TGF-β2体外诱导骨髓间充质干细胞表达软骨细胞表型的观察

目的：观察骨髓间充质干细胞（MSCs）在TGF-β2诱导下向软骨细胞表型转化的能力,探讨其作为软骨组织工程种子细胞的可能性。方法：抽取兔髂骨骨髓液3-4ml,进行原代和传代培养,传代后实验组以高糖DMEM无血清特定培养液诱导f含TGF-β2 10ng／ml、地塞米松10^-7M、维生素C50μmol／L）,对照组以高糖DMEM无血清培养液培养,相差显微镜下观察细胞形态变化,免疫组织化学染色检测软骨特异性Ⅱ型胶原表达。结果：诱导后细胞体外扩增能力显著降低,细胞形态由成纤维样梭形向多角形、多边形或类圆形转变,诱导21天后细胞形态变化最为显著,Ⅱ型胶原免疫组化染色深而均匀。结论：TGF-β2可有效诱导MSCs向软骨细胞表型转化,分泌软骨细胞特异性基质,有可能成为软骨组织工程较理想的种子细胞来源。     

转化生长因子-β2体外诱导骨髓间充质干细胞表达软骨细胞表型的观察

目的观察骨髓间充质干细胞(MSCs)在转化生长因子(TGF-β2)诱导下向软骨细胞表型转化的能力,探讨其作为软骨组织工程种子细胞的可能性。方法抽取兔髂骨骨髓液3～4ml,进行原代和传代培养,传代后实验组以高糖DMEM无血清特定培养液诱导,培养液含TGF-β210ng/ml、地塞米松10-7mol/L、维生素C50μmol/L;对照组以高糖DMEM无血清培养液培养,相差显微镜下观察细胞形态变化,免疫组织化学染色检测软骨特异性Ⅱ型胶原表达。结果诱导后细胞体外扩增能力显著降低,细胞形态由成纤维样梭形向多角形、多边形或类圆形转变,诱导21d后细胞形态变化最为显著,Ⅱ型胶原免疫组织化学染色深而均匀。结论TGF-β2可有效诱导MSCs向软骨细胞表型转化,分泌软骨细胞特异性基质,有可能成为软骨组织工程较理想的种子细胞来源。     

TGF-β1和bFGFs体外诱导成人骨髓间充质干细胞表达软骨细胞表型的实验研究

目的：从人骨髓中分离间充质干细胞(mesenchymal stem cells，MSCs)，应用流式细胞学技术分析不同细胞因子对细胞增殖分化的影响并观察细胞组织化学特点。结果：MSCs具有独特的表征，即CD29阳性，CD34阴性：TGF—β1(transforming growth faetorsβ1，TGF—β1)、bFGFs(base fibroblast growth faethors，bFGFs)及两者的联合应用可诱导MSCs表达软骨细胞表型向成软骨细胞方向分化：结论：MSCs是一群均一的细胞，具有独特表征，本实验所采用的细胞分离方法为筛选合适的细胞体外扩增及分化提供了有意义的线索。     

诱导骨髓间充质干细胞向软骨细胞分化的体外研究

目的 探讨转化生长因子β1（transforming growth factor β1，TGF—β1）、胰岛素样生长因子1（insulinlike growth factor1，IGF-1）在诱导骨髓间充质干细胞（marrow mesenchymal stem ceils，MSCs）向软骨细胞分化过程中的相互作用，并研究细胞密度对MSCs向软骨细胞分化的影响。方法 取健康昆明种小白鼠骨髓，用全骨髓贴壁法筛选获得MSCs，体外培养传代。采用特定的诱导培养使MSCs向软骨细胞分化，按培养基内添加生长因子的不同分成3个实验组和对照组。实验组分别为：TGF—β1＋IGF-1联合应用组（TGF—β1 10ng／ml、IGF-1 50ng／m1）；TGF—β1单独应用组（TGF—β1 10ng／m1）；IGF-1单独应用组（IGF-1 50ng／m1）；对照组不添加任何生长因子。TGF—β1＋IGF-1联合应用组于诱导14d和21d，分别进行甲苯胺蓝染色及免疫荧光双染法鉴定；于诱导7、14和21d各组分别提取诱导细胞总RNA，进行RT—PCR扩增，检测TGF—β1、IGF-1对诱导细胞Ⅱ型胶原表达量的影响；比较MSCs在平板培养及细胞团培养时，Ⅱ型胶原表达量的差异。结果TGF—β1＋IGF-1联合应用组诱导培养14d，诱导软骨细胞甲苯胺蓝染色呈阳性，免疫荧光染色可见诱导软骨细胞的细胞外基质含有Ⅱ型胶原。各组基因扩增产物的凝胶电泳可见，TGF—β1＋IGF-1联合应用组和TGF—β1单独应用组Ⅱ型胶原扩增片段呈阳性；IGF-1单独应用组和对照组，未见Ⅱ型胶原扩增条带；凝胶成像系统灰度扫描示Ⅱ型胶原表达量TGF—β1＋IGF-1联合应用组各时间点均比TGF—β1单独应用组明显增加（P〈0．05）。细胞团培养模式下，诱导细胞表达Ⅱ型胶原比平板培养模式更加显著。结论 MSCs向软骨细胞诱导分化时，IGF-1对TGF—β1有明显的促进作用；细胞培养密度提高有利于MSCs成软骨细胞表型。     

骨髓间质干细胞体外定向诱导分化为软骨细胞的实验研究

目的：探讨分离骨髓间充质干细胞（MSCs）并诱导其向软骨细胞转化的体外培养方法,为软骨组织工程的种子细胞来源提供实验依据。方法：抽取兔髂骨骨髓液,经梯度离心法和贴壁法进行体外培养,贴壁细胞传代,取第3代细胞在培养基中添加软骨分化诱导剂[含转化生长因子（TGF-β2）10ng／ml、地塞米松10^7mol／L、维生素C50μmol／L,经7、14、21d诱导培养后,倒置显微镜观察细胞形态,免疫组织化学染色检测软骨特异性Ⅱ型胶原表达。将诱导细胞与软骨支架材料-聚磷酸钙纤维／左旋聚乳酸（CPP／PLLA）复合,1周后终止培养,扫描电镜观察细胞黏附情况。结果：诱导后细胞体外扩增能力显著降低,细胞形态由成纤维样梭形向多角形、多边形或类圆形转变,诱导21d后细胞形态变化最为显著,Ⅱ型胶原免疫组化染色深而均匀。诱导后的MSCs可在支架材料内良好黏附生长。结论：体外培养的MSCs可定向诱导分化为软骨细胞,分泌软骨细胞特异性基质,可用作软骨组织工程的种子细胞。     

成人骨髓基质干细胞体外定向诱导分化为软骨细胞的实验研究

目的 建立临床成人骨髓基质干细胞(MSCs)体外培养、定向诱导分化为软骨细胞的途径。方法抽取成人骨髓，Percol密度梯度离心法进行体外培养，贴壁细胞传代，取第3代细胞在培养基中添加软骨分化诱导剂地塞米松、维生素C和不同剂量转化生长因子-β(TGF-β)，培养16d后,在倒置显微镜观察细胞形态，甲苯胺蓝染色蛋白多糖，逆转录一聚合酶链反应(RT-PCR)、免疫细胞化学(SABC法)检测Ⅱ型胶原表达，诱导后MSCs与新型材料聚乳酸和羟基乙醇共聚物(PL-GA)复合。结果 Percoll密度梯度离心法培养可获得均一的。MSCs；5、10ng TGF-β诱导分化的MSCs生长迅速。呈典型的软骨细胞形态，甲苯胺蓝染色阳性，Ⅱ型胶原表达阳性，MSCs对材料PL-GA黏附力强。结论 可以从成人骨髓中培养出MSCs，并可定向诱导分化为软骨细胞，5～10ng TGF-β为最佳诱导剂量，成人MSCs可用作临床自体软骨组织工程种子细胞。     

骨髓间质干细胞向软骨细胞表型定向诱导分化的实验研究

目的 研究体外培养的猪骨髓间质干细胞（Bone Marrow Stem Cells,MSCs)在特定培养液作用下向软骨细胞表型转化，探讨其作为组织工程化软骨的种子细胞的可行性。方法 取成年崇明长枫杂交猪髂骨骨髓5ml，在低糖DMEM完全培养液培养2周，传代后以高糖DMEM无血清特定培养液诱导（含胰岛素2mg/L、转铁蛋白3mg/L、丙酮酸100mg/L、地塞米松10^-7mol/L、TGF－β1 10ng/ml)，在相关显微镜和电镜下进行观察，免疫组化检测Ⅱ型胶原分泌，原位杂交检测Ⅱ型胶原mRNA表达。结果 细胞形态由成纤维样梭形向多角形、多边形转变，透视电镜观察见大量扩张粗面内质网、高尔基体、线粒体。诱导培养后第7，14dⅡ型胶原免疫组化阳性，同时原位杂交检测Ⅱ型胶原mRNA表达呈阳性。结论 MSCs在特定培养液诱导下能向软骨细胞表型转化，并能分泌软膏特异性基质，有可能成为软骨组织工程较理想的种子细胞来源的应用前景。     

骨髓间充质干细胞在β3转化生长因子联合胰岛素样生长因子-1定向诱导下的软骨组织工程

目的探讨β3转化生长因子（TGF-β3）在诱导骨髓间充质干细胞（mesenchymal stem cells,MSCs）向软骨细胞分化中胰岛素样生长因子-1（IGF-1）的作用以及在软骨组织工程中的应用。方法在体外用TGF—β3或（和）IGF-1诱导藻酸钠微球中的MSCs向软骨细胞定向分化,免疫组织化学、逆转录-聚合酶链反应（RT—PCR）检测Ⅱ型胶原和聚集蛋白聚糖（aggrecan）的表达,Western印迹法检测Sox9蛋白的表达,激光共聚焦显微镜和扫描电镜观察该软骨细胞在壳聚糖支架上的生长。结果TGF-β3。能诱导藻酸钠微球中的MSCs表达软骨特异性的Ⅱ型胶原、聚集蛋白聚糖和Sox9,IGF-1能显著性地增强这种作用（P〈0．05）。Ⅱ型胶原、聚集蛋白聚糖和Sox9之间的相关系数分别为0．95和0．91。诱导的软骨细胞能在壳聚糖支架上黏附、迁徙、增殖。结论在TGF-β3诱导MSCs分化成软骨细胞地过程中,IGF-1可能通过促进Sox9的表达起到协同作用。诱导分化后的软骨细胞与壳聚糖复合支架表现出良好的组织相容性。     

骨髓间充质干细胞复合纤维蛋白封闭剂体内构建可注射性组织工程软骨

目的 探讨利用人骨髓间充质干细胞（marrow mesenchymal stem cells，MSCs）与可注射性纤维蛋白封闭剂（fibrinsealant，FS）复合，在裸鼠体内构建组织工程软骨的可行性。方法 体外分离扩增健康人MSCs，以含有转化生长因子β1（transforming growth factor β1，TGF—β1）、地塞米松、维生素C的培养基进行成软骨诱导，诱导第7、14天分别检测软骨细胞特异的生物学特性。将诱导7d的MSCs与FS复合，接种于裸鼠背部皮下作为实验组，同时设单纯只注射FS或MSCs的支架对照组和细胞对照组。分别于接种后6、12周取材进行大体观察，行HE、阿尔新蓝染色和Ⅱ型胶原免疫组织化学染色评价其成软骨能力。结果 MSCs以特定的培养基诱导后由纺锤形变为多角形，并表达软骨细胞分泌的基质。复合物接种6和12周后，实验组均可形成软骨样组织块，6周时形成的组织块较小而质地柔韧，陷窝清楚，可检测到阳性阿尔新蓝及Ⅱ型胶原表达；12周形成的组织块较大，质地较硬，表面光滑，软骨细胞位于成熟的陷窝中，阿尔新蓝及Ⅱ型胶原免疫组化阳性染色较6周增强。两个对照组均无软骨样组织块形成。结论 MSCs复合FS可以作为一种较优良的可注射性组织工程软骨的构建方法。     

低频微动后转化生长因子β1与胰岛素样生长因子Ⅰ在新骨组织中的表达研究

目的 研究转化生长因子β1（transforming growth factor β1，TGF—β1）与胰岛素样生长因子Ⅰ（insulinlike growth factor Ⅰ，IGF—Ⅰ）在低频微动引起骨折间接愈合过程中的表达与意义。方法 山东雌性高腿绵羊15只，行双侧胫骨中段横形截骨，形成2mm骨缺损，用带有微动装置的单边外固定支架固定。术后10d，随机选择一侧肢体为微动组，以频率1Hz，幅度0．25mm（30min／d）微动，4周结束；另一侧后肢不微动，为对照组。术后3、4和6周分别处死5只动物，应用免疫组织化学与RT—PCR检测骨痂组织中TGF—β1与IGF—Ⅰ的表达。结果免疫组织化学：术后3周，微动组TGF—β1在骨痂边缘的新生软骨细胞各区均有阳性表达，以增殖区最为显著；IGF—Ⅰ主要表达于软骨内骨化带边缘的成骨细胞，钙化并转化为新骨的软骨细胞与骨细胞中。对照组的相应区域，TGF—β1有少量表达，IGF—Ⅰ几乎无表达。4周，微动组新骨组织逐渐成熟，TGF—β1表达强度减弱，阳性信号主要位于细胞外基质与骨化带周围成骨细胞中；IGF—I的表达趋于高峰，主要集中在新骨表面的成骨细胞、趋于成熟的骨细胞及趋于钙化的类骨质。对照组TGF—β1与IGF—Ⅰ仅有少量表达。6周，微动组TGF—β1的表达显著衰退，IGF—Ⅰ仍有适量表达，主要在新生骨小梁骨细胞中。对照组TGF—β1与IGF—Ⅰ仅有微量表达。微动组术后3、4周TGF—β1，3、4、6周IGF—Ⅰ吸光度（A）值与对照组相比，差异有统计学意义（P〈0．05）。RT—PCR电泳示：术后3、4周，微动组骨痂中TGF—β1与IGF—Ⅰ的mRNA有较高的表达量；对照组骨痂中TGF—β1、IGF—Ⅰ的mRNA有轻度表达。术后6周，微动组TGF—β1、IGF—Ⅰ的mRNA表达量显著降低，但仍略高于对照组。微动组术后3、4周TGF—β1，3、4、6周IGF—Ⅰ A值与对照组相比，差异有统计学意义（P〈0．05）。结论低频微动在骨折愈合早期，可以促进TGF—β1与IGF—Ⅰ的表达。它们协同调节软骨内骨化的进程；后期主要由IGF—Ⅰ调节骨细胞的分化与类骨质的矿化，其可能更多的参与调节微动各个时期的细胞生物行为。     

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 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.     

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.     

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.     

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.     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

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.