miR-31-5p靶向Notch1调节骨关节炎软骨细胞增殖和凋亡的作用

目的明确miR-31-5p在骨关节炎软骨细胞中的作用。方法采用Hulth法进行大鼠骨关节炎造模,并分离原代软骨细胞,白细胞介素(interleukin,IL)-1β诱导体外模型,检测miR-31-5p的表达变化;进一步通过在线数据库预测miR-31-5p靶点并验证,细胞增殖检测试剂盒(cell counting kit-8,CCK-8)和流式细胞术检测miR-31-5p对原代软骨细胞增殖和凋亡的影响。结果骨关节炎大鼠中miR-31-5p表达下调;miR-31-5p mimics促进软骨细胞增殖,而miR-31-5p inhibitor诱导软骨细胞凋亡增加;此外,miR-31-5p inhibitor促进IL-6和基质金属蛋白酶13(matrix metalloprotein,MMP-13)表达增加;荧光素酶报告基因实验证实Notch1是miR-31-5p的直接靶点,Notch1过表达质粒会部分抵消miR-31-5p mimics对软骨细胞的增殖保护作用。结论miR-31-5p下调表达介导骨关节炎软骨细胞增殖受限和凋亡发生,可能参与骨关节炎的发病。     

lncRNA XIST靶向miR-302a-3p对IL-1β诱导软骨细胞损伤的调控机制

目的 探讨lncRNA X染色体失活特异转录因子（XIST）靶向miR-302a-3p对白细胞介素-1β（IL-1β）诱导软骨细胞损伤的调控机制。方法 SW1353细胞分为Control组、IL-1β组、IL-1β+si-NC组、IL-1β+si-XIST组、IL-1β+si-PDK1组、IL-1β+si-XIST+miR-NC inhibitor组、IL-1β+si-XIST+miR-302a-3p inhibitor组。检测XIST、miR-302a-3p以及3-磷酸肌醇依赖性蛋白激酶1（PDK1）mRNA表达;噻唑蓝（MTT）实验测定细胞活力;流式细胞术检测细胞凋亡;qRT-PCR检测炎症因子（TNF-α、IL-1β、IL-4、IL-6、IL-10）水平;双荧光素酶报告基因检测实验证实miR-302a-3p与XIST或PDK1的靶向关系;免疫印迹法检测凋亡蛋白（Bcl-2、Bax）及PDK1蛋白表达。结果 与IL-1β组相比,IL-1β+si-XIST组XIST表达下调,细胞活力升高,凋亡率降低,Bax表达及TNF-α、IL-1β、IL-6水平下降,Bcl-2表达及IL-4、IL-10水平升高（P<0.05）。XIST直接靶向下调miR-302a-3p表达,miR-302a-3p下调可恢复si-XIST介导的促增殖、抗凋亡和炎症反应作用（P<0.05）。PDK1是miR-302a-3p的靶基因,沉默PDK1可抑制细胞的炎症反应（P<0.05）。结论 敲低XIST可提高IL-1β诱导软骨细胞的细胞活力,减轻OA样软骨细胞损伤,其作用机制与靶向上调miR-302a-3p进而抑制PDK1表达有关。     

LncRNA NUTM2A-AS1调控miR-183-5p/TGFα影响骨关节炎软骨细胞增殖、凋亡的研究

目的 探讨LncRNA NUTM2A-AS1对白细胞介素-1β（IL-1β）诱导的软骨细胞损伤的影响及分子机制。方法 将软骨细胞随机分为对照组、模型组（5 μg/L的IL-1β）、miR-183-5p+模型组、miR-NC+模型组、si-LncRNA NUTM2A-AS1+模型组、si-TGFα+模型组、si-NC+模型组、pcDNA-TGFα+si-LncRNA NUTM2A-AS1+模型组、pcDNA+si-LncRNA NUTM2A-AS1+模型组;运用实时荧光定量PCR（RT-qPCR）检测LncRNA NUTM2A-AS1、miR-183-5p和TGFα mRNA的表达水平;运用细胞计数试剂盒8（CCK-8）检测细胞活性;运用流式细胞术检测软骨细胞凋亡情况;通过酶联免疫吸附法（ELISA）检测TNF-α、IL-6水平;通过双荧光素酶报告实验检测NUTM2A-AS1、miR-183-5p、TGFα之间的靶向关系。结果 IL-1β诱导的软骨细胞中LncRNA NUTM2A-AS1和TGFα表达升高,miR-183-5p表达降低,软骨细胞活性降低,而凋亡率升高,TNF-α、IL-6水平升高。低表达LncRNA NUTM2A-AS1、低表达TGFα或过表达miR-183-5p后可促进细胞增殖及抑制细胞凋亡、炎症反应。结论 低表达LncRNA NUTM2A-AS1通过调控miR-183-5p/TGFα抑制IL-1β诱导的软骨细胞凋亡及炎症反应,促进细胞存活。     

LncRNA SNHG1通过miR-377-3p/AKT2轴对宫颈癌细胞增殖、凋亡和迁移的影响

目的 探讨长链非编码RNA小核仁RNA宿主基因1(lnc RNA SNHG1)对宫颈癌(CC)细胞增殖、凋亡和迁移的调控机制。方法 体外培养人CC细胞系Si Ha、Hela、Ca Ski和人正常宫颈上皮细胞HUCEC,实时荧光定量PCR(RT-q PCR)检测细胞中SNHG1、微小RNA-377-3p(miR-37 7-3p)和丝氨酸/苏氨酸激酶2(AKT2)m RNA的表达水平。将SNHG1小分子干扰RNA(si-SNHG1)转染Hela细胞构建SNHG1敲低细胞,并在SNHG1敲低细胞系中下调miR-37 7-3p表达进行验证。实验分为对照组(NC组)、si-NC组、si-SNHG1组、si-SNHG1+miR-377-3p inhibitor阴性对照组(inhibitor-NC)、si-SNHG1+miR-377-3p inhibitor组。转染48 h后,RT-q PCR检测转染效果;Western Blot检测细胞AKT2蛋白表达水平;MTT法检测细胞增殖能力;流式细胞术检测细胞凋亡率;Transwell小室实验检测细胞侵袭能力;划痕愈合实验检测细胞迁移能力。双荧光素酶报告基...     

过氧化物酶Ⅰ在骨关节炎软骨组织中的表达与分布及意义

目的观察过氧化物酶Ⅰ（PrxⅠ）在正常和骨关节炎（OA）膝关节软骨组织中的表达和分布特点,探讨PrxⅠ与活性氧歧化物和凋亡等在OA软骨表层聚集现象之间的关联。方法分别从正常膝关节提取正常软骨（NC,n=21）和接受膝关节表面置换术的OA患者提取OA软骨（OA,n=21）,应用Westernblot技术检测PrxⅠ在正常软骨细胞和OA软骨细胞中表达水平的总体差异,并用免疫组织化学技术观察PrxⅠ蛋白在正常与OA软骨表/中/深各层组织表达和分布的特点。结果 Western blot证实PrxⅠ在OA软骨组织中的表达水平较正常软骨组织显著提高2.89倍（t=18.34,P〈0.01）。免疫组织化学显示PrxⅠ在正常软骨组织的表层、中层和深层呈现较均一的表达,但是,在OA软骨组织中,PrxⅠ的表达水平存在显著层间差异。PrxⅠ在软骨组织深层表达水平显著升高,但在浅层细胞中,PrxI的表达水平反而显著减低甚至缺如。结论虽然总体表达水平升高,但PrxⅠ在OA软骨组织表层的表达缺如,可能与OA软骨组织表层活性氧歧化物蓄积和细胞凋亡聚集现象相关。     

骨关节炎早中期关节软骨YKL-40表达与软骨细胞凋亡的关系

背景：软骨细胞凋亡是骨关节炎（osteoarthritis,OA）发病过程中重要的病理学特征。YKL-40是壳质酶蛋白家族的一种糖蛋白,但不具有壳质酶活性,在关节炎软骨、滑膜、巨噬细胞等均有表达,可能与炎症的状态、组织重塑等功能有关。YKL-40在OA早中期中的作用尚有待研究。目的：探讨OA早中期关节软骨YKL-40表达与软骨细胞凋亡率（apoptosisindex,AI）的关系。方法：通过前交叉韧带切断术（anterior cruciate ligament transaction,ACLT）建立SD大鼠膝关节OA模型,组织学评估软骨退变程度,采用改良Mankin评分系统进行评估,免疫组织化学法检测YKL-40的表达情况及软骨细胞AI,观察两个指标的表达特点,分析两者在此病变过程中的关系。结果：随造模时间的延长,软骨出现退变并逐渐加重,YKL-40的表达与软骨细胞AI呈正相关。结论：软骨细胞凋亡是OA早中期的重要事件,YKL-40可能为OA早中期病理过程中软骨细胞凋亡的重要影响因子。     

hsa_circ_0005105靶向miR-508-3p对关节炎软骨细胞的影响

目的 探讨hsa_circ_0005105对关节炎软骨细胞增殖、凋亡及炎症因子分泌的影响及机制。方法 实时荧光定量PCR（RT-qPCR）检测软骨细胞中hsa_circ_0005105和miR-508-3p的表达水平;将软骨细胞分为NC组、IL-1β组、IL-1β+si-NC组、IL-1β+si-hsa_circ_0005105组、IL-1β+miR-NC组、IL-1β+miR-508-3p组、IL-1β+si-hsa_circ_0005105+anti-miR-NC组、IL-1β+si-hsa_circ_0005105+anti-miR-508-3p组;蛋白质印迹法检测凋亡蛋白表达;流式细胞术检测凋亡;CCK-8与平板克隆形成能力检测细胞增殖能力;酶联免疫吸附法检测TNF-α、IL-6水平;双荧光素酶报告实验检测hsa_circ_0005105和miR-508-3p的靶向关系。结果 IL-1β诱导的软骨细胞中hsa_circ_0005105表达水平升高,miR-508-3p表达水平降低（P<0.05）。低表达hsa_circ_0005105或过表达miR-508-3p可降低IL-1β诱导的软骨细胞Bax、Cleaved-caspase-9、Cleaved-caspase-3相对表达水平、细胞凋亡率,升高Bcl-2蛋白水平、细胞活性,细胞克隆形成数增多,TNF-α和IL-6水平降低（P<0.05）。hsa_circ_0005105靶向调控miR-508-3p;低表达miR-508-3p可以逆转hsa_circ_0005105低表达对IL-1β诱导的软骨细胞损伤及炎症因子分泌的影响。结论 低表达hsa_circ_0005105通过靶向上调miR-508-3p抑制IL-1β诱导的软骨细胞凋亡及炎症因子分泌,促进细胞增殖。     

miR-195及miR-21-3p在老年重症急性胰腺炎中的表达及相关性

选取新疆医科大学第一附属医院2020年2月—2022年3月收治的老年重症急性胰腺炎患者102例作为研究对象，按照不同疾病严重程度分为轻度组（n=45）及重度组（n=57），同时选择健康受试者50例作为对照组，全部人员均接受了荧光定量法检测，对3组人员的miR-195及miR-21-3p表达水平进行测量；对比轻度组与重度组急性生理与慢性健康评估（APACHEⅡ）评分、RANSON系统评分；采用Spearman相关性探讨APACHEⅡ及RANSON分别与微小RNA-195 (miR-195)及微小RNA-21-3p(miR-21-3p)表达水平相关性；将老年重症急性胰腺炎患者按照不同预后分为死亡组（n=21）及生存组（n=36），采用ROC曲线分析miR-195及miR-21-3p对老年重症急性胰腺炎的预测价值。结果显示，轻度组与重度组的miR-195及miR-21-3p表达水平均明显高于对照组，重度组的miR-195及miR-21-3表达水平均明显高于轻度组，差异有统计学意义（P<0.05）。重度组与轻度组相比，APACHEⅡ评分及RANSON评分均较高，差异有统计学意义（P<...     

益母草碱对骨关节炎大鼠细胞自噬的机制研究

目的 探讨益母草碱对骨关节炎(OA)大鼠软骨细胞自噬和凋亡的影响以及PTEN诱导假定激酶1(PINK1)/帕金森病蛋白(Parkin)信号通路发挥作用。方法 采用标准前交叉韧带横断术(ACLT)构建OA大鼠模型,将建模成功的大鼠分为OA组、益母草碱-L组、益母草碱-M组、益母草碱-H组,每组12只,另取12只为假手术组;HE染色检测各组大鼠软骨细胞形态变化;透射电镜观察各组大鼠软骨细胞超微结构;TUNEL法检测各组大鼠软骨细胞凋亡;RT-qPCR检测各组大鼠软骨组织PINK1、Parkin、P62、LC3B mRNA表达水平;Western blot检测各组大鼠软骨组织PINK1、Parkin、P62、LC3B蛋白表达水平。结果 与假手术组相比,OA组大鼠软骨形态异常、结构模糊、表面出现裂缝、软骨细胞线粒体数量减少、少量自噬体存在,软骨细胞凋亡率、软骨组织P62 mRNA和蛋白水平显著升高,软骨组织PINK1、Parkin、LC3B mRNA和蛋白水平显著降低(P<0.05)。与OA组比较,益母草碱-L、M、H组大鼠软骨形态逐渐恢复、结构逐渐清晰、表面裂缝减少、软骨细胞数量恢复、...     

miR-518a-5p靶向HDAC2调控甲状腺鳞癌细胞SW579凋亡的实验研究

目的:探讨miR-518a-5p调控甲状腺鳞癌细胞SW579凋亡的潜在机制.方法:通过实时荧光定量PCR分析33例癌组织和癌旁组织中miR-518a-5p的表达水平.使用miR-518a-5p mimics和miR-518a-5p inhibitor甲状腺鳞癌细胞SW579中过表达或敲低miR-518a-5p,检测细胞...     

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.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

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.