人血管内皮细胞生长因子腺病毒表达系统的构建及体外表达

目的　构建人VEGF12 1腺病毒表达载体 ,探讨应用血管内皮细胞生长因子 (vascularendothelialgrowthfactor,VEGF)基因治疗骨科缺血性疾患的可行性。　方法　采用分子克隆技术 ,从pCDI/VEGF12 1质粒获得hVEGF12 1cDNA ,经穿梭质粒pShuttle克隆到腺病毒质粒上 ,构成Adeno VEGF12 1腺病毒重组质粒 ,经酶切及测序鉴定正确后 ,包装成为重组Adeno VEGF12 1腺病毒 ,并进行电镜观察及滴度测定。用病毒感染小鼠骨髓基质细胞 ,用逆转录PCR方法检测VEGF12 1基因在骨髓基质细胞中的转录 ,用免疫印迹及免疫组化方法检测VEGF蛋白的表达。　结果　经酶切鉴定及基因测序证实重组腺病毒质粒构建成功 ,电镜显示包装细胞中有病毒存在 ,包装的病毒滴度为 8× 10 10 pfu/ml,RT PCR证实有VEGF12 1mRNA的转录 ,免疫印迹及免疫组化检测有VEGF12 1蛋白的表达 ,而对照未见VEGF12 1转录和表达。　结论　构建的VEGF12 1腺病毒表达载体可在体外表达 ,VEGF基因治疗有可能用于骨科缺血性疾患     

共表达腺病毒载体构建鉴定及其转染骨髓间充质干细胞观察

目的：构建并鉴定绿色荧光蛋白标记的人骨形态发生蛋白（bone morphogenetic protein,BMP）2和血管内皮生长因子（vascular endotheliel growth factor,VEGF）165双基因共表达的重组腺病毒,为研究该双基因对骨髓间充质干细胞成骨方向诱导和体内骨缺损修复作用奠定基础。方法：从cDNA文库中PCR扩增BMP2和VEGF165目的基因,并将其插入腺病毒穿梭质粒pAd-MCMV-GFP的多克隆位点,将构建的重组穿梭质粒pAd-MCMV-BMP2-VEGF165和腺病毒辅助质粒pBHGloxΔE1,3Cre共转染细胞HEK293细胞内,经历腺病毒基因重组及出毒后收集细胞,多次冻融离心获取病毒溶液（Ad-BMP2-VEGF165）。进一步纯化并测定病毒滴度,随后通过转染兔骨髓间充质干细胞并检测BMP2和VEGF165双目的基因表达和倒置荧光显微镜下观察绿色荧光蛋白表达。结果：基因测序、菌落PCR、Western blotting、Real-time PCR、绿色荧光蛋白表达均表明载体Ad-BMP2-VEGF165构建成功,可稳定转染骨髓间充质干细胞内并稳定表达,经测定腺病毒载体滴度达到1×10¹⁰ PFU/ml。结论：携带人BMP2和VEGF165双基因共表达重组腺病毒载体构建成功,并能获得高滴度的病毒感染液。     

携带人VEGF_(165)和ANG-1双基因的腺病毒载体的构建及目的基因的表达

[目的]构建并鉴定携带人血管内皮细胞生长因子165(VEGF165)和血管生成素-1(ANG-1)双基因共表达重组腺病毒载体pAd-VIA。[方法]采用基因克隆技术克隆目的基因VEGF165、ANG-1基因,将得到的基因通过引入内部核糖体进入位点序列(IRES),亚克隆至含有报告基因EGFP的穿梭载体pTrack-CMV中,构建携带双基因的腺病毒穿梭载体pTrack-CMV-VIA。进而使用AdEasyTM腺病毒系统重组并包装腺病毒。通过绿色荧光蛋白(GFP)表达、酶联免疫吸附分析(ELISA)方法检测制备的腺病毒pAd-VIA感染的大鼠骨髓基质干细胞中外源基因VEGF165及Ang-1的表达。[结果]该重组腺病毒质粒经测序、酶切鉴定,证明基因序列正确。转染QBI-293A细胞后,可观察到GFP明显表达。重组合腺病毒载体pAd-VIA获得成功包装,扩增后病毒滴度为2×1010PFU/ml,大鼠骨髓基质干细胞转染48 h后,绿色荧光蛋白表达阳性,ELISA结果显示转染组在感染48 h后,培养细胞上清中的VEGF165浓度为(42.5±2.082)ng/105细胞,ANG-1浓度为(16.67±2.08)ng/105细胞,未转染组几乎未检测到外源基因的表达,有统计学差异(P0.05)。[结论]成功构建携带人VEGF165、ANG-1双基因共表达重组腺病毒载体,为组织工程人工骨血管化的研究奠定基础。     

LMP-1基因慢病毒载体构建及其在大鼠骨髓间充质干细胞的表达

目的：构建人LMP-1重组慢病毒载体,体外转染大鼠骨髓间充质干细胞,检测LMP-1基因在大鼠骨髓间充质干细胞的表达。方法：利用PCR法从cDNA文库中钓取LMP-1基因,将其与经AgeI酶切线性化的慢病毒载体pGC-FU-EGFP相连接,转化感受态大肠杆菌,筛选出阳性克隆pGC-FU-LMP-1-EGFP,基因测序对其鉴定。经293T细胞包装后,收集富舍病毒颗粒LV-LMP-1-EGFP的细胞上清,浓缩并标定滴度,RT-PCR检测并鉴定。以最佳MOI值体外转染大鼠骨髓间充质干细胞,荧光显微镜观察转染是否成功,流式细胞仪检测转染效率,RT-PCR和Westernblot检测转染细胞LMP-1基因的表达。结果：①基因测序及RT-PCR检测证实携带人LMP-1基因的慢病毒载体构建成功,包装后获得滴度为2×10^8 TU／ml的LV-LMP-1-EGFP。②以MOI=100转染大鼠骨髓间充质干细胞,荧光显微镜下可见大量绿色荧光蛋白表达,转染效率可达93．5％,经RT-PCR与Westernblot检测,被转染细胞内有LMP-1基因表达。结论：成功构建携带人LMP-1基因的慢病毒载体,可高效转染大鼠骨髓间充质干细胞,被转染细胞可高效表达LMP-1基因。     

ANG-1基因重组腺病毒载体的构建及其转染骨髓问充质干细胞的实验研究

目的构建携带大鼠血管生成素．1（angiopoietin-1,ANG．1）基因的重组腺病毒载体,并检测其转染对大鼠骨髓间充质干细胞（bone marrow mesenchymal stemcells,BMSCs）活力的影响。方法RT-PCR法获取大鼠ANG-1基因并亚克隆至穿梭质粒pAdTrack-CMV,经测序无误后与骨架质粒pAdEasy-1在BJ5183中同源重组。重组质粒pAdEasy-1-ANG-1经鉴定后转染293细胞进行病毒包装扩增。体外转染BMSCs,检测转染后BMSCs中ANG-1的表达。MTT法评估常氧及缺氧环境下ANG-1对BMSCs的影响。结果重组腺病毒载体pAdEasy-1-ANG-1经测序及酶切鉴定正确;BMSCs经转染ANG-1基因后表达ANG-1。MTT法检测提示常氧及缺氧条件下转染前后BMSCs活性的差异均无统计学意义（缺氧组与缺氧下转染组相比,P〉0-05;常氧组与常氧下转染组相比,P〉0-05）。结论成功构建大鼠ANG-1基因重组腺病毒载体,且其转染在体外不影响BMSCs的活性。     

人骨形成蛋白7基因重组2型腺相关病毒载体的构建及其在骨髓间充质干细胞中的表达

目的构建人骨形成蛋白7基因（hBMP7）重组腺相关病毒载体,并观察其在兔骨髓间充质干细胞中的表达。方法将骨形成蛋白7基因片段克隆入穿梭质粒pUC18获得重组质粒pUC18-hBMP7。KpnⅠ和鼠Ⅱ双酶切质粒pUC18-hBMP7／与pSNAV,用T4DNA连接酶连接分别回收的两片段后转化大肠杆菌DH5α感受态细胞,获得重组质粒PSNAV—hBMP7／,转染BHK-21细胞,筛选培养,用能表达Rap和Cap的重组Ⅰ型单纯疱疹病毒HSVl-rc／△UL2感染此细胞,裂解细胞收获病毒液。采用氯仿处理-PEG／NaCl沉淀-氯仿抽提法分离浓缩、纯化与测定病毒滴度。用rAAV2-hBMP7／和rAAV2-EGFP在体外分别转染兔骨髓间充质干细胞。流式细胞仪、RT-PCR和Western—blot方法检测兔骨髓间充质干细胞中hBMP-7基因的转录和表达。结果成功构建具有感染活性的重组腺相关病毒载体rAAV2-hBMP7／,病毒载体对兔骨髓间充质干细胞早期转染效率可达99．8％,hBMP7／在兔骨髓间充质干细胞中可得到转录和表达。结论成功构建了人骨形成蛋白7基因重组腺相关病毒载体,rAAV2-hBMP7／载体在体外可转染兔骨髓间充质干细胞,并获得较高的转染效率。     

应用AdEasy腺病毒载体系统构建血管内皮生长因子165重组腺病毒

目的利用AdEasy腺病毒载体系统构建血管内皮生长因子165（VEGF165）重组腺病毒，并在293T细胞中扩增。方法将PCR获取的VEGF165基因酶切并插入到pAdTrack-CMV中，构建成腺病毒穿梭质粒pAdTrack-VEGF165，经PmeI酶切线性化后，采用电穿孔转化到事先电转化腺病毒骨架质粒pAdEasy-1的BJ5183大肠杆菌感受态细胞中，挑选同源重组菌落。提取质粒并用Pac I酶切鉴定，线性化重组质粒pAdEasy-VEGF165转染293T细胞，包装成重组腺病毒颗粒，荧光显微镜下观察绿色荧光表达，并扩增收集重组腺病毒，测定病毒滴度。结果经限制性内切酶检测、基因测序及和绿色荧光观察证实成功构建了携带VEGF165基因的重组腺病毒，并扩增出10^9pfu／mL的高滴度重组腺病毒。结论成功构建了携带VEGF165基因的重组腺病毒载体，为研究骨组织工程血管化局部基因治疗奠定了基础。     

大鼠VEGF腺病毒基因转染系统的构建及鉴定

目的:探讨构建携带大鼠血管内皮细胞生长因子(VEGF)的重组腺病毒载体方法，为后续的基因转染研究作准备。方法:采用RT-PCR扩增的方法获取鼠源性的VEGF,并克隆入穿梭质粒pDC316。构建的质粒pDC316-VEGF经酶切及测序鉴定正确后，通过lipofectamine2000的介导与腺病毒包装质粒pBHGE3共转染至人胚肾细胞HEK293，经同源重组后获得携带鼠VEGF的重组腺病毒VDC316-VEGF。应用PCR鉴定重组腺病毒，空斑传代纯化病毒并反复冻融扩增病毒。以50%组织培养感染剂量法(TCID50)测定病毒滴度。结果:PCR鉴定证实重组腺病毒含有鼠VEGF,病毒滴度为3×109pfu/mL。结论:成功构建的携带大鼠VEGF的重组腺病毒载体能在HEK293细胞内扩增获得足够高的病毒滴度,可作为后续基因治疗研究工作中可靠的基因转染工具。     

骨形成蛋白7重组腺病毒的构建及转染骨髓间充质干细胞的研究

目的 构建骨形成蛋白(BMP)7重组腺病毒，使其转染骨髓间充质干细胞并在细胞内得到表达。方法 将BMP7基因克隆到转移载体pAdTrack—CMV中，在细菌BJ5183中与pAdEasy腺病毒基因组进行同源重组，得到BMP7重组腺病毒基因组，通过转染HEK293细胞包装出重组腺病毒。利用BMP7重组腺病毒转染分离纯化后的骨髓间充质干细胞，鉴定BMP7在细胞内的表达。结果 经过多聚酶链反应(PCR)及酶切鉴定证明获得了BMP7转移质粒padTrack—BMP7和BMP7重组腺病毒基因组，并包装出重组腺病毒。逆转录PCR和免疫组织化学证明BMP7在重组腺病毒转染后的骨髓间充质干细胞中得到了表达。结论 BMP7重组腺病毒的构建和在骨髓间充质干细胞中的表达，为BMP7基因治疗的研究奠定了基础。     

大鼠PnNOS基因修饰脂肪源性干细胞的构建

目的 构建过表达大鼠阴茎神经源性一氧化氮合酶（PnNOS）基因大鼠脂肪源性干细胞（ADSCs）,为基因修饰ADSCs移植治疗勃起功能障碍（ED）大鼠模型提供种子细胞.方法 获取大鼠PnNOS基因,并与线性化的腺病毒真核表达载体pDC315-EGFP定向克隆连接.构建正确的pDC315-PnNOS-EGFP穿梭质粒转染293 T细胞,采用Western Blot检测PnNOS基因在293 T细胞中的表达情况.利用AdMax腺病毒包装系统包装产生重组腺病毒,包装后扩增纯化并测定病毒滴度.PnNOS基因重组腺病毒转染大鼠ADSCs,观察GFP表达情况和Western Blot检测PnNOS基因表达情况.结果 经PCR鉴定、限制性酶切分析、测序鉴定和目的质粒Western Blot表达检测鉴定,证实pDC315-PnNOS-EGFP重组腺病毒载体构建成功.重组腺病毒包装成功且病毒滴度为5.0×109 PFU/ml.Western Blot于大鼠ADSCs中检测到约161 KDa大小条带,其与PnNOS蛋白分子量大小基本相一致.结论 大鼠PnNOS基因修饰的ADSCs构建成功,从而为基因修饰ADSCs移植治疗ED提供了良好的基因工程细胞.     

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.