利用高通量宏基因组测序技术检测血液病患者感染性病原体的横断面研究

目的利用高通量宏基因组测序技术对血液病患者感染性病原体进行横断面调查，为此类感染性疾病高危患者的快速诊断及早期针对性用药提供依据。 方法回顾性分析2019年1月至6月华中科技大学同济医学院附属同济医院血液科血液病患者外周血临床标本高通量宏基因组分析数据及患者临床特征，并归纳血液病患者的感染病原体种类特征。 结果共纳入41例患者资料，检出病原体阳性患者24例，其中细菌感染以假单胞菌属感染比例最高（4/24、16.67%），其次为不动杆菌属（2/24、8.33%）、克雷伯菌属(2/24、8.33%）、葡萄球菌属（2/24、8.33%）和黄单胞杆菌属（2/24、8.33%）；而奈瑟菌属、米勒菌属、幽门螺杆菌以及结核分枝杆菌则较罕见。共有6例患者检出混合型感染，其中以病毒和细菌混合型感染最为多见（4/24、16.67%）。真菌感染的病原菌种类较细菌性病原体更为分散，白色念珠菌、青霉菌、肺孢子菌和根霉菌检出1例（占0.04%），无明显聚集性；病原体相对丰度方面，83.33%（5/6）真菌病原体阳性患者的检出序列片段数偏少（< 100），仅1例检出高负荷真菌感染（曲霉菌序列片段数为2 836）。病毒类病原体的检测结果显示，病毒筛查谱限于已知的常见DNA病毒；从测序结果看，24例检测阳性患者中巨细胞病毒、EB病毒和单纯疱疹病毒1型为检出率最高的病毒，均占20.83%（5/24）；较真菌，病毒种类存在一定聚集性，其相对负荷亦较高（平均序列片段数> 200）；而单纯疱疹病毒2型和指环病毒属病毒检出率相对较低，分别占4.17%（1/24）和8.33%（2/24）。 结论本研究创新性地利用高通量宏基因组测序技术检测血液病患者感染性疾病的病原体谱系；利用高通量宏基因组测序技术可快速锁定病原体并予以针对性抗菌药物治疗具有重要的临床价值。     

黏质沙雷菌致腹膜透析相关性腹膜炎1例暨文献复习

黏质沙雷菌属肠杆菌科,是一种重要的条件致病性革兰阴性菌。该菌广泛分布于自然界中,是水、土壤、植物和动物中的常居菌群,通常很少引起感染,但在机体免疫力低下的患者中,可导致呼吸道、泌尿道等部位感染,甚至会引起医院感染的爆发。本文报道1例黏质沙雷菌致腹膜透析相关性腹膜炎的罕见病例并结合文献复习,总结该病原体导致腹膜炎的临床特...     

男性泌尿生殖道感染患者奈瑟菌属菌种的基因检测

目的:检测从男性泌尿生殖道感染患者分离的奈瑟菌属菌种的基因并探讨非淋病奈瑟菌的致病性以及奈瑟菌属菌种感染的实验室诊断方法。方法:用聚合酶链反应及核苷酸序列测定方法,检测男性泌尿生殖道感染患者泌尿生殖道分离的奈瑟菌属菌种的淋病奈瑟菌核酸扩增荧光检测试剂的反应及其染色体上16SrRNA基因、淋病奈瑟菌DNA甲基转移酶基因orf1、隐蔽性质粒基因cppB及外膜蛋白基因nspA。结果:男性泌尿生殖道感染患者泌尿生殖道分离的14株奈瑟菌属菌种经16SrRNA基因检测鉴定为淋病奈瑟菌2株、粘液奈瑟菌3株、灰色奈瑟菌3株、干燥奈瑟菌2株、微黄奈瑟菌2株、嗜乳糖奈瑟菌1株、多糖奈瑟菌1株,其中淋病奈瑟菌核酸扩增荧光检测试剂阳性反应的9株、cppB阳性反应1株、orf1阳性反应5株、nspA阳性反应3株。16SrRNA基因检测与常规细菌学方法鉴定结果比较,两者的符合率85.7%。结论:引起男性泌尿生殖道感染的非淋病奈瑟菌缺乏cppB,大多数菌株缺乏淋病奈瑟菌毒力相关的orf1与nspA并且可在淋病奈瑟菌核酸扩增荧光检测试剂检测中显示阳性反应,从而造成淋病奈瑟菌鉴定与淋病诊断的误诊以及其他奈瑟菌感染的漏诊。在疑似奈瑟菌属菌种感染的实验室检查中联合使用常规细菌学方法与基因检测方法,可有助于提高奈瑟菌属菌种鉴定及其感染诊断的准确率。     

前十字韧带重建术后大芬戈尔德菌膝关节感染一例报告

报告1例由革兰阳性厌氧菌大芬戈尔德菌导致的前十字韧带重建术后膝关节感染。患者在接受前十字韧带重建术后出现发热、膝关节疼痛、肿胀, 通过病史、体格检查、影像学检查和第二代测序技术确诊为前十字韧带重建术后大芬戈尔德菌感染。通过文献复习, 检索并分析了37篇大芬戈尔德菌感染性疾病的文献, 同时回顾了厌氧菌的鉴定要点、第二代测序技术的应用和前十字韧带重建术后感染的治疗现状。关节镜下前十字韧带重建术后感染发生率较低, 厌氧菌感染则更为罕见;厌氧菌培养困难, 利用第二代测序技术可辅助诊断。在优先保留重建韧带的基础上, 联合使用关节镜下清创引流冲洗术和敏感抗生素治疗为主。     

高通量测序分析老年血液透析患者肠道菌群的改变

目的:了解老年血液透析(hemodialysis,HD)患者肠道菌群分布和丰度的变化规律。方法:采集51例HD患者作为疾病(Case)组,53例血肌酐正常的健康志愿者作为对照(Control)组;采集研究对象晨起新鲜粪便样品,抽提其中微生物总基因组DNA,采用Ⅱ代基因测序技术对粪便样品16S r DNA V3高变区进行扩增测序;划分可操作分类单元(operational taxonomic unit,OTU),使用QIIME分析平台对所有OTU进行物种注释、多样性分析、主坐标分析及肠型分析;采用PICRUSt法预测肠道微生物基因功能及其在KEGG通路上的丰度差异,运用R Studio软件对数据进行统计学分析。结果:两组样品检测出肠道菌群分属14个门和252个属;厚壁菌门和拟杆菌门在Case组和Control组均为最优势菌门,丰度和分别为88.50(±13)%和93.55(±8.8)%,差异无统计学意义;Case组厚壁菌门的丰度下降显著(P0.01),拟杆菌门的丰度升高显著(P0.01),厚壁/拟杆比值明显减低;Case组有27个菌属的丰度与Control组相比差异有统计学意义(P0.01),分别属于厚壁菌门(21个)、拟杆菌门(3个)以及变形菌门(3个),其中10个菌属的丰度升高,以拟杆菌属升高最为显著,17个菌属的丰度降低,以柔嫩梭菌、罗斯菌属、巨单胞菌属等肠道益生菌减少为主;Case组肠型分析为拟杆菌肠型,三大营养物质分解代谢相关的基因表达明显增强,与Control组的柔嫩梭菌肠型差异有统计学意义(P0.01)。结论:老年HD患者肠道菌群呈门结构组成和菌属丰度紊乱,提示血肌酐升高和血液透析可能影响肠道菌群的生存环境,主要表现为厚壁菌门细菌减少,拟杆菌门细菌适应性繁殖,引起拟杆菌属丰度增加以及糖代谢、脂肪代谢和氨基酸代谢相关的基因表达增强,机体能量缺乏超出肠道菌群的代偿能力导致能量代谢失衡,最终导致PEW(protein-energy wasting,PEW)的发生、发展。     

米氏克雷伯菌合并白色念珠菌感染致不明原因发热一例并文献复习

目的:探讨联合应用宏基因组学和培养组学技术对米氏克雷伯菌合并白色念珠菌感染所致不明原因发热患者的病原检测、分离和治疗措施。方法:分析济南市疾病预防控制中心联合山东大学齐鲁医院对2019年7月1日收治的1例米氏克雷伯菌合并白色念珠菌感染导致的不明原因发热患者的诊疗过程,并复习相关文献。结果:该患者主动脉层术后持续间断发热,经抗真菌治疗后效果不佳,经宏基因组学测序联合培养组学技术分离病原提示疑似米氏克雷伯菌合并白色念珠菌感染,调整使用头孢哌酮钠舒巴坦钠联合卡泊芬净抗感染治疗后,患者发热症状消失,实验室指标恢复正常后出院。结论:米氏克雷伯菌感染较少见,且易误诊为其他克雷伯菌,应用宏基因组学联合培养组学技术可尽早明确该病原所致感染,以进行针对性的抗感染治疗。     

胃癌根治术后腹腔感染的病原学分析

目的：对胃癌患者行根治性切除术后腹腔感染的病原学特征进行回顾性分析。方法回顾性分析479例胃癌患者根治术后腹腔感染的病原学种类及药敏结果。结果479例患者中32例术后出现腹腔感染（6.68%）,病原学阳性者27例,阳性率为84.38%。检出病原菌32株,其中革兰阴性菌24株（75.00%）,包括大肠埃希菌15株（46.86%）,肺炎克雷伯菌3株（9.38%）,普通变形杆菌、奇异变形杆菌、阴沟肠杆菌、普城沙雷菌、不动杆菌及铜绿假单胞菌各1株（各占3.13%）;革兰阳性菌7株（21.88%）,包括粪肠球菌4株（12.50%）,耐久肠球菌、金黄色葡萄球菌及溶血性葡萄球菌各1株（3.13%）;真菌1株（3.13%）。药敏结果显示32株病原菌中,对常用抗菌药物的耐药率较高,其中革兰阴性菌对美洛培南敏感性最高（91.67%）,而革兰阳性菌对万古霉素最为敏感（85.71%）。结论大肠埃希菌、粪肠球菌、肺炎克雷伯菌是胃癌患者根治术后腹腔感染最主要的致病菌,临床上应注意合理使用抗菌药物。     

输尿管支架管结壳患者尿液菌群的分布特点

目的探讨输尿管支架管结壳患者尿液菌群的分布特点。方法选取2018年10月至2019年3月在山东省立第三医院、山东大学齐鲁医院、济南市中心医院和济南市济钢医院就诊的35例输尿管支架管置入术后患者。纳入标准:年龄18~65岁;输尿管镜碎石术后留置内支架管4周。排除标准:尿液细菌培养阳性;严重肉眼血尿;近期口服抗生素;存在明显残石患者。本研究采用横断面研究方法(临床研究注册号为ChiCTR1800020025),根据有无支架管结壳将患者分为结壳组23例和无结壳组12例。收集拔管当日患者尿液行细菌16s DNA检测。使用UPARSE、UCHIME和RDP calssifier等软件分析两组患者尿液菌群分布特点,明确两组患者尿液中细菌种类总数、细菌丰度,以及丰度占比较大的细菌类别,比较两组患者尿液细菌种类、数量及细菌丰度的差异,明确结壳组患者尿液中丰度占比较大的细菌菌属。结果两组患者的年龄、性别、体质指数、置管侧别、内支架管型号及结石成分差异均无统计学意义(P>0.05)。16s DNA检测结果显示,结壳组丰度占比>1%的菌属数量为11个,丰度占比>0.01%的菌属数量为74个;无结壳组丰度占比>1%的菌属数量为7个,丰度占比>0.01%的菌属数量为11个,两组丰度占比>1%的菌属数量比较差异有统计学意义(t=5.12,P=0.000)。结壳组中菌属丰度占比前3位分别为乳杆菌属(23.1%)、拟杆菌属(18.8%)和未分级拟杆菌属(17.1%),非结壳组中菌属丰度占比前3位分别是为埃希菌-志贺菌属(32.2%)、肠球菌属(24.9%)和假单胞菌属(18.2%)。两组间差异最大的3种细菌是乳杆菌属(P=0.010),拟杆菌属(P=0.004)和未分级拟杆菌属(P=0.004)。结论支架管结壳患者尿液中细菌种类和数量都明显多于非支架管结壳患者。拟杆菌属细菌在支架管结壳患者尿液中的细菌种类丰度较大。     

124例布鲁菌病患者血清肝功能指标的检测

目的分析乌鲁木齐地区124例布鲁菌病患者肝功能及感染相关指标的变化,为临床诊治提供依据。方法选取2012年10月至2015年8月124例布鲁菌病患者为病例组,100例同期健康体检者为对照组。分别检测两组研究对象血清丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、γ谷氨酰胺转移酶(GGT)、碱性磷酸酶(ALP)、总胆红素(TBil)、直接胆红素(DBil)、总蛋白(TP)、白蛋白(ALB)、超敏C-反应蛋白(sCRP)和降钙素原(PCT)以及白细胞介素-6(IL-6)的水平。结果病例组患者肝脏功能指标:ALT、AST、GGT和ALP水平分别为(94.6±48.0)U/L、(72.9±31.1)U/L、(108.2±53.0)U/L和(131.2±56.3)U/L,显著高于对照组的(31.1±21.4)U/L、(26.5±9.41)U/L、(35.2±30.5)U/L和(61.9±24.9)U/L,差异均具有统计学意义(t=13.2、11.0、12.9、12.3,P均0.001);病例组患者感染相关指标sCRP、PCT、IL-6水平分别为(59.8±23.7)mg/L、(10.9±3.77)ng/ml和(16.2±12.8)pg/ml,显著高于对照组的(3.07±1.20)mg/L、(0.37±0.17)ng/ml和(4.58±1.97)pg/ml,差异均具有统计学意义(t=28.1、31.0、9.96,P均0.001)。结论布鲁菌病患者部分肝功能指标升高提示患者肝功能受损,该疾病患者有明显的非特异性炎症相关指标的升高。     

CRP及PCT联合检测在诊断小儿沙门菌属肠炎中的诊断价值

目的：分析C反应蛋白（CRP）及血清降钙素原（PCT）联合检测在诊断小儿沙门菌属肠炎中的价值。方法：将沙门菌属肠炎患儿48例作为观察组,选取同期健康体检者48例作为对照组,比较2组血清PCT及CRP水平,单项检测及联合检测的灵敏度、准确度、特异度、阳性诊断率及阴性诊断率。结果：观察组患儿PCT、CRP水平均显著高于对照组（P <0.05）,CRP+PCT联合检测方案灵敏度、准确度、特异度、阳性诊断率及阴性诊断率均高于单项检测方案（P <0.05）。结论：沙门菌属肠炎患儿PCT和CRP水平较健康体检者均明显升高,联合检测对提高沙门菌属肠炎患儿检出率有一定的参考价值,值得临床推广应用。     

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.