纤维连接蛋白在增生性瘢痕中的分布及其意义的研究

取１０例增生性瘢痕和相邻或相近部位的正常皮肤作组织切片，行ＨＥ染色和免疫组织化学染色，光镜下观察正常皮肤和增生性瘢痕中相应各层纤维连接蛋白（ＦＮ）的分布特点，并进行对照研究。结果发现：正常皮肤基底膜、真皮乳头层及血管内皮ＦＮ弱阳性。增生性瘢痕中，＂基底膜＂ＦＮ弱阳性；＂真皮＂全层由外至内ＦＮ呈弱阳性─强阳性─弱阳性；中层含有大量ＦＮ阳性的成纤维细胞；部分瘢痕最下层ＦＮ分布呈＂树根＂状突入皮下组织内。据此认为增生性瘢痕增生最旺盛的部分在中层；ＦＮ与瘢痕增生关系密切。     

增生性瘢痕中纤维连接蛋白和层粘连蛋白的分布

取临床病人的增生性瘢痕和相邻的正常皮肤作组织切片，分别行纤维连接蛋白免疫比喻杂色和层粘连蛋白免疫组织化学染色。结果发现：（１）增生性瘢痕中，基底膜ＦＮ呈弱阳性；真皮全层由浅及深ＦＮ呈弱阳性－强阳性－弱阳性分布，中层含有大量ＦＮ阳性的成纤维细胞；部分瘢痕量深层ＦＮ分布呈“树根”状突入皮下组织内，提示增生性瘢痕增生最旺盛的部位在中层。真皮ＦＮ阳性与否和强弱是判断瘢痕增生程度的一种指标。（２）增生性瘢痕     

纤维连接蛋白在增生性瘢痕中的分布及其意义的研究

取10例增生性瘢痕和相邻或相近部位的正常皮肤作组织切片,行 HE 染色和免疫组织化学染色,光镜下观察正常皮肤和增生性瘢痕中相应各层纤维连接蛋白(FN)的分布特点,并进行对照研究。结果发现:正常皮肤基底膜、真皮乳头层及血管内皮 FN 弱阳性。增生性瘢痕中,“基底膜”FN 弱阳性;“真皮”全层由外至内 FN 呈弱阳性-强阳性-弱阳性;中层含有大量 FN 阳性的成纤维细胞;部分瘢痕最下层 FN 分布呈“树根”状突入皮下组织内。据此认为增生性瘢痕增生最旺盛的部分在中层;FN 与瘢痕增生关系密切。     

膀胱癌基底膜层粘蛋白,胶原蛋白Ⅳ与纤维连接蛋白分布表达的？…

目的 探讨膀胱癌基底膜中层粘蛋白，胶原蛋白Ⅳ与纤维连接蛋白分布表达的相关性。方法 用免疫组织化学方法测定３５例膀胱移行上皮癌和３例低分化鳞状上皮癌肿瘤组织基底膜层粘蛋白（ＬＮ），胶原蛋白Ⅳ（ＣｏｌⅣ）和纤维连接蛋白（ＦＮ）含量与分布，结果病理级别高，浸润性生长的膀胱移行上皮癌，基底膜ＬＮ，ＣｏｌⅣ和ＦＮ一样，阳性染色少，分布不连续，反之，病理级别低，非浸润性生长的肿瘤，基底膜ＬＮ，ＣｏｌⅣ也和Ｆ     

前列腺癌组织中细胞外基质的免疫组织化学研究

为探讨前列腺癌（ＰＣａ）细胞的转移机制，应用免疫组织化学ＡＢＣ法在良性前列腺增生（ＢＰＨ）及ＰＣａ组织中对基膜连接蛋白（ＬＮ），胶原Ⅳ型蛋白（ＣＯＬⅣ），纤维连接蛋白（ＦＮ）等细胞外基质（ＥＣＭ）蛋白的表达进行检测，结果ＢＰＨ组织中基底膜部位ＬＮ，ＣＯＬⅣ及ＦＮ的染色呈连续线状分布，ＰＣａ组组织基底膜部位ＬＮ，ＣＯＬⅣ及ＦＮ的阳性染色呈碎片状或断线状分布。ＣＯＬⅣ在ＢＰＨ与ＰＣａ组织中的强阳性率无显著性差异（Ｐ＞０．０５）。结果提示ＥＣＭ在ＰＣａ组织中基底膜部位的明显缺失（非连续线状分布）可能是肿瘤转移的重要因素。     

富含半胱氨酸的酸性分泌糖蛋白在病理性瘢痕中的表达及其意义

目的观察富含半胱氨酸的酸性分泌糖蛋白(Secreted protein,acidic and rich in cysteine,SPARC)在瘢痕疙瘩和增生性瘢痕中的表达规律及其意义。方法瘢痕患者的瘢痕疙瘩和3～12个月增生性瘢痕组织各26例;另取手术剩余的正常成人皮肤组织5例;所有标本用40 g/L甲醛固定,行连续切片,厚4μm,应用链菌素生物素-过氧化物酶标记物免疫组织染色法染色。同时设正常对照(正常皮肤)、阳性对照(胃癌癌变组织)、阴性对照(磷酸盐缓冲液代替一抗)。鼠抗人SPARC单克隆一抗浓度为1:200。结果正常成人皮肤中SPARC表达稀少,局限在真皮-表皮交界的乳头真皮,部分靠近基底膜血管和皮肤附件。SPARC在增生性瘢痕的真皮瘢痕组织、皮肤附件中低表达,且早期增生性瘢痕中表达无明显强于晚期增生性瘢痕(P>0.05)。在真皮中SPARC呈弥散性散在分布(同增生性瘢痕),阳性信号表达较低。增生性瘢痕及瘢痕疙瘩的SPARC较正常皮肤表达无差异(P>0.05)。结论SPARC在3～12个月增生性瘢痕中呈低表达,在瘢痕疙瘩中低表达。     

腱糖蛋白C在瘢痕疙瘩和增生性瘢痕中的表达

目的　观察腱糖蛋白C(Tn C)在瘢痕疙瘩和增生性瘢痕中的表达规律。　 方法　取瘢痕患者的瘢痕疙瘩和 6～ 10个月增生性瘢痕组织各 10例 ,并取部分患者距瘢痕边缘 1cm的正常皮肤 ;另取手术剩余的正常成人皮肤组织 5例。采用免疫组织化学方法 ,检测Tn C在瘢痕疙瘩、增生性瘢痕和正常成人皮肤中的表达。　结果　正常成人皮肤中Tn C表达稀少 ,局限在真皮 表皮交界的乳头真皮 ,部分靠近基底膜血管和皮肤附件。Tn C在瘢痕疙瘩和增生性瘢痕的真皮瘢痕组织、皮肤附件中呈弥散分布 ,表达显著增强 (P <0.0 1),以瘢痕疙瘩的增强尤为明显。瘢痕疙瘩旁正常皮肤附件的Tn C较正常皮肤表达增强 ,在增生性瘢痕旁的正常皮肤中未见到Tn C的高表达。　结论　Tn C在瘢痕疙瘩和 6～ 10个月增生性瘢痕中呈异常高表达 ,值得进一步研究。     

肌成纤维细胞在病理性瘢痕形成中的机制

目的 探讨肌成纤维细胞在病理性瘢痕形成机制中的作用。方法 对1998年～2000年门诊或住院的13例增生性瘢痕，14例瘢痕疙瘩及7例成熟瘢痕患者的相应组织，应用光镜、电镜及免疫组织化学染色，进行观察、检测。结果 增生性瘢痕的超微结构中均可见典型的肌成纤维细胞；免疫组织化学染色可见有不同程度表达的肌成纤维细胞。瘢痕疙瘩及成熟瘢痕的超微结构和免疫组织化学结果均未见肌成纤维细胞。结论 肌成纤维细胞的生物学行为可能与增生性瘢痕的形成及瘢痕畸形有关，并可用于增生性瘢痕与瘢痕疙瘩的鉴别。     

HGF/c-met蛋白在人增生性瘢痕组织中定位与表达的研究

目的：以肝细胞生长因子（Hepatocyte growth factor，HGF）及其受体c—met蛋白为研究对象，研究其在人增生性瘢痕中的定位和表达。方法：采集住院患者的增生性癜痕标本，以免疫组织化学染色的方法检测HGF／c—met在增生性瘢痕组织中的定位和表达，使用计算机辅助图像分析技术比较真皮层HGF／c—met表达水平的变化。结果：在表皮层，增生性瘢痕组织和正常皮肤组织中的HGF／c—met均呈强阳性表达；相对于正常皮肤组织，人增生性瘢痕组织真皮层中HGF／c-met的表达明显增加，特别是在真皮层的成纤维细胞中，差异显著。结论：HGF／c—met在真皮层表达水平的改变可能是影响人增生性瘢痕形成的重要因素。     

β-内啡肽与μ-阿片受体在正常皮肤与增生性瘢痕组织中的分布特征与生物学意义

目的 观察β-内啡肽和μ-阿片受体(MOR)在人正常皮肤与增生性瘢痕组织中的表达特点.方法 采取10例正常人皮肤组织和10例痛痒症状明显的增殖期增生性瘢痕患者病变处皮肤与非病变处正常组织,运用免疫组织化学技术对所取标本进行β-内啡肽和MOR荧光染色,并应用RT-PCR方法检测皮肤组织中MOR mRNA的表达情况.结果 在所有被检测的皮肤组织标本中,真表皮内均发现β-内啡肽和MOR的阳性表达.其中正常人皮肤与瘢痕患者非病变处来源组织真皮与表皮内的β-内啡肽和MOR的表达差异无统计学意义(P>0.05);而增生性瘢痕患处组织真皮与表皮内β-内啡肽和MOR的表达明显强于其他两组(P<0.01).同时,PCR的结果显示,瘢痕组织中MORmRNA的含量也远远高于正常皮肤.结论 β-内啡肽和MOB在正常皮肤与增生性瘢痕组织中的分布存在差异,这可能是造成瘢痕愈合后感觉异常的重要因素.     

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.