白蛋白诱导的肾小管细胞凋亡与丝裂素激活蛋白激酶信号通路

目的 探讨白蛋白诱导肾小管上皮细胞凋亡以及诱导凋亡的信号传导机制｡ 方法 将培养的大鼠肾小管细胞NRK-52E分别与不同浓度(10､ 20､ 30 mg/ml)的去脂无内毒素牛血清白蛋白(BSA)共同孵育6､ 12､ 18和24 h｡透射电镜､共聚焦激光显微镜和流式细胞仪检测细胞凋亡｡BSA 20 mg/ml刺激NRK-52E细胞15､ 30､ 60和120 min后, Westen印迹测定p38､氨基末端激酶(JNK)和细胞外信号调节激酶(ERK)活性｡将SB202190(20 μmol/L, p38抑制剂)､SP600125(10 μmol/L, JNK抑制剂)和PD98059(20 μmol/L, ERK抑制剂)分别与白蛋白和NRK-52E细胞共同孵育24 h后检测细胞凋亡｡结果 白蛋白以时间和剂量依赖方式诱导肾小管细胞凋亡｡白蛋白与NRK-52E细胞共孵育后,p38和JNK活性明显升高,ERK活性显著降低｡SB202190和SP600125可分别抑制白蛋白诱导NRK-52E细胞凋亡,而PD98059促进白蛋白诱导的NRK-52E细胞凋亡｡结论 白蛋白以时间和剂量依赖方式诱导肾小管细胞凋亡,而p38和JNK激活与ERK抑制介导了白蛋白诱导的肾小管细胞凋亡｡     

转化生长因子β1对肾小管上皮细胞中结缔组织生长因子基因启动子活性的影响

目的探讨转化生长因子[β1（TCF-β1）对人近端肾小管上皮细胞系HK-2中结缔组织生长因子（CTGF）基因启动子活性的调控作用，以及丝裂原激活蛋白激酶（MAPK）途径对该生长因子作用的影响。方法构建含有人类CTGF基因启动子的报告基因pCTGF-luc，将其瞬时转染HK-2细胞。通过检测荧光素酶的活性观察TGF-β1和MAPK途径抑制剂对CTGF基因启动子活性的影响。结果TGF-β1以剂量和时间依赖方式上调HK-2中CTGF基因启动子的活性。最佳刺激浓度是5ng／ml，最佳刺激时间为12h，荧光素酶相对活性分别为对照组的1．82倍和2．10倍（P〈0．05）。应用PD98059、SB203580和SP600125分别特异性抑制MAPK途径的胞外信号调节蛋白激酶（ERK）、蛋白激酶p38（p38MAPK）和c-Jun-氨基末端激酶（JNK）通路，对TGF-β1上调CTGF启动子活性的作用有不同影响。PD98059显著增加HK-2中pCTGF-luc的基础活性．并在一定浓度范围内（0．5～10μmol／L）促进TGF-β1的上调作用。SB203580对pCTGF-luc基础活性无影响，但以剂量依赖方式显著抑制TGF-β1的激活效应。而SP600125对基础状态和TGF-β1刺激下CTGF基因启动子活性无影响。结论TGF-β1以剂量和时间依赖方式上调HK-2中CTGF基因启动子活性，在转录水平调节CTGF表达。MAPK途径的ERK和p38MAPK通路可影响TGF-β1的这一调控作用。     

丝裂素活化蛋白激酶信号转导途径对血小板源生长因子所致鼠肾系膜细胞表型转化的调控作用

目的 研究血小板源生长因子（PDGF）对肾小球系膜细胞（MC）表型转化的影响,并探讨丝裂素活化蛋白激酶（MAPK）信号转导途径在其作用中的调控机制。方法 以体外培养的大鼠MC为对象,观察PDGF对细胞增殖、α-平滑肌肌动蛋白（SMA）表达和细胞内c-Jun氨基末端激酶（JNK）活性的作用;观察细胞外信号调节激酶（ERK）途径上游信号MEK-1阻断剂PD98059对PDGF所致上术作用的影响;应用raf-1基因转染并稳定高表达的MC观察其对α-SMA表达,细胞形态及其超微结构的影响。结果 PDGF可刺激MC持续增殖;刺激6～48h可使α-SMA表达增加,但持续刺激72h以上则可导致其表达被抑制近50%,PDGF对JNK活性无明显影响,阻断ERK活化不影响JNK活性及PDGF对α-SMA表达的短时刺激作用。Raf-1蛋白激酶稳定高表达的MC细胞内α-SMA表达缺失,同时细胞内微丝、微管结构减少,细胞形态改变。结论 PDGF对系膜细胞表型转化的影响表现为促进细胞持续增殖、短时作用刺激α-SMA表达而持续作用则抑制α-SMA表达,提示其为具有调控MC增殖和分化双重作用的细胞因子。PDGF的作用可能与MAPK不同亚类的调控有关,其中Raf-1和JNK活性可能对细胞表型具有关键调控作用。     

丝裂原蛋白激酶信号转导通路在机械通气相关性肺损伤中的作用

目的观察机械通气介导肺损伤（VILI）过程中丝裂原蛋白激酶（MAPK）的活性变化以及对细胞因子的影响，从中探讨VILI发生机制和MAPK的作用。方法72只SD大鼠随机分为未处理的对照组（不行机械通气）、正常通气组、过度通气组和采用MAPK抑制剂SP600125（JNK）、SB203580（p38）、PD98059（ERK）分别预处理上述3组。机械通气4h后取大鼠肺组织采用Western blot方法测定各组的总JNK、ERK、p-38蛋白激酶的表达及其磷酸化水平变化。同时以酶联免疫吸附试验（EUSA）方法测定大鼠肺组织、支气管肺泡灌洗液（BALF）和血浆中的肿瘤坏死因子-α（TNF-α）、巨噬细胞炎性蛋白-2（MIP-2）浓度。结果正常和过度机械通气4h后均能激活JNK、ERK、p38激酶，但以过度通气组为著（P〈0．01）。过度通气组大鼠肺组织、BALF、血浆中的TNF-α、MIP-2含量显著高于其他组（P〈0．01）。JNK、ERK、p38抑制剂显著降低肺组织、BALF中的TNF-α、MIP-2含量（P〈0．05或0．01），且JNK和ERK抑制剂作用强于p38抑制剂。结论过度机械通气激活了肺细胞中的JNK、ERK、p38激酶，且JNK、ERK、p38参与了VILI细胞因子的产生，即MAPK信号转导通路的激活可能是VILI发生机制之一。     

17 β雌二醇通过丝裂原活化蛋白激酶抑制前列腺癌细胞系PC3增殖

目的探讨丝裂原活化蛋白激酶在17β雌二醇(E2)抑制前列腺癌PC3细胞生长中的作用。方法检测不同浓度E2作用不同时间后PC3细胞生长抑制率。流式细胞仪分析细胞周期分布,TUNEL染色检测凋亡。Western blot检测ERK1/2,JNK和p38活性。RT-PCR法检测雌激素受体(ER)α、ERβ、P21WAF1和cyclinD1的表达。结果E2抑制PC3细胞增殖,并且可以激活ERK1/2、JNK和p38。处理因素作用48h后,对照组、E2、E2 PD98059、E2 SP600125、E2 SB203580组细胞的凋亡率分别为(0.9±0.1)%;(23.0±1.4)%;(30.0±1.2)%;(10.6±0.8)%和(14.6±0.7)%,(P<0.05)。E2使细胞阻滞在G1期,PD98059、SP600125、SB203580分别预处理1h后细胞分别进一步阻滞在G1期;轻度阻滞在G1期和进入S期。RT-PCR发现PC3细胞表达ERα和ERβ,E2、E2 PD98059、E2 SP600125、E2 SB203580组中cyclinD1、P21WAF1基因表达分别为对照组的(0.42±0.03)、(3.13±0.02)倍;(0.21±0.03)、(3.08±0.05)倍;(0.43±0.01)、(1.31±0.04)倍;(2.81±0.02)、(3.14±0.02)倍(P<0.05)。结论E2激活JNK增加P21WAF1基因表达,并激活p38抑制cyclinD1表达,使细胞阻滞在G1期,JNK和p38通路还介导E2引起PC3细胞凋亡。同时E2又可激活ERK1/2,轻度拮抗上述作用。     

JNK对转化生长因子β1所致大鼠腹膜间皮细胞转分化的调控作用

目的 探讨c-Jun 氨基末端激酶(JNK)在转化生长因子β1(TGF-β1)诱导大鼠腹膜间皮细胞（RPMC）转分化中的调控作用。 方法 采用腹腔注射胰蛋白酶法分离培养RPMC，取第2代腹腔间皮细胞用于实验研究。观察TGF-β1对α平滑肌肌动蛋白(α-SMA)、Ⅰ型胶原(ColⅠ)、E钙黏蛋白(E-cadherin)以及磷酸化(p)JNK表达的影响；应用JNK特异性抑制剂SP600125预处理细胞后，观察其对TGF-β1所致上述作用的影响。RT-PCR法检测α-SMA、ColⅠ及E-cadherin mRNA表达；Western印迹法检测α-SMA、ColⅠ、E-cadherin及p-JNK蛋白表达；间接免疫荧光检测α-SMA在细胞内的表达和分布。 结果 TGF-β1刺激RPMC能导致α-SMA、ColⅠ蛋白表达上调，E-cadherin蛋白表达下调，呈时间依赖性。TGF-β1刺激RPMC 5 min出现p-JNK表达上调，10 min达高峰(P < 0.01)。SP600125能够抑制JNK的磷酸化(P < 0.05)，也能抑制TGF-β1诱导的α-SMA、ColⅠmRNA和蛋白的高表达以及E-cadherin表达的下调 (均P < 0.05)。间接免疫荧光结果显示，TGF-β1刺激RPMC 48 h，胞内α-SMA表达明显增多，SP600125能有效抑制其高表达。 结论 JNK在TGF-β1诱导大鼠腹膜间皮细胞转分化中具有重要的调控作用，JNK特异性抑制剂的应用可能为临床防治腹膜纤维化提供新的途径。     

丝裂原活化蛋白激酶类和蛋白激酶C在转化生长因子β1诱导肾小管细胞结缔组织生长因子表达中的作用

目的了解转化生长因子β1（TGF-β1）诱导肾小管细胞结缔组织生长因子（CTGF）表达的机制，特别是蛋白激酶C（PKC）和丝裂原活化蛋白激酶（MAPK）在CTGF基因表达中的作用及其对Smad磷酸化的影响。方法分别应用PKC抑制剂G06850以及MAPK的3个组成成分ERK、JNK和p38MAPK的抑制剂PD98059、U0126、SP600125和SB203580阻断相应通路，观察其对TGF．131诱导的CTGF表达以及Smad2／Smad3磷酸化的影响。结果TGF-β1（5μg／L）以时间依赖方式诱导HK-2细胞中Smad2／Smad3的磷酸化，从基础值0．87±0．09上升至2h时高峰2．350±0.11。PKC抑制剂G06850（5μmol／L）和ERK抑制剂PD98059（10μmol／L）、U0126（10μmol／L）可部分抑制TGF-β1诱导的CTGF表达，而p38MAPK抑制剂SB203580（20μmol／L）和JNK抑制剂SP600125（10μmol／L）对TGF-β1诱导的CTGF的表达无影响。PKC抑制剂G06850（5μmol／L）可减少TGF-β1诱导的Smad2／Smad3磷酸化，而ERK抑制剂PD98059（10μmol／L）和U0126（10μmol／L）对Smad2／Smad3的磷酸化没有影响。结论在肾小管上皮细胞中，TGF-β1诱导CTGF的表达需要PKC和Ras／MEK／ERK的参与。PKC以Smad依赖的方式参与肾小管上皮细胞中TGF-β1诱导的CTGF的表达，而Ras／MEK／ERK对CTGF表达的调节不依赖于Smads。     

表皮生长因子对人小细胞肺癌细胞Survivin表达的影响及其机制

目的 探讨表皮生长因子(EGF)对人小细胞肺癌NIC-H446细胞中凋亡抑制因子Survivin表达的影响及其调控Survivin的机制.方法 噻唑蓝(MTT)法测定EGF对细胞增殖率的作用.逆转录-聚合酶链反应(RT-PCR)和免疫印迹(Western blot)方法测定EGF对NIC -H446细胞Survivin表达的影响.Western blot方法测定EGF对NIC-H446细胞p38丝裂原活化激酶(p38MAPK)、磷酸化p38MAPK(p-p38MAPK)、c-Jun氨基端激酶(JNK)、磷酸化JNK (p-JNK)、细胞外信号调节蛋白激酶(ERK)、磷酸化ERK(p-ERK)信号通路蛋白的表达影响.结果 EGF可促进NIC-H446细胞增殖,具有浓度-时间依赖性.与对照组(0.36±0.06、0.57 ±0.15)比较,EGF组Survivin mRNA(0.69±0.12)和蛋白(0.89±0.19)表达明显升高(P＜0.01).与对照组(0.29±0.08)比较,EGF组p-p38MAPK蛋白表达水平(0.68±0.27)明显上升(P＜0.01),其他蛋白表达均无明显变化.EGF+ SB203580组Survivin蛋白表达(0.56±0.17)、p-p38MAPK蛋白表达(0.41±0.11)显著低于EGF组(0.92 ±0.21、0.72 ±0.19,P＜0.01),与对照组比较差异无统计学意义.结论 EGF通过活化p38MAPK信号通路上调小细胞肺癌细胞中Survivin的表达,促进细胞增殖,这可能是小细胞肺癌发展的重要机制.     

结缔组织生长因子诱导人近端肾小管上皮细胞整合素连接激酶的表达及与激酶信号途径的关系

目的探讨结缔组织生长因子（CTGF）对人近端肾小管上皮细胞系HK-2整合素连接激酶（ILK）表达的影响，以及丝裂原激活蛋白激酶（MAPK）和磷脂酰肌醇3激酶（P13-K）途径对该因子表达的影响。方法用不同浓度的CTGF作用HK-2细胞24h及50μg／L的CTGF作用HK-2细胞不同时间，以实时PCR和Western印迹方法检测ILKmRNA及蛋白的表达。用信号通路特异性抑制剂预处理，观察其对CTGF的干预作用。结果CTGF呈时间及浓度依赖性诱导人近端肾小管上皮细胞ILK蛋白表达。5、20、50μg／L的CTGF可使ILK表达量分别增加为对照组的3．284、5．103、5．638倍。50μg／LCTGF使ILK的表达在6h开始升高，高峰在48h（为对照组5．740倍），MEK抑制剂PD98059和P13．K抑制剂LY294002显著降低CTGF诱导的HK-2细胞ILK基因和蛋白的表达（P均〈0．05）。p38MAPK抑制剂SB203580对CTGF诱导的ILK表达无显著影响。结论CTGF能诱导HK-2细胞ILK蛋白的表达，该作用可能与ERK1／2和P13-K信号途径激活有关。     

p38MAPK信号途径抑制剂SB203580对大鼠重症急性胰腺炎胰腺组织中TNF-α表达的调控作用

目的研究p38丝裂原活化蛋白激酶(p38 MAPK)信号转导通路在大鼠重症急性胰腺炎(SAP)胰腺组织中的变化规律,探讨p38 MAPK特异性抑制剂SB203580对SAP发展和胰腺组织中TNF-α表达水平的影响。方法采用胰胆管内注射牛磺胆酸钠的方法诱导大鼠重症急性胰腺炎模型,使用SB203580抑制P38MAPK信号传导通路,通过监测大鼠血清淀粉酶(Serum amylase,AMS)和TNF-α的表达检测,观察P38MAPK抑制剂SB203580对大鼠SAP发展和TNF-α表达水平的影响。结果 SAP组TNF-α的表达明显高于对照组。胰腺组织TNF-α的表达水平随胰腺炎病情的进展而升高(P<0.05),使用p38MAPK抑制剂可以显著降低TNF-α的表达(P<0.05)。结论 SB203580可能通过抑制胰腺组织p38 MAPK信号通路进而降低TNF-α的活性,减少炎症介质的释放,达到减轻胰腺损伤,治疗急性胰腺炎的目的。     

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.     

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.     

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.