähnen. Immerhin fiel die spezifische Aktivität des Kollagen/Mineral-Anteils im Knochen der Metaphyse während dem 4–12tägigen Zeitintervall auf die Hälfte, im Gegensatz zum Knochen der Diaphyse und der Schneidezähne, bei welchen während dieser Zeitspanne kein Unterschied in diesem Verhältnis beobachtet wurde.Diese Ergebnisse zeigen, daß Kollagen in der Wachstumszone der Metaphyse durch Resorption verschwindet, bevor es ganz mineralisiert ist, und daß der Austausch ein relativ unwichtiger Faktor in der Kinetik auf lange Sicht des Knochenminerals ist.

     

Instrumented ligamentotaxis and stabilization of compression and burst fractures of dorsolumbar and mid-lumbar spines

Background:

Controversy continues regarding the best treatment for compression and burst fractures. The axial distraction reduction utilizing the technique employing the long straight rod or curved short rod without derotation to reduce fracture are practised together with short segment posterolateral fusion (PLF). Effects of the early postoperative mobilization without posterolateral fusion on reduction maintenance and fracture consolidation were not evaluated so far. The present prospective study is designed to assess the effectiveness of i) reduction and restoration of sagittal alignment, ii) no posterolateral fusion on the reduced, fractured vertebral body and injured disc, iii) fracture consolidation and iv) the fate of the unfused cephalad and caudal injured motion segments of the fractured vertebra.

Materials and Methods:

The study includes 15 Denis burst and two Denis type D compression fractures between T₁₂ and L₃. The lordotic distraction technique was used for ligamentotaxis utilizing the contoured short rods and pedicle screw fixator. Three vertebrae including the fractured one were fixed. The patients after surgery were braced for ten weeks with activity restriction for 2-4 weeks. The patients were evaluated for change in vertebral body height, sagittal curve, reduction of retropulsion, improvement in neural deficit. The unfused motion segments, residual postoperative pain and bone and metal failure were also evaluated.

Results:

The preoperative and postreduction percentile vertebral heights at, zero (immediate postoperative), at three, six and 12 months followup were 62.4, 94.8, 94.6, 94.5 and 94.5%, respectively. The percentages of the intracanal fragment retropulsion at preoperative, and postoperative at zero, 3, 6 and 12 months followup were 59.0, 36.2,, 36.0, 32.3, and 13.6% respectively.The preoperative and postreduction percentile loss of the canal dimension and at zero, three, six and 12 months were 52.1, 45.0, 44.0, 41.0 and 29% respectively suggesting that the under-reduced fragment was being resorbed gradually by a remodeling process. The mean initial kyphosis of 33° became mean 2° immediately after reduction and mean 3° at the final followup. The fractured vertebral bodies consolidated in an average period of ten weeks (range 8-14 weeks). The restored disc heights were relatively well maintained throughout the observation period. All paraparetic patients recovered neurologically. There were no postoperative complications.

Conclusion:

Instrument-aided ligamentotaxis for compression and burst fractures utilizing the short contoured rod derotation technique and the instrumented stabilization of the fractured spine are found to be effective procedures which contribute to the fractured vertebral body consolidation without recollapse and maintain the motion segment function.     

Principles and Practice of Hemofiltration and Hemodiafiltration

There is growing interest in the convective dialysis therapies, hemofiltration (HF) and hemodiafiltration (HDF). Both require dialysis membranes which are highly permeable to solutes as well as fluid, and in both cases large volumes of ultrafiltration are the condition for convective transport. In HDF the convection is combined with diffusion, and as a consequence, maximum clearance over the entire molecular weight spectrum is achieved. Optimal forms of HDF provide urea clearance 10–15% higher than the corresponding diffusive mode. The larger the solute, the greater is the impact of convection, and β₂-microglobulin (β₂m) levels may be up to 70% reduced. Traditional postdilution HF provides high clearance of medium sized and large molecules. Satisfactory clearance of small solutes requires blood flows in excess of 500 ml/min. With access to practically unlimited volumes of substitution solution through on-line ultrafiltration, predilution HF can now be used. This increases the clearance of small solutes to an acceptable range. For HDF as well as HF, large patient populations consistently treated for longer periods of time are needed to make valid outcome comparisons with other therapies.     

Recognition and management of phaeochromocytoma and paraganglioma

Phaeochromocytomas and paragangliomas (PPGL) are catecholamine-secreting neuroendocrine tumours arising from the chromaffin cells in the adrenal medulla. These tumours may be identified incidentally, as part of a work-up for multiple endocrine neoplasia or following haemodynamic surges during unrelated procedures. Advances in perioperative management and improved management of intraoperative haemodynamic instability have significantly reduced surgical mortality from around 40% to less than 3%. Surgery is the definitive treatment in most cases and laparoscopic resection where possible is associated with improved outcomes. Anaesthetic management of PPGL cases represents a unique haemodynamic challenge both before and after tumour resection. In this article we describe the physiology of these tumours, their diagnosis, preoperative optimization methods, intraoperative anaesthetic management and management of postoperative complications.     

骨折不愈合与延迟愈合的成因与治疗

目的探讨骨折不愈合与延迟愈合的成因、报肯治疗的方法与设果。方法对1990年7月～2004年12月间收治的107例骨折不愈台、54例骨折延迟愈合2例先天性胫骨骨不连进行回顾性研究，分析原因，随访治疗结果。18例延迟愈合行保守治疗，本组其他145例行手术治疗，结果除2例先天性胫骨骨不连外，其余161例的成因中均有医源性因素。10例失去随访，153例平均随访17（6-28）个月，骨折均获骨性连接，愈合时间平均10（6-14）个月，肢体功能恢复良好，结论医源性技术缺陷是骨折不愈合与延迟愈合的主要原因，针对各种不同因素进行合理治疗可获得满意效果。     

Physiology and pharmacology of nausea and vomiting

Nausea and vomiting are both very unpleasant experiences. The physiology is poorly understood; however, understanding what we do know is key to tailoring a preventative or therapeutic antiemetic regime. There are two key sites in the central nervous system implicated in the organization of the vomiting reflex: the vomiting centre and the chemoreceptor trigger zone. There are five key neurotransmitters involved in afferent feedback to these areas. These are histamine (H₁ receptors), dopamine (D₂), serotonin (5-HT₃), acetyl choline (muscarinic) and neurokinin (substance P). Postoperative nausea and vomiting will occur in around one-third of elective patients who have no prophylaxis. This can result in many detrimental effects including patient dissatisfaction, unplanned admission and prolonged recovery. It is therefore essential that clinicians understand how they can prevent and treat nausea and vomiting using either a single agent or a combination of antiemetics to target relevant receptors. Commonly used drugs include antihistamines, dopamine antagonists, serotonin antagonists and steroids. More novel agents are being developed such as aprepitant, a neurokinin receptor antagonist, palonosetron, a 5HT₃ receptor antagonist and nabilone, a synthetic cannabinoid.     

Physiology and pharmacology of nausea and vomiting

Nausea and vomiting are both very unpleasant experiences. The physiology is poorly understood; however, understanding what we do know is key to tailoring a preventative or therapeutic antiemetic regime. There are two key sites in the central nervous system implicated in the organization of the vomiting reflex: the vomiting centre and the chemoreceptor trigger zone. There are five key neurotransmitters involved in afferent feedback to these areas. These are histamine (H₁ receptors), dopamine (D₂), serotonin (5-HT₃), acetyl choline (muscarinic) and neurokinin (substance P). Postoperative nausea and vomiting will occur in around one-third of elective patients who have no prophylaxis. This can result in many detrimental effects including patient dissatisfaction, unplanned admission and prolonged recovery. It is therefore essential that clinicians understand how they can prevent and treat nausea and vomiting using either a single agent or a combination of antiemetics to target relevant receptors. Commonly used drugs include antihistamines, dopamine antagonists, serotonin antagonists and steroids. More novel agents are being developed such as aprepitant, a neurokinin receptor antagonist, palonosetron, a 5HT₃ receptor antagonist, and nabilone, a synthetic cannabinoid.