VEGF-ASODN转染对胃癌细胞VEGF和survivin表达的影响

目的:观察血管内皮细胞生长因子反义寡核苷酸（VEGF-ASODN）转染胃癌细胞SGC-7901对血管内皮生长因子（VEGF）和生存素（survivin）表达的影响。方法:人工合成硫代磷酸化VEGF-ASODN。实验分为5组：对照组，错义组，实验1组(转染浓度为100 ng∕mL),实验2组（转染浓度为400 ng∕mL）及实验3组（转染浓度为700 ng∕mL）。转染后实时荧光定量RT-PCR检测细胞RNA起始拷贝数; ELESA法检测细胞及培养上清液VEGF 蛋白含量; Western-blot法检测细胞生存素蛋白表达量; 流式细胞仪检测细胞凋亡; 细胞生长曲线检测转染对细胞生长的影响。结果:3个实验组VEGF mRNA水平和VEGF蛋白表达量及培养上清液VEGF 蛋白含量均明显降低，survivin蛋白的表达水平随转染浓度的升高而降低，转染VEGF-ASODN能使胃癌细胞凋亡增加、细胞生长减缓。结论:VEGF-ASODN转染胃癌细胞SGC-7901能显著抑制细胞VEGF的表达，促进细胞凋亡，抑制细胞增殖。     

血管内皮生长因子重组腺病毒转染鼠骨髓基质细胞及其产物促内皮细胞增殖的研究

目的探讨腺病毒介导血管内皮生长因子165(VEGF165)基因转染骨髓基质细胞(BMSCs)后对VEGF基因的转录、表达及其产物生物活性的影响。方法体外培养4只大鼠骨髓基质细胞,用携带VEGF165基因的重组腺病毒转染培养细胞;通过逆转录聚合酶链反应、免疫印记法和酶联免疫吸附法检测VEGF在转染细胞内的转录、表达和细胞外分泌情况;通过血管内皮细胞增殖实验测定转染VEGF165基因后的BMSCs培养上清中VEGF蛋白的生物活性。结果腺病毒介导VEGF165基因转染BMSCs后可以获得有效的转录及表达,其分泌于培养上清中的表达产物可明显促进大鼠主动脉血管内皮细胞的增殖(P<001),具有很强的生物学活性。结论腺病毒可安全、有效地转染BMSCs,VEGF165基因转染的鼠BMSCs可有效表达具有生物活性的VEGF蛋白。     

血管内皮生长因子治疗下肢缺血性疾病的研究进展

单独使用血管内皮生长因子（VEGF）基因治疗下肢缺血性疾病的研究由来已久，目前尚无满意疗效。目前已证实血管内皮前体细胞（EPC）可定向分化血管内皮细胞并能形成新生血管，其中VEGF在EPC定向分化、体内动员、体外扩增及转染EPC后定向移植治疗周围缺血性疾病等过程中发挥重要作用。笔者对VEGF在基因治疗、细胞治疗和基因转染细胞治疗下肢缺血性疾病的研究进展综述如下。     

血管内皮生长因子基因转染血管内皮祖细胞治疗肢体缺血的实验研究

目的利用血管内皮生长因子（vascular endothelial growth factor,VEGF-165）基因转染体外诱导的血管内皮祖细胞（endothelial progenitor cells,EPCs）,并移植到下肢缺血的新西兰兔体内,观测其促进血管新生,改善肢体缺血的效果。方法（1）梯度离心法分离兔骨髓单个核细胞,然后用含有VEGF、bFGF、IGF-1的M199培养液诱导培养EPCs。并以免疫荧光、透射电镜等方法进行鉴定。（2）用携带VEGF165基因的腺病毒质粒（Adv-GFP-VEGF165）转染所培养的细胞,ELISA法检测上清液中VEGF蛋白的表达。（3）制作兔下肢缺血模型,并将其随机分为A、B、C 3组,分别移植EPCs、VEGF165基因转染后的EPCs、M199培养基,多种方法检测移植效果及局部整合情况。结果（1）自兔骨髓诱导出梭形贴壁细胞,免疫荧光及电镜检测证实为EPCs。（2）Adv-GFP-VEGF165成功转染EPCs,ELISA法检测转染VEGF165后的EPCs其上清液中VEGF蛋白浓度明显升高。（3）Brdu示踪显示移植细胞整合到缺血局部,CTA及免疫组化检查显示VEGF-165基因转染后的EPCs移植后其改善肢体缺血效果优于其他两组。结论VEGF基因转染EPCs后能改进EPCs质量,移植后促血管新生能力增强,其效果优于未转染组。     

同时携带人血管内皮生长因子和血管生成素基因的内皮祖细胞血管再生研究

目的用腺相关病毒（adeno-associated virus,AAV）载体将人血管内皮生长因子165 （vascular endothelial growth factors,VEGF165）和血管生成素-1（angiopoietin-1,Angl）基因同时转入骨髓源性内皮祖细胞（endothelial progenitor cells,EPCs）中,观察外源基因的表达并评价其促血管再生的能力。方法用同时携带人VEGF165和Angl基因的AAV载体AAV2-hAngl/VEGF165转染体外培养的兔骨髓源EPCs,用RT-PCR和细胞免疫化学法检测外源基因的表达。实验用新西兰大白兔24只,制作成右下肢缺血模型,随机分成3组：PBS、EPC和EPC/AV组。造模后第10天,向缺血肌组织中分别注射PBS、EPCs和AAV2-hAngl/VEGF165转染的EPCs,用免疫组织化学法评价其血管再生效应。结果EPCs可高效地被AAV2-hAngl/VEGF165转染而表达Angl和VEGF165。细胞移植4周后,EPC/AV组存活的EPCs密度（283±137）/mm^-2明显高于EPC组（191±88）/mm^-2;EPC/AV组的毛细血管密度（856±212）/mm^-2明显高于EPC组（564±177/mm^-2）和PBS组（308±112）/mm^-2;α-SMA阳性血管密度（6.9±3.0）/mm^-2明显高于PBS组（3.6±1.8）/mm^-2,P〈0.05。结论AAV载体可同时将人VEGF165和Angl基因转入EPCs中,转染后的EPCs具有更强的促血管再生能力。     

血管内皮细胞生长因子体外转染血管内皮祖细胞的研究

目的 探讨脂质体介导血管内皮细胞生长因子(VEGF)基因转染血管内皮祖细胞(EPC)应用于基因治疗的可行性、安全性。方法 体外分离、培养、免疫组织化学及流式细胞仪鉴定EPC,转染VEGF后用免疫组织化学和ELISA检测EPC表达VEGF蛋白,噻唑蓝(MTT)检测EPC对VEGF质粒转染的敏感性。结果 EPC表达CD_(34)、CD_(31)、KDR及CD_(133)细胞表面标志,转染后EPC胞内表达VEGF。脂质体介导PcDNA3.1(-)/VEGF_(165)质粒转染、PcDNA3.1(-)/VEGF_(165)空质粒转染、不转染任何质粒的3组EPC培养基上清中表达的VEGF分别为(352±35)ng/L、(45±5)ng/L、0 ng/L(P<0.05),VEGF质粒转染对EPC增殖无影响。结论 EPC可作为VEGF转染的靶细胞,用于基因治疗。     

人脐血来源内皮祖细胞的纯化鉴定及定向分化的研究

目的 检测CD133^＋血管内皮祖细胞（EPC）的细胞表面标志物，鉴定其生物学特性。方法 采用免疫磁珠法分离人脐血EPC，用EGM-2MV培养基[含表皮生长因子（EGF）、血管内皮生长因子（VEGF）、成纤维细胞生长因子（FGF）2等具有诱导分化作用的细胞因子]进行体外培养。应用流式细胞术、免疫组织化学等方法检测CD133^＋细胞的比例、原代EPC的生长曲线及生长特性。透射电镜查找Weibel-Palade小体。同时设计EPC裸鼠成瘤实验，观察瘤体生长及血管增生情况，以鉴定EPC的生物学特性。结果 CD133^＋细胞在免疫磁珠分离前后的比例各为0．91％及85．52％。EPC原代培养时细胞形态正常、密度均匀，前3d为相对抑制期，此后快速增殖，10d后达80％～90％融合。EPC生长曲线显示，接种后5d内细胞数量无明显变化，从第7天开始明显增加，第17天达高峰。光学显微镜下可见，原代EPC贴壁后呈梭形，接种后7d数量明显增加，呈克隆状生长。透射电镜观察到，细胞膜伸出许多伪足丝，基底膜呈多层；细胞质内可见一种短棒状小体，含平行管状的内部结构，即Weibel-Palade小体，确定其为EPC。裸鼠成瘤实验可见EPC组肿瘤瘕体及血管数量大于或多于对照组；抗人血管性假血友病因子（vWF）免疫荧光染色显示，大量EPC参与肿瘤血管生成。结论本实验分离培养的CD133^＋细胞具有分化为成熟血管内皮细胞的能力，即为EPC。裸鼠成瘤实验初步证明EPC参与血管重建，具有促进血管新生、加速缺血组织血管化的作用。     

VEGF基因转染血管内皮祖细胞的实验研究

目的:探讨血管内皮生长因子（VEGF）基因转染血管内皮祖细胞（EPCs）的方法及效果。方法:取生长活跃的EPCs,分别转染不同浓度的携带VEGF-165基因的腺病毒质粒（Adv-GFP-VEGF165）（转染组）及空质粒（Adv-GFP）（空质粒组）,并设空白对照组。荧光显微镜下观察转染效果,MTT法检测不同病毒滴度时细胞增殖情况;ABC-ELISA法检测上清液中VEGF蛋白表达情况。结果:转染组镜下观察到大部分细胞呈现绿色荧光。病毒滴度为1∶100的转染会导致细胞生长停滞,并造成细胞损害; 1∶50的转染后对细胞增殖无明显影响。ELISA检测证实转染组上清液中VEGF蛋白浓度明显高于空质粒组及空白对照组（P<0.01）。结论:以腺病毒为载体的VEGF基因转染EPCs是可行的,1∶0是合适的转染比率,转染后上清液中VEGF蛋白表达明显增加。     

脂质体介导血管内皮生长因子基因片段在犬骨髓基质干细胞中的表达及其影响

目的 探讨脂质体介导的重组血管内皮生长因子165(vascularendothelial growthfactor 165,VEGF165)基因转染后的犬骨髓基质干细胞分泌血管内皮生长因子(vascular endothelialgrowth factor,VEGF)的能力及细胞增殖能力的改变,为改善骨缺血坏死的干细胞治疗方法提供基础.方法 实验分VEGF165基因转染组与空白对照组,从成年犬的胫骨抽取骨髓,体外分离纯化,贴壁培养骨髓基质干细胞,传代培养后以脂质体法将携带荧光蛋白VEGF165基因的穿梭质粒转入实验组骨髓基质干细胞中,在荧光显微镜视下观察转染效率,并通过ELISA法分别检测转染后1、3、5、7、9、11、13 d实验组与对照组培养液中VEGF的含量,对结果进行统计分析.MTT法检测转染细胞的增殖能力,绘制增殖曲线.结果 重组人血管内皮生长因子165(recombinate the human being vasular endotheial growth factor165,hVEGF165)基因通过脂质体能够成功转染犬骨髓基质干细胞并分泌VEGF.h-VEGF165基因转染组培养液中VEGF蛋白含有量较未转染组增高,ELISA结果显示转染后上清液中第2天即可出现VEGF浓度的增高,到第7天时达到分泌高峰,筛选后的细胞上清液中VEGF浓度稳定在300ng/L左右,与对照组相比升高约10倍,其差别具有显著的统计学意义.骨髓基质干细胞转染基因后,细胞的增殖能力同对照组相比无明显差别.结论 采用基因转染技术可将hVEGF165基因转染到犬骨髓间充质干细胞中并可有效表达VEGF. hVEGF165基因转染犬骨髓基质干细胞对细胞的增殖能力无明显影响.     

成人骨髓间充质干细胞分化为血管内皮细胞的研究

目的研究成人骨髓间充质干细胞（marrow mesenchymal stem cells，MSCs）体外分化为血管内皮细胞的能力并探讨其诱导条件。方法分离成人骨髓单个核细胞，经贴壁法获取MSCs。所获细胞分4组进行诱导：组1、2以5×10^3／cm^2细胞密度接分别接种于含2％和15％胎牛血清的L—DMEM培养基；组3、4以5×10^4／cm^2细胞密度分别接种于上述两种血清浓度的培养基，各组细胞经血管内皮生长因子（vascular endothelial growth factor，VEGF）辅以牛脑提取物的诱导，对照组为正常传代培养的MSCs。在诱导的第14、21天分别测定表面分子CD34、VEGFR-2、CD31和Ⅶ因子相关抗原（factor Ⅷ—related antigen，又称von Willebrand factor，vWF）以及体外成血管实验对分化细胞进行鉴定，同时测定不同诱导条件下的细胞增殖指数（proliferation index，PI）。结果组3细胞经诱导后，内皮系表面分子CD34、VEGFR-2、CD31、vWF于第14天均有不同程度表达，分别为8．5％、12．0％、40．0％、30．0％．其中CD34、VEGFR-2在第21天表达上调，为15．5％、20．0％，余各诱导组细胞未表达上述表面分子；诱导后的组3细胞呈低增殖状态（PI值约为10．4％），在半固体培养基中还可形成血管腔样结构。结论从成人骨髓中分离培养的MSCs，在较高细胞接种密度和低增殖状态下，经VEGF、牛脑垂体提取物诱导后，可分化为血管内皮细胞，可作为治疗性血管生成及组织工程理想的种子细胞。     

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.