胰岛素样生长因子-2在婴幼儿血管瘤中的表达及意义

目的:探讨胰岛素样生长因子-2在不同年龄、不同病理分期婴幼儿血管瘤中的表达水平及意义。方法:采用免疫组化SP法检测50例婴幼儿血管瘤、27例血管畸形及5例正常皮肤组织中I GF-2的表达。应用SPSS13.0统计软件进行数据分析。结果:免疫组化结果显示:婴幼儿血管瘤组和血管畸形组IGF-2的阳性表达率比较,差异具有统计学意义(χ2=7.46,P<0.05);婴幼儿血管瘤组和正常皮肤组I GF-2的阳性表达率比较,差异具有统计学意义(χ2=9.41,P<0.05);I GF-2蛋白的表达水平在血管畸形组织中与正常皮肤组织中的差异无统计学意义(χ2=0.0333,P>0.05)。婴幼儿血管瘤患儿年龄与I GF-2蛋白的表达强度的相关分析,线性回归分量和非线性回归分量均有统计学意义(P值均<0.05)。婴幼儿血管瘤的年龄与肿瘤病理分期有关系(χ2=24.91,P<0.05)。I GF-2蛋白的表达强度和病理分期有关系(χ2=19.03,P<0.05)。结论:婴幼儿血管瘤中I GF-2蛋白的表达强度、肿瘤的病理分期和患儿年龄两两间存在关联。IGF-2可能在婴幼儿血管瘤的发展过程中起促进增殖的作用。IGF-2蛋白的表达状况能在一定程度上反映瘤体的发展趋势。     

葡萄糖转运蛋白-1在血管瘤和血管畸形中的表达及其意义

目的检测葡萄糖转运蛋白-1(glucose transporter-1,Glut1)在血管瘤和血管畸形组织中的表达并探讨其意义。方法各阶段婴幼儿血管瘤标本52例、海绵状静脉畸形25例、动静脉畸形9例、毛细血管畸形2例、正常皮肤软组织5例。应用En Vision法免疫组化染色检测Glut1在上述标本中的表达。结果增生早期,较多血管瘤内皮细胞表达Glut1;增生中期,绝大部分微血管内皮细胞和散在分布的内皮细胞表达Glut1;增生晚期,Glut1表达迅速减弱;消退期血管瘤微血管内皮细胞不表达Glut1。所有海绵状静脉畸形、动静脉畸形、毛细血管畸形、正常皮肤软组织中的小动静脉和微血管均不表达Glut1。结论Glut1是血管瘤内皮细胞发展过程中的一种表型,而不是其固有特征,Glut1表达是血管瘤内皮细胞适应代谢需要而产生的。     

Livin、Smac在婴幼儿增生期血管瘤中的表达及其意义

目的研究婴幼儿增生期血管瘤组织中Livin和Smac的表达并进行相关性分析,初步探讨Livin和Smac在血管瘤发病机制中的作用。方法采用RT-PCR和免疫组化分别检测LivinmRNA、SmacmRNA和蛋白在20例婴幼儿增生期血管瘤和15例正常皮肤组织中的表达。结果以上2种组织中LivinmRNA、SmacmRNA和蛋白的表达,其差异均有统计学意义(P0.05)。血管瘤中LivinmRNA的表达水平和蛋白的阳性表达率高于正常皮肤组织(P0.05),血管瘤中SmacmRNA的表达水平和蛋白的阳性表达率低于正常皮肤组织(P0.05);增生期血管瘤组织中Livin和Smac蛋白的表达呈负关联。结论Livin基因高表达可能抑制了Smac基因表达,从而导致了血管瘤内皮细胞增殖和凋亡的失衡,最终导致了血管瘤的形成。     

血管紧张素Ⅱ受体在皮肤血管瘤不同时期的表达

目的：观察血管紧张素Ⅱ 1型受体（AT1）和2型受体（AT2）在毛细血管瘤组织中的表达，探讨血管紧张素Ⅱ与毛细血管瘤发生、发展及自然消退可能的关系.方法：采用免疫组织化学的方法检测AT1和AT2受体在29例毛细血管瘤和9例正常皮肤组织中的表达和分布规律.结果：在增生期毛细血管瘤组织中扩张的微血管内皮细胞仅见AT1受体表达，未见AT2受体表达.在消退期毛细血管瘤组织中扩张的微血管内皮细胞可同时检测到AT1和AT2受体阳性染色信号.结论：血管紧张素Ⅱ可能通过AT1和AT2受体参与血管瘤的发生、发展及自然消退。     

血管瘤组织中TRAIL蛋白及其mRNA的表达和意义

目的检测血管瘤组织中TRAIL(肿瘤坏死因子相关凋亡诱导配体)蛋白及其mRNA的表达,并探讨其意义。方法采用免疫组织化学和原位杂交方法检测血管瘤增殖期、退化期、血管畸形和正常皮肤组织中TRAIL蛋白和mRNA的表达。结果TRAIL蛋白和mRNA在血管瘤增殖期和退化期中的阳性表达率分别为45.45%(15/33)和78.57%(22/28),66.67%(22/33)和89.29%(25/28),血管畸形和正常皮肤组织中均为阴性。秩和检验分别为Hc=54.03,Hc=71.82,四者之间差异均有统计学意义(P<0.01),两两之间比较,增殖期与退化期之间差异均有统计学意义(P<0.01)。结论TRAIL可能通过诱导内皮细胞凋亡,促进血管瘤的消退。     

血管瘤组织中端粒酶逆转录酶基因表达与端粒酶活性的关系

目的　探讨端粒酶逆转录酶 (hTERT )基因在血管瘤组织中的表达及其与端粒酶活性的关系。方法　采用原位逆转录 聚合酶链反应 (RT PCR )和链霉抗生物素蛋白 过氧化物酶(SP)免疫组织化学方法分别检测 40例 (增生期 2 0例、退化期 2 0例 )血管瘤组织及 2 0例正常皮肤组织中hTERTmRNA表达 ,并采用端粒重复序列扩增 (TRAP)法测定血管瘤组织中端粒酶活性。结果　增生期血管瘤组织中hTERTmRNA阳性表达率为 80 .0 % ,退化期血管瘤组织中hTERTmRNA阳性表达率为 15 .0 % ,而正常皮肤组织中hTERTmRNA无阳性表达 ,增生期血管瘤与退化期血管瘤hTERTmRNA表达率差异具有显著性 (P <0 .0 1)。增生期血管瘤组织中端粒酶活性为81.4% ,退化期血管瘤组织中端粒酶活性 2 1.6% ,正常皮肤组织中无端粒酶活性 ,增生期血管瘤与退化期血管瘤组织中端粒酶活性比较 ,差异有显著性 (P <0 .0 1)。结论　端粒酶活性与血管瘤内皮细胞增殖状况和hTERTmRNA表达密切相关 ,在血管瘤的发生和发展中起着重要的作用。     

细胞凋亡及Bcl-2、Bax在血管瘤和血管畸形中的表达

目的 探讨细胞凋亡及Bcl-2、Bax与血管瘤及血管畸形的关系。方法 用SP法测定草莓状血管瘤和血管畸形68例及正常皮肤11例中Ki-67、Bcl-2、Bax的表达；用TUNEL法测定内皮细胞凋亡指数(AI)。结果 Ki-67在增生期草莓状血管瘤中的表达阳性率为100％，而在其他组中未见阳性表达；Bax在草莓状血管瘤中的表达明显高于血管畸形和正常皮肤，两者差异有显著性意义；Bcl-2均未见阳性表达；草莓状血管瘤的AI明显高于血管畸形和正常皮肤，差异有显著性意义。在草莓状血管瘤中，伴随Bax的表达强度增加，AI逐渐增加，两者呈正相关。结论 细胞凋亡可能与草莓状血管瘤自然消退有关，Bcl-2和Bax在细胞凋亡中可能起着重要的调控作用。     

Ki-67抗原在血管瘤和血管畸形组织中的表达

目的探讨Ki-67抗原在血管瘤和血管畸形组织中的表达及其临床意义.方法应用免疫组织化学SP方法,测定各类血管瘤组织石蜡标本76例和正常皮肤11例中Ki-67抗原的表达.结果Ki-67抗原在增生期草莓状血管瘤中的表达阳性率为100%,与在消退期草莓状血管瘤、血管畸形和正常皮肤中的表达差异有统计学意义.结论测定Ki-67抗原的表达情况有助于区分血管瘤和血管畸形以及血管瘤的分期,对于进一步进行病因学的研究和正确的选择治疗方法具有重要意义.     

整合素β3在人皮肤血管瘤中的表达及意义

目的：探讨整合素β3在血管瘤发生、发展及退化过程中的表达状况及意义。方法：采用RT—PCR技术,检测人血管瘤增生期、消退期及正常皮肤组织中整合素β3的表达,利用SPSS软件进行数据分析,增生期血管瘤标本中整合素β3的表达明显高于消退期及正常皮肤组织,差异有显著性意义（P〈0．05）;消退期标本与正常皮肤组织中β3的表达无显著性差异（P〉O．05）。结论：整合素β3在血管瘤的发生发展中起到重要的作用。     

促血管生成素-1、2及Tie2在血管瘤及血管畸形中的表达及意义

目的 探讨促血管生成素-1(Ang-1)、促血管生成素-2(Ang-2)及其受体Tie2在血管瘤和血管畸形组织中的表达及意义.方法 应用免疫组织化学S-P方法,测定血管瘤、血管畸形的血管内皮细胞中Ang-1、Ang-2及Tie2的表达. 结果 Ang-2、Tie2的表达在增生期血管瘤最强;在退化期血管瘤中的表达次之;而在血管畸形中表达较弱,与小儿正常皮肤表达无显著性差异.而Ang-1的表达,各组差异无统计学意义. 结论 Ang-1、Ang-2及其受体Tie2在血管瘤的血管生成以及血管瘤的自然消退过程中可能起着重要的作用;Ang-1、Ang-2及其受体Tie2的表达可能与血管畸形的发病无明显关系.     

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.