白介素-16基因多态性与膝关节原发骨性关节炎易感性韵关联研究

[目的]探讨白介素-16(IL-16)基因多态性与膝关节原发性骨性关节炎(OA)的易感关联.[方法]采用病例-对照研究,纳入95例中国汉族膝OA患者和95例年龄、性别匹配的健康对照者.用聚合酶链反应和限制性片段长度多态性等方法筛查IL-16基因的三个单核苷酸多态性(SNP)位点,并测序验证酶切结果.进行拟和优度x2检验、H-W平衡检验、连锁不平衡分析、单个位点和单倍型的非条件Logistic回归,分析IL-16基因多态性与膝OA的易感关联.[结果]三个SNP位点均符合H-W平衡.显性遗传模式非条件Logistic回归显示,rs11556218位点中,T/G基因型对膝OA可能有保护作用(OR=0.40,95%CI=0.21-0.73,P=0.008);rs4072111中,C/T可能增加发病风险(OR=1.98,95%CI=1.08-3.65,P=0.036).连锁不平衡分析提示rs11556218与rs4778889存在连锁不平衡(D'=0.625,r2=0.217),单倍型TTT可能增加发病风险(OR=2.42,95%CI=1.15-5.10,P=0.021),GCC可能减低发病风险(OR=0.43,95%CI=0.19-0.98,P=0.045).[结论]中国汉族人群中,IL-16基因的rs11556218、rs4072111、rs4778889位点的多态性可能与膝OA易感性相关.     

汉族人群白介素17受体C基因单核苷酸多态性与青少年特发性脊柱侧凸的相关性

【摘要】　目的：探讨白介素17受体C（IL-17RC）基因单核苷酸多态性与中国汉族人群青少年特发性脊柱侧凸（adolescent idiopathic scoliosis,AIS）易感性之间的相关性。方法：收集529例AIS女性患者及512例正常同龄女性青少年的静脉血标本,采用聚合酶链反应－限制性片段长度多态性（PCR-RFLP）方法鉴定和统计两组人群IL-17RC基因rs708567和rs279545多态性位点的基因型及等位基因分布频率;比较两组间不同多态性位点各基因型及等位基因分布频率的差异。结果：研究Power值（81%）大于80%,AIS患者组及正常对照组各多态性位点的基因型分布均符合Hardy-Weinberg遗传平衡定律。AIS组rs708567多态性位点GG基因型和G等位基因的分布频率显著高于对照组GG基因型（90.17% vs. 85.55%,P=0.023）和G等位基因（95.1% vs. 92.8%,P=0.028）的分布频率;携带GG基因型青少年中AIS的发病率约为携带AG基因型青少年的1.5倍（OR值=1.55;95% CI:1.45~3.11）。rs279545多态性位点各基因型及等位基因的分布频率在两组间均无统计学差异。结论：中国汉族人群中IL-17RC基因单核苷酸多态性与AIS的发生相关。     

hsCRP基因突变与新疆农村维吾尔族慢性肾脏病的相关研究

目的:探讨慢性肾脏病非透析患者hs CRP基因启动子区域rs2808630、rs1205、rs2794520、rs1800947、rs1417938位点单核苷酸多态性的分布频率,进而探讨该基因多态性位点与新疆农村维吾尔族慢性肾脏病患病的关系。方法:87例慢性肾脏病非透析患者及298例健康者均测定血浆hs CRP,并应用SNa Pshot方法测定rs2808630、rs1205、rs2794520、rs1800947、rs1417938位点的基因型,并用等位基因特异性杂交分析法对hs CRP多态性位点进行分析。结果:hs CRP基因rs2794520位点基因型CT在CKD组出现的几率大于健康对照组(P0.05),基因型TT在CKD组中出现的几率小于健康对照组(P0.05);等位基因C和T CKD组与健康对照组差异有统计学意义(P0.05)。rs1205位点基因型CT在CKD组出现的几率大于健康对照组(P0.05),基因型TT在CKD组中出现的几率小于健康对照组(P0.05);等位基因C和T CKD组与健康对照组差异有统计学意义(P0.05),另rs1800947、rs2808630、rs1417938位点所检测出的基因型在慢性肾脏病患者组与健康对照组差异无统计学意义。单体型T-T-C-T-T在CKD组的频率小于健康对照组(P=0.02,OR=0.668,95%CI=0.470~0.949)。结论:hs CRP基因rs2808630、rs1205可能与新疆农村维吾尔族CKD患病易感性有关,单体型T-T-C-T-T有可能是新疆农村维吾尔族CKD患病的一个保护因素。     

白介素-1β基因多态性与晚期膝骨关节炎易感性的关联性研究

目的探讨IL-1β基因的单核苷酸多态性和单体型与中国汉族人晚期膝骨关节炎（KOA）的易感性相关。方法采用病例对照研究,纳入120例中国汉族膝OA患者和130例年龄、性别匹配的健康对照者,用酶联免疫吸附测定法（ELISA）测定血清中IL-1β的水平,用聚合酶链反应和限制性片段长度多态性（PCR—RFLP）方法对IL-1β基因的-511C／T（rs16944）、＋3954C／T（rs114363）和-31C／T（rs1143627）位点进行单核苷酸多态性进行分析,并测序验证酶切结果。结果膝骨性关节炎患者组血清中白细胞介素1β水平明显高于健康对照组（t=-8．26,P〈0．01）,单核苷酸多态性分析显示：在膝OA患者组和健康对照组之间IL-1β-31C／T位点基因型分布和等位基因频率没有明显差异,该研究中没有发现IL-1β＋3954Tr基因型。膝OA患中的IL-1β-511TC、IL-1β＋3954CT基因型频率较健康对照组增加（P〈0．05,P〈0．05）,通过Logistic回归分析,IL-1β-511TC、IL-1β＋3954CT基因型与膝OA高风险发病率具有相关性（IL-1β-511TC,OR=1．842,95％CI=1．021—3．327,P〈0．05;IL-1β＋3954CT,OR=2．372,95％CI=1．022—5．509,P〈0．05）。此外,单体型分析显示与单体型TCC相比,单体型TCT和CCC与膝OA高风险发病率具有更强的相关性（TCT．OR=3．24,95％CI：1．50—7．00,P〈0．01;CCC．OR=6．07,95％CI：2．20—16．07,P〈0．01）。结论白细胞介素-1β基因的-511C／T（rs16944）和＋3954C／T（rs114363）位点多态性与中国汉族人膝OA的易感性相关。     

胰岛素降解酶基因单核苷酸多态性与前列腺癌的关系研究

目的研究胰岛素降解酶(IDE)基因单核苷酸多态性与前列腺癌之间的关系。方法运用TaqMan探针SNP分析法测定192例胰腺癌患者和258例正常对照IDE基因rs4646953和rs2251101两个位点基因型,并分析IDE基因多态性与前列腺癌的关系。结果病例组IDE基因rs4646953位点TT、CT以及CC3种基因型等位基因频率分别为85.4%、14.1%和0.5%;对照组3种基因型等位基因频率分别为88.4%、10.1%和1.6%。病例组rs2251101位点TT、CT以及CC3种基因型频率分别为81.8%、16.7%和1.6%;对照组3种基因型等位基因频率分别为73.6%、23.3%和3.1%。病例组IDE基因rs4646953位点的基因型分布与正常对照组比较未见统计学差异(P=0.348),rs2251101位点病例组CT和CC基因型低于正常对照组(P=0.039)。结论 IDE基因rs2251101位点变异与前列腺癌相关。     

CIGALTl基因多态性与维吾尔族IgA肾病易感性的关联性分析

目的探讨β1,3-转移酶（C1GALTl）基因单核苷酸位点（SNP）rs9639031、rs5882115多态性与新疆维吾尔族IgA肾病（IgA ephropathy,IgAN）遗传易感性的关系。方法选取经肾活检明确诊断为IgAN的90例维吾尔族患者为实验组,以同期在同一医院体检的90例维吾尔族健康体检者作为对照组,2组的性别和年龄等相匹配。采集纳入研究对象的外周血,提取DNA,应用PCR法扩增C1GALT1因上2个SNP分别为rs9639031、rs5882115位点对应的基因片段;采用直接测序法检测2个SNP位点的基因型,分析rs9639031、rs5882115基因型及基因频率在2组间分布的差异,进一步分析C1GAT态性与IgAN发病的关系。结果（1）C1GALT1因SNPrs5882115中各基因型、等位基因频率在IgAN组与对照组的分布有显著性差异（基因型P=0．014,等位基因P=0．005）。IgAN组DI、Ⅱ型频率（32．2％、2．2％）较对照组（14．4％、1．1％）高,对照组DE）型频率（84．4％）较IgAN组（65．6％）高。单因素Logist回归分析显示,rs5882115多态性对IgAN患病风险可能有影响（P=0．005）,携带DI基因型的患病风险为携带DD基因型的2．874倍（OR=2．874,95％CI=1．3756．007）,而携带I等位基因的患病风险亦较携带D等位基因高（OR=2．469,95％CI=1．290～４.728）。（2）C1GALT1基因rs9639031中,IgAN组CC、CT、TT基因型及c、T等位基因频率分别为40．0％、42．2％、17．8％、61．1％、38．9％,对照组分别为32．2％、46．7oA、21．1％、55．6％、44．4％,但差异无统计学意义（P〉0．05）。结论C1GALTl基因上的SNP位点rs5882115多态性可能与维吾尔族IgAN发病风险有一定关系,但未发现C1GALT1基因上的SNP位点rs9639031多态性与维吾尔族IgAN发病风险的关联性。     

SPO11基因单核苷酸多态性与陕西回族人群非梗阻性无精症相关性研究

目的探讨SPO11基因单核苷酸多态性在陕西回族非梗阻性无精症人群中的分布及其与无精症发病风险的关联。方法采用聚合酶链反应-限制性片段长度多态性（PCR-RFLP）方法,分析40例陕西回族非梗阻性无精症患者和45例陕西回族正常对照男性SPO11基因SNP位点（rs28368082）的基因分型和等位基因频率,以及其与非梗阻性无精症发病的相关性。结果 SPO11基因SNP位点（rs28368082）的CC,CT两种基因型频率在病例和对照组中分布存在显著性差异（P=0.048）,携带CT基因型的个体患非梗阻性无精症的风险是CC基因型的7.76倍（95%CI=0.89～66.58）。结论SPO11基因SNP位点（rs28368082）与陕西回族人群非梗阻性无精症发病风险存在关联,可能是陕西回族人群非梗阻性无精症的遗传易感基因之一。     

趋化因子受体6基因与陕西汉中地区类风湿关节炎汉族人群相关性

目的探讨趋化因子受体6基因单核苷酸多态性位点与中国陕西汉中地区类风湿关节炎汉族人群的相关性。 方法采用病例-对照研究方法,收集768例RA患者和960例正常对照DNA样本;用聚合酶链反应（PCR）法扩增目的条带,使用单碱基延伸法（SnapShot）对rs1331301、rs1556413、rs3093024、rs1854853和rs3093023位点基因分型,分析与RA的相关性。 结果CCR6基因5个标签SNP位点均符合哈迪温伯格平衡（HWE）,RA组和对照组基因型差异均无统计学意义（P > 0.05）。rs3093024位点A等位基因（OR = 1.22、P = 0.003）,显性模式（OR = 1.33、P = 0.0048）RA组与对照组差异具有统计学意义。rs1854853位点A等位基因（OR = 1.20、P = 0.0067）,显性模式（OR = 1.35、P = 0.0063）,RA组与对照组差异具有统计学意义。rs3093023位点T等位基因（OR = 1.26、P = 0.0009）,显性模式（OR = 1.38、P = 0.0015）,隐性模式（OR = 1.33、P = 0.025）,RA组与对照组差异有统计学意义。rs1331301和rs1556413两个SNP位点等位基因和显性、隐性模式,RA组与对照组差异均无统计学意义。 结论CCR6基因rs3093023、rs3093024和rs1854853三个单核苷酸多态性位点,可能是陕西汉中地区汉族人类风湿关节炎的易感基因位点。     

内皮型一氧化氮合酶Glu298Asp基因多态性与老年原发性高血压微量白蛋白尿的关系

目的研究内皮型一氧化氮合酶（eNOS）Glu298Asp基因多态性与老年原发性高血压（EH）微量白蛋白尿（MAU）的关系。方法从到医院就诊的老年EH患者中筛选出202例无显性蛋白尿的患者,行24h MAU测定,并应用基因芯片技术检测eNOS Glu298Asp基因多态性,按照24hMAU定量分为MAU组和非MAU组（NAU组）,比较两组基因型和等位基因分布差异。结果两组等位基因和基因型的分布不同,MAU组等位基因T及含等位基因T的基因型（GT＋TT）分布频率明显升高（χ^2=6.62,P〈0.01;χ^2=7.29,P〈0.01）;T等位基因变异使老年EH患者MAU的相对危险度显著增高（OR=2.361,95%CI=1.256～4.437）。结论 T等位基因是老年EH患者MAU的易感基因,携带T等位基因导致老年EH患者出现MAU的风险显著增高。     

IL-28B单核苷酸基因多态性与CHB干扰素疗效的相关性

目的：探讨IL-28B单核苷酸基因多态性与慢性乙型肝炎（CHB）干扰素疗效的相关性。方法选取300例HBeAg阳性CHB患者，给予聚乙二醇化干扰素α（Peg-INF-α）规范治疗48周后以PCR法对IL-28B SNP rs12979860及IL-28B SNP rs8099917基因分型进行检测。结果治疗后HBV DNA定量、ALT、AST水平明显较治疗前下降（P＜0.05），HBeAg转移率53.13%，随访1年后应答率49.44%；Peg-INF-α应答患者与非应答患者IL-28B SNP rs12979860基因型CC、CT、TT分布及等位基因C、T频率比较差异无统计学意义（P＞0.05），IL-28B SNP rs8099917基因型TT、TG分布及等位基因T、G频率比较差异具有统计学意义（P＜0.05）。结论 IL-28B SNP rs8099917可能对干扰素治疗的应答反应性形成影响，其中等位基因G的频率升高可能提示着干扰素的成功应答，因而检测IL-28B SNP rs8099917对干扰素治疗的CHB患者治疗疗效有一定预测价值。     

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.