体外化疗后残余肝癌细胞侵袭转移潜能变化及其机制

目的 探讨体外化疗后残余肝癌细胞侵袭转移潜能变化及其机制.方法 以2 mol/L奥沙利铂对人肝癌细胞株MHCC97L和HepG2进行体外冲击化疗,获得残癌细胞株MHCC97L-oxa和HepG2-oxa.对比研究残癌细胞株和母细胞株的侵袭、运动、增殖能力以及分子表型的差异.结果 与母细胞株比较,MHCC97L-oxa和HepG2-oxa细胞显示出显著增强的运动能力(19.17 ±2.64比29.50±5.28,P＜0.01和12.33±2.73比21.17±3.13,P＜0.01)和侵袭能力(增强0.89倍,P＜0.01和增强1.58倍,P＜0.01),而增殖能力则显著下降.MHCC97L-oxa和HepG2-oxa细胞在形态和分子表型上明显区别于MHCC97L和HepG2,呈现出间质细胞形态,伴E-钙粘蛋白(E-cadherin)表达显著下调,N-cadherin、波形蛋白(vimentin)以及转录因子Snail表达显著增强,细胞呈现上皮-间质转化.结论体外化疗后残余肝癌细胞发生上皮-间质转化,侵袭转移潜能增强.     

丙型肝炎病毒核心蛋白通过活化stat3通路促进肝癌细胞上皮间质转化的研究

目的探讨丙型肝炎病毒核心蛋白（HCVc）对肝癌细胞信号转导子和转录激活子3（stat3）通路及上皮间质转化（EMT）的影响。 方法将含HCVc基因序列的重组质粒pEGFP-N3-HCVc转染人肝癌细胞HepG2,Real-Time PCR和Western blotting检测HCVc、总stat3、磷酸化stat3（p-stat3）及EMT指标蛋白E-cadherin、Vimentin、Snail的表达,划痕实验及Transwell实验检测细胞迁移和侵袭情况。 结果划痕实验及Transwell实验结果显示,过表达HCVc可增强HepG2细胞的迁移和侵袭能力;stat3通路抑制剂AG490处理可抑制HepG2细胞的侵袭能力。RT-PCR和Western blotting结果显示,过表达HCVc后,HepG2细胞中p-stat3、Vimentin及Snail在表达升高,E-cadherin表达下降;AG490处理可下调p-stat3、Vimentin及Snail表达,增强E-cadherin表达。 结论HCVc可活化stat3通路促进肝癌细胞上皮间质转化,增强肝癌细胞的迁移和侵袭能力。     

奥曲肽上调Smad4表达抑制肝癌细胞生长

目的观察奥曲肽（octreotide，OCT）对Bel7402人肝癌细胞内Smad4调节及其对肝癌细胞的抑制作用。方法以MTr法测量OCT对Bel7402细胞增殖的影响，光镜下观察细胞形态的变化。以细胞迁移实验和粘附实验观察细胞侵袭和粘附能力的影响。以流式细胞仪检测细胞周期和Smad4蛋白的变化。以裸鼠人肝癌种植模型，观察OCT对种植瘤生长的影响，以免疫组化观察种植瘤内Smad4蛋白的表达。以半定量RT—PCR观察体内外Smad4mRNA的表达。结果OCT处理的Bel7402细胞增殖能力和细胞形态无明显改变，细胞的侵袭和粘附能力明显下降，细胞生长静止期（G0／G1）的比例显著增加（48．0％±3．2％vs57．7％±0．9％），OCT明显抑制裸鼠人肝癌种植瘤的生长，抑瘤率达到67．9％。体外OCT流式细胞仪检测治疗组种植瘤内Smad4蛋白（6．36±1．22）的表达显著高于对照组（3．22±1．20）。体内外Smad4 mRNA的表达，治疗组（0．701±0．035，1．091±0．131）也明显高于对照组（O．531±O．073，0．634±0．222）。结论OCT能显著抑制体内外肝癌细胞的生长，上调肝癌细胞内Smad4的表达可能是其抑瘤的重要机制。     

胸腺素β4基因沉默对膀胱移行细胞癌上皮间质转化的逆转作用

目的 观察胸腺素β4(Tβ4)基因沉默对膀胱癌细胞上皮间质转化(EMT)的逆转,探讨其在肿瘤侵袭转移中的作用机制.方法 使用针对Tβ4的慢病毒载体(knti-Tβ4)转染膀胱癌细胞株T24.采用定量逆转录-聚合酶链反应(RT-PCR)、Western blot法检测Tβ4、整合素连接激酶(ILK)和上皮性标记基因E-cadherin、β-catenin的表达改变;Immunofluorescence法检测ILK、E-cadherin、β-catenin在转染后124细胞中的表达改变;细胞划痕实验、Boyden小室体外侵袭实验、AO/EB荧光染色法反映细胞转移潜能和凋亡的变化.结果 转染后48 h的T24细胞,Tp4、ILK、β-catenin mRNA或蛋白表达开始下降,以转染后96 h明显;而上皮标记基因E-cadherin在转染96h后,表达显著增加(P<0.05);Immunofluorescence显示ILK和β-catenin在细胞质、细胞核中表达减弱,而E-cadherin在胞膜中表达增强,细胞形态向正常上皮细胞转化;转染后的324细胞体外迁移能力与侵袭力下降[(10.4±1.2)%比(73.5±1.4)%],细胞凋亡增多(12.3%比36.6%).结论 肿瘤细胞中的Tβ4表达下调可以逆转肿瘤细胞的间质表型,而向正常上皮表型转化,降低肿瘤转移潜能.     

miR-195-5p通过靶向ROCK1抑制肾癌细胞迁移、侵袭和上皮-间质转化

目的探讨miR-195-5p对肾癌细胞迁移、侵袭和上皮-间质转化的影响。方法通过转染miR-195-5p mimics或inhibitors分别过表达或抑制肾癌细胞中miR-195-5p的表达,转染靶向Rho相关螺旋蛋白激酶1(ROCK1)的小干扰RNA敲低肾癌细胞中ROCK1的表达量,利用细胞划痕实验和Transwell小室实验分别检测肾癌细胞的迁移和侵袭能力。通过双荧光素酶报告实验验证miR-195-5p对ROCK1的靶向调控作用,利用免疫印迹试验检测ROCK1及上皮-间质转化相关蛋白的表达水平。结果过表达miR-195-5p可显著抑制肾癌细胞的迁移、侵袭和上皮-间质转化,而抑制miR-195-5p的表达可明显促进肾癌细胞的迁移、侵袭和上皮-间质转化(P<0.05)。miR-195-5p可通过靶向ROCK1调控其在肾癌细胞中表达。敲低ROCK1后可部分抵消miR-195-5p inhibitors对肾癌细胞迁移、侵袭和上皮-间质转化的影响。结论miR-195-5p可通过靶向ROCK1抑制肾癌细胞的迁移、侵袭和上皮-间质转化。     

Smad4在TGF-β诱导人胆管癌细胞上皮-间质转化中的作用

目的 探讨Smad4在TGF-β诱导人胆管癌细胞上皮-间质转化(epithelial-mesenchymal transition,EMT)中的作用.方法 用转化生长因子β1(transforming growth factor-β1,TGF-β1)处理RBE人胆管癌细胞系24h后,观察其形态变化,采用Western Blotting检测TGF-β1处理0h、12h、24h、48h后RBE细胞N-钙黏蛋白(N-cadherin)和E-钙黏蛋白(E-cadherin)的表达.通过RNA干扰技术建立稳定干扰Smad4表达的细胞系,在无TGF-β1处理或TGF-β1处理24h后,观察Smad4干扰组与野生型组和空载体组细胞的形态差异,Western Blotting检测各组N-cadherin和E-cadherin的表达水平.结果 TGF-β1诱导RBE细胞的形态由上皮样向间质样转变,促进 N-cadherin表达增加和E-cadherin表达降低.在无TGF-β1处理时,Smad4干扰组细胞比野生型组和空载体组细胞的形态更趋于上皮样,E-cadherin表达水平也显著高于野生型组和空载体组(P＜0.05).在TGF-β1处理24h后,Smad4干扰组细胞形态的间质样变化程度、N-cadherin表达量明显低于野生型组和空载体组(P＜0.05);野生型组和空载体组细胞E-cadherin的表达缺失,而Smad4干扰组细胞仍表达较高水平的E-cadherin,两者间差异显著(P＜0.05).结论 TGF-β依赖Smad4介导人胆管癌细胞发生上皮-间质转化.     

转化生长因子-β1诱导肝星状细胞间质上皮转化研究

目的 检测转化生长因子(TGF)-β1对肝星状细胞(HSCs)间质上皮转化的作用。方法 用人重组TGF-β1及其中和抗体孵育原代人肝星状细胞48 h,以Western blot检测肝星状细胞间质标记Vimentin、desmin和上皮标记CK18及白蛋白(Albumin)的表达,并分析其迁移能力和形态变化。结果 TGF-β1可显著下调肝星状细胞表达Vimentin和desmin,而使其表达CK18及Albumin,同时其迁移能力显著下降(3083±629,P＜0.05),细胞形态由星芒状向铺路石样转化。在同时接受TGF-β1中和抗体孵育的肝星状细胞中,上述标记表达,迁移力(9250±1146,P＞0.05)和形态变化不明显。结论 TGF-β1可显著诱导肝星状细胞向肝上皮细胞转化,提示其可能是肝细胞重要再生来源之一。     

低氧对肝癌细胞上皮间质转化及侵袭转移能力的影响

目的:观察低氧环境下肝癌细胞上皮-间质转化(EMT)情况和侵袭转移能力的改变。方法:选取2种具有不同侵袭转移能力的人肝癌细胞株SMMC-7721和HepG2,通过1%O2低氧培养建立人肝癌细胞物理缺氧模型。动态观察2种细胞在低氧环境中的形态学改变;应用Westernblot方法检测上皮细胞标志蛋白E-cadherin和间质细胞标志蛋白vimentin表达的变化;应用Transwell小室检测肝癌细胞迁移、侵袭能力。结果:低氧环境中,该2种肝癌细胞均由原来的紧密排列上午上皮样状态转为较松散的纺锤体样改变;Western blot检测显示,2种肝癌细胞株的E-cadherin表达量明显下降(均P<0.01),而vimentin表达量明显升高(均P<0.01);Transwell迁移及侵袭实验显示,2种肝癌细胞的迁移及侵袭能力明显增强(均P<0.01);SMMC-7721细胞的上述变化均较HepG2细胞明显(均P<0.01)。结论:低氧环境可诱导肝癌细胞发生EMT,并增强肝癌细胞的迁移和侵袭能力。     

微小RNA-101通过USP22抑制人肝癌MHCC97H细胞的上皮-间质转化功能

目的研究微小核糖核酸(miR)-101对人肝细胞癌(肝癌)MHCC97H细胞的上皮-间质转化功能的影响及其相关机制。方法 MHCC97H肝癌细胞株分别转染miR-101 mimics和negative control mimic,分别作为M101组、NCM组,并设立未转染对照(control)组,采用逆转录聚合酶链反应(RT-PCR)法检测各组细胞miR-101含量。Transwell实验检测3组细胞迁移能力和侵袭能力。Western-blot法检测3组细胞vimentin、α-catenin、E-cadherin和USP22表达水平。双荧光素酶实验检测miR-101与USP22的关系。结果 M101组miR-101的表达水平明显上调,表达水平约为control组的761倍(P0.05)。M101组迁移细胞数量明显低于control组的[(15.7±1.6)个比(94.1±1.8)个,P0.05]。M101组侵袭细胞数量明显低于control组的[(9.1±0.4)个比(51.6±0.9)个,P0.05]。M101组细胞vimentin蛋白表达量明显降低,α-catenin及E-cadherin蛋白表达量明显升高,USP22蛋白表达量明显降低。双荧光素酶检验结果显示USP22为miR-101的下游靶基因。结论 miR-101可能通过降低下游靶基因USP22水平影响EMT相关蛋白表达,抑制MHCC97H肝癌细胞的上皮-间质转化功能。     

MicroRNA在胃癌上皮-间质转化中的研究进展

上皮-间质转化不仅参与正常胚胎发育过程中器官和组织的生成,而且也有助于提高癌细胞的侵袭及转移.当上皮-间质转化受到刺激时,细胞和细胞之间黏附及极性由于黏附分子如E-钙黏蛋的消失而被打乱,导致细胞之间的相互作用发生改变,导致细胞发生间充质表型的改变,最终激活癌细胞的迁移和侵袭.研究证明部分转录因子、生长因子以及相关信号通路参与上皮-间质转化过程,而miRNA可通过调控癌基因或抑癌基因参与胃癌细胞的增殖、凋亡、侵袭及转移过程,其中也涉及上皮-间质转化的调控.本文就近年来miRNA在胃癌EMT过程中的具体调控机制予以综述.     

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.