JAK/STAT通路在金属蛋白酶1组织抑制剂抑制肾小球系膜细胞凋亡中的作用

目的 探讨金属蛋白酶1组织抑制剂（TIMP-1）抑制大鼠肾小球系膜细胞（RMC）凋亡与Janus激酶/信号转导和转录激活子（JAK/STAT）通路的关系。 方法 用无血清培养基体外培养pcDNA3空载体、人正义、反义TIMP-1基因重组真核表达载体转染RMC。根据是否加JAK2特异性抑制剂AG490刺激24 h,将细胞分为未转染组、未转染＋AG490组、空载体组、空载体＋AG490组、正义组、正义＋AG490组、反义组和反义＋AG490组。另外设正常培养条件下的RMC作为正常对照组。应用流式细胞技术检测各组RMC的凋亡率。RT-PCR检测TIMP-1、bcl-xl、cyclin D1、p27kip1和JAK2 mRNA的表达。Western印迹检测胞质中JAK2、STAT3、STAT5及其相应磷酸化蛋白(p-JAK2、p-STAT3、p-STAT5)的表达。 结果 未转染组、正义组及反义组RMC凋亡率分别为（10.59±0.96）％、（7.08±0.43）％和（21.91±0.25）％，各组间差异有统计学意义(P < 0.05或P < 0.01)。在未加AG490的各组RMC中,bcl-xl和cyclin D1 mRNA在正义组中表达最高，反义组中最低，p27kip1 mRNA在反义组中表达最高。加入AG490后，各组细胞的凋亡率均显著增加（P < 0.01）；TIMP-1、bcl-xl和cyclin D1 mRNA表达均减少；p27kip1 mRNA表达均增加。在未加AG490的各组细胞中，p-JAK2、p-STAT3和p-STAT5在正义组中表达最高，反义组中最低。加入AG490后上述蛋白表达均减少，且正义＋AG490组最高，反义＋AG490组最低。 结论 TIMP-1表达受JAK/STAT信号通路调控，后者可通过上调前者的表达抑制RMC凋亡；TIMP-1通过JAK/STAT信号通路抑制RMC凋亡。 bcl-xl、cyclin D1和p27kip1参与了上述过程。     

JAK2/STAT3通路参与过氧化氢抑制小鼠原代颗粒细胞增殖的研究

目的通过过氧化氢(H2O2)处理体外培养的小鼠原代颗粒细胞(mGC),探讨JAK2/STAT3信号通路在H2O2抑制mGC增殖中的作用。方法应用H2O2、JAK2抑制剂AG490(不同浓度、不同作用时间)处理mGC;用CCK-8、增殖细胞核抗原蛋白(PCNA)水平检测细胞增殖情况,RT-PCR检测JAK2mRNA水平,Western blot检测JAK2、p-JAK2、STAT3、p-STAT3、Cyclin D1的蛋白表达水平。结果 H2O2与AG490均以剂量和时间依赖方式降低mGC活率。750μmol/L的H2O2处理mGC 24h明显降低细胞活率(P0.01),降低PCNA蛋白水平(P0.01),并下调JAK2mRNA和蛋白表达水平(P0.01);80μmol/L的JAK2抑制剂AG490可降低细胞活率(P0.01),且使细胞中的p-JAK2、JAK2、STAT3、p-STAT3、PCNA、Cyclin D1表达均下降(P0.05)。结论 H2O2抑制mGC增殖可能与JAK2/STAT3信号通路有关。     

JAK2/STAT3信号通路在乌司他丁减轻星形胶质细胞氧糖剥夺损伤中的作用

目的评价蛋白酪氨酸激酶2/信号传导和转录活化因子3(JAK2/STAT3)信号通路在乌司他丁减轻星形胶质细胞氧糖剥夺损伤中的作用。方法选择出生24 h内的SD大鼠,提取原代星形胶质细胞进行培养,采用随机数字表法将星形胶质细胞分为4组(n=14):对照组(C组)、氧糖剥夺组(OGD组)、乌司他丁组(U组)和AG490+乌司他丁组(A+U组)。采用糖氧剥夺10 h的方法建立氧糖剥夺损伤模型。U组于造模前24 h时加入乌司他丁终浓度1 000 U/ml;A+U组于造模前48 h时加入AG490终浓度20 μmol/L,于造模前24 h时加入乌司他丁终浓度1 000 U/ml。各组处理结束后,采用MTS法检测细胞活力,Western blot法检测磷酸化JAK2(p-JAK2)和磷酸化STAT3(p-STAT3)表达,免疫荧光法检测caspase-3表达。结果与C组比较,OGD组和A+U组细胞活力降低,p-JAK2和p-STAT3表达下调,caspase-3表达上调,U组细胞活力降低,p-JAK2、p-STAT3和caspase-3表达上调(P<0.05)。与OGD组比较,U组细胞活力升...     

信号传导阻滞剂AG490抑制膀胱癌细胞生长的研究

目的:观察信号传导阻滞剂AG490对膀胱癌细胞增殖和凋亡的影响,探讨通过药物阻断STAT3信号转导通路在治疗膀胱癌中的作用。方法:应用不同剂量AG490处理膀胱癌细胞系BIU87,台盼蓝排斥试验检测细胞活力,MTT法检测细胞增殖,克隆形成试验检测膀胱癌干细胞对药物的敏感性,Hoechst33258/PI荧光双染检测细胞凋亡特征,流式细胞仪检测细胞周期和早期凋亡,Westernblot检测pJAK2、STAT3、pSTAT3、CyclinD1、BclxL蛋白表达水平。结果:AG490明显抑制膀胱癌细胞增殖和干细胞克隆形成,使细胞周期阻滞,促进膀胱癌细胞凋亡;并可使pJAK2、STAT3、pSTAT3、CyclinD1、BclxL蛋白表达水平明显下降。结论:信号传导阻滞剂AG490通过阻断JAK/STAT3信号转导通路,抑制膀胱癌细胞的增殖,促进其凋亡,为膀胱癌治疗提供新的方法。     

JAK2信号通路介导人恶性黑素瘤A375细胞的自噬和凋亡机制研究

目的:探讨JAK2/STAT3信号通路介导人恶性黑素瘤A375细胞的自噬和凋亡活性,为黑素瘤的发生机制和潜在干预靶点提供理论依据。方法:人恶性黑素瘤A375细胞经复苏和传代后随机分为对照组和JAK2抑制剂干预组,比较两组细胞培养12h、24h、48h和72h的增殖率(采用MTT定量法)及凋亡率(采用流式细胞术),培养72h的细胞JAK2、p-JAK2、STAT3、LC3B和p-STAT3蛋白相对表达量(采用Western blot法),检测IL-6和TNF-α水平(采用ELISA法),检测Caspase-3和Bax/Bcl-2 mRNA相对表达量[采用反转录PCR(RT-PCR)法]。结果:两组培养12h、24h、48h和72h的细胞增殖率比较,干预组各时间点均明显小于对照组,而凋亡率明显大于对照组,差异有统计学意义(P<0.05)。干预组培养72h的细胞p-JAK2和p-STAT3蛋白相对表达量、IL-6和TNF-α水平明显低于对照组,但LC3B蛋白、Caspase-3和Bax/Bcl-2 mRNA相对表达量均明显高于对照组,差异有统计学意义(P<0.05)。结论:JAK2/STAT3信号通路异常激活可能是人黑素瘤A375细胞恶性增殖的重要通路之一,靶向干预JAK2/STAT3信号通路可以促进细胞自噬和凋亡活性上调,有望成为临床干预的重要靶点。     

白细胞介素6促胆囊癌细胞增殖、侵袭与JAK/STAT3信号通路的关系

目的:探讨炎症因子白细胞介素6(IL-6)对胆囊癌细胞生物学行为的影响及其与JAK/STAT3信号通路的关系.方法:将胆囊癌细胞株GBC-SD用IL-6或IL-6+AG490(JAK/STAT3通路抑制剂)作用后,分别用MTT法检测增殖情况;Transwell法检测侵袭能力;明胶酶谱法检测基质金属蛋白酶9(MMP-9)活性;Western blot法检测磷酸化STAT3(p-STAT3)和血管内皮生长因子(VEGF)蛋白的表达.结果:IL-6(10,50,100 ng/mL)作用后,GBC-SD细胞增殖呈浓度依赖性增加(均P＜0.05),AG490能取消IL-6对细胞增殖的促进作用.IL-6作用GBC-SD细胞后,细胞侵袭能力及MMP-9的分泌明显增加(均P＜0.05),细胞p-STAT3和VEGF的表达明显上调,加入AG490后,以上作用均被取消.结论:IL-6能促进胆囊癌细胞的增殖通和侵袭,其作用可能与其活化JAK/STAT3信号通路,从而上调下游的MMP-9和VEGF的表达有关.     

骨痨愈康丸通过JAK3/STAT3信号通路对佐剂性关节炎大鼠炎症反应的影响

目的 基于JAK3/STAT3信号通路探讨骨痨愈康丸对类风湿关节炎模型大鼠的影响机制。方法 将60只Wistar大鼠,随机分为正常对照(Control)组、模型(CIA)组、骨痨愈康丸(GL)组、骨痨愈康丸+JAK受体酪氨酸激酶抑制剂AG490(GL+AG490)组、JAK受体酪氨酸激酶抑制剂AG490(AG490)组,除正常对照组外,其余四组均建立胶原诱导性类风湿关节炎(CIA)大鼠模型。通过ELISA法检测血清中TNF-α、IL-6、IL-17水平,运用免疫组化法与实时荧光定量聚合酶链式反应(real-time PCR)检测踝关节软骨和滑膜组织中JAK3、STAT3蛋白及mRNA的表达情况。结果 与Control组比较,CIA、GL、GL+AG490、AG490组大鼠踝关节肿胀明显,伴关节畸形、大鼠活动明显减少、跛行、毛色暗淡无光泽、体重减轻;模型大鼠血清中TNF-α、IL-6、IL-17水平显著升高;JAK3、STAT3蛋白表达显著升高(P<0.05)。与CIA组相比,各治疗组大鼠血清中TNF-α、IL-6、IL-17水平降低;JAK3、STAT3蛋白及mRNA表达下调(P...     

SOX2基因对骨关节炎软骨细胞凋亡的影响研究

目的 探讨SOX2基因对人骨关节炎（OA）软骨细胞凋亡的影响及机制。方法 以正常软骨组织作为对照,通过Western blotting检测OA软骨组织SOX2蛋白表达。从人OA中分离软骨细胞,参照Lipofectamine TM2000说明将重组体pcDNA3.1-SOX2及空载体pcDNA3.1转染软骨细胞,并设置空白对照组。AG490作为JAK2/STAT3信号通路抑制剂,各组细胞处理48 h,通过流式细胞术、ROS试剂盒分别检测各组细胞凋亡率及ROS水平。Western blotting检测JAK2、p-JAK2、STAT3和p-STAT3的蛋白相对表达量。结果 人OA软骨组织SOX2表达明显低于在正常软骨组织表达（0.065±0.009 vs 0.313±0.028, P<0.05）。转染pcDNA3.1-SOX2的OA软骨细胞SOX2表达明显高于空白组（0.556±0.048 vs 0.122±0.013, P<0.05）。pcDNA3.1-SOX2可明显降低OA软骨细胞凋亡率(3.11±0.42 vs 8.54±0.68)及ROS水平(23.46±2.15 vs 52.67±4.41),上调p-JAK2（0.142±0.013 vs 0.065±0.009）和p-STAT3表达（0.218±0.020 vs 0.126±0.015）（P<0.05）,AG490（15.23±1.13 vs 8.15±0.62）可诱导OA软骨细胞凋亡,而pcDNA3.1-SOX2可减弱AG490对OA软骨细胞凋亡促进作用（P<0.05）。结论 SOX2可抑制OA软骨细胞凋亡,其机制可能与激活JAK2/STAT3信号通路有关。     

红景天苷对缺氧肾小管上皮细胞Toll受体2、IL-6表达及其凋亡的影响

目的:观察红景天苷(salidroside Sal.)对氯化钴(cobaltous chloride,Co Cl2·6H2O)诱导的缺氧人肾小管上皮细胞(human kidney tubular epithelia cell,HKC)Toll样受体2(toll-like receptor 2,TLR-2)表达、白细胞介素-6(interleukin-6,IL-6)的分泌及细胞凋亡的影响。方法:HKC细胞置于六孔板培养,随机分为正常对照组、缺氧模型组、红景天苷(salidroside Sal.)干预组(25μg/ml、50μg/ml、100μg/ml)。其中缺氧模型采用300μmol/L氯化钴处理6 h得到,红景天苷干预组在此模型基础上再用不同浓度的红景天苷处理缺氧细胞24 h。RT-PCR和Western blot检测TLR-2的表达,ELISA检测各组细胞上清中IL-6含量,流式细胞仪检测缺氧HKC凋亡情况。结果:氯化钴诱导HKC TLR-2蛋白(P<0.05)及RNA表达上调(P<0.01)、IL-6分泌增加(P<0.01)及细胞凋亡增加(P<0.01)。25μg/ml和50μg/ml的红景天苷能降低缺氧HKC细胞IL-6的水平(P<0.01),50μg/ml红景天苷抑制作用强于25μg/ml(P<0.05)。与缺氧模型组比较,尽管100μg/ml红景天苷能降低缺氧HKC细胞IL-6的绝对值水平,但差异无统计学意义(P>0.05)。25μg/ml,50μg/ml和100μg/ml红景天苷均能抑制TLR-2蛋白表达(P<0.01),且100μg/ml较25μg/ml红景天苷抑制作用显著(P<0.05),但25μg/ml与50μg/ml、50μg/ml与100μg/ml红景天苷比较,它们抑制作用的强弱差异无统计学意义(P>0.05)。三种浓度的红景天苷也能抑制缺氧HKC TLR-2的RNA表达(P<0.01),50μg/ml及100μg/ml红景天苷抑制作用强于25μg/ml红景天苷(P<0.05),但50μg/ml与100μg/ml红景天苷比较,二者抑制作用差异无统计学意义(P>0.05)。50μg/ml和100μg/ml红景天苷能抑制缺氧HKC凋亡(P<0.01),但25μg/ml红景天苷未表现出抑制凋亡的作用(P>0.05),50μg/ml与100μg/ml红景天苷比较,两者抑制凋亡的作用差异无统计学意义(P>0.05)。结论:红景天苷对缺氧HKC的TLR-2蛋白及RNA表达、IL-6的分泌及细胞凋亡均有抑制作用,但其抑制效应呈现非剂量依赖性。     

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 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.     

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.     

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.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

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.     

Systemic analgesia adapted to the children's condition

A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.