miR-124-3p经Wnt通路因子Axin1调控骨髓间充质干细胞的研究

目的 探讨miR-124-3p经Wnt通路因子A(Axin1)对骨髓间充质干细胞（BMSCs）的分子靶向机制及调节BMSCs的成骨分化进而参与绝经后骨质疏松（PMOP）的形成。方法 收集20例股骨骨折需要手术并扩髓或暴露髓腔的患者,10例绝经后骨质疏松妇女（PMOP组）和10例非骨质疏松的绝经后妇女（对照组）,术中取骨髓组织3~5 mL,建立体外BMSCs细胞模型,用流式细胞仪检测BMSCs标志物,将BMSCs诱导分化为成骨细胞,RT-qPCR法检测miR-124-3p的表达。双荧光素酶报告基因系统检测miR-124-3p结合位点A-Axin1。构建miR-124-3p过表达载体,miR-124-3p过表达转染PMOP-BMSCs同时更换成骨诱导培养基进行成骨诱导培养。诱导第7、14、21 天 分别收集细胞进行检测碱性磷酸酯酶染色（ALP）和茜素红染色。成骨诱导第7天,RT-qPCR检测各组BMSCs中Runx2、Osterix靶因子Axin1的表达。Western Blotting检测miR-124-3p转染BMSCs后的表达与Axin1关系。结果 ①RT-qPCR法检测miR-124-3p的表达,PMOP组低于对照组。②miR-124-3p过表达转染、成骨诱导,随着诱导时间的延长,细胞培养液中ALP水平逐渐上升,茜素红染色可见结节沉积逐增加。③RT-qPCR检测成骨诱导第7天,Runx2和Osterix的表达,BMSC+成骨分化液组明显高于BMSC组,BMSC+过表达miR-124-3p组较其对照组明显上升;Axin1的表达,BMSC+成骨分化液组明显低于BMSC组,BMSC+过表达miR-124-3p组较其对照组显降低。④荧光素酶报告基因实验证明了miR-124-3p与Axin1的可结合性。⑤Western Blotting检测BMSCs,miR-124-3p过表达组Axin1表达显著下降,而miR-124-3p抑制组Axin1表达显著升高。结论 miR-124-3p可通过Wnt通路靶点Axin1调节BMSCs的成骨分化进而参与PMOP的形成。     

miR-21对骨质疏松小鼠骨髓基质细胞增殖的影响

目的探讨miR-21对骨质疏松小鼠骨髓基质细胞(BMSCs)增殖的影响。方法采用双侧卵巢切除法构建骨质疏松小鼠模型(VOX),分离、培养、纯化小鼠BMSCs并采用si PORT Neo FX转染pre-miR-21、pre-miR-negative control(pre-miR-NC)、antmiR-21、ant-miR-negative control(ant-miR-NC)并进行RT-PCR验证,MTT法检测小鼠BMSCs增殖情况、茜素红与碱性磷酸酶染色法检测小鼠BMSCs成骨能力、Western-blotting检测细胞增殖、成骨分化相关蛋白水平。结果骨质疏松症小鼠BMSCs中miR-21相对表达水平低于Ctrl组(P0.05),OVX-pre-miR-21组BMSCs中miR-21相对表达水平、细胞增殖、PCNA水平、Ki-67水平、ALP染色程度、ALP活性、茜素红染色程度、Runx2水平、Osterix水平均高于OVX-pre-miR-NC组(P0.05),OVX-premiR-NC组BMSCs中miR-21相对表达水平、细胞增殖、PCNA水平、Ki-67水平、ALP染色程度、ALP活性、茜素红染色程度、Runx2水平、Osterix水平均显著低于Ctrl-pre-miR-NC(P0.05); OVX-ant-miR-21组BMSCs中miR-21相对表达水平、细胞增殖、PCNA水平、Ki-67水平、ALP染色程度、ALP活性、茜素红染色程度、Runx2水平、Osterix水平均显著低于OVX-ant-miR-NC组(P0.05),OVX-ant-miR-NC组BMSCs中miR-21相对表达水平、细胞增殖、PCNA水平、Ki-67水平、ALP染色程度、ALP活性、茜素红染色程度、Runx2水平、Osterix水平均显著低于Ctrl-ant-miR-NC(P0.05)。结论提高miR-21表达水平可促进骨质疏松小鼠BMSCs增殖能力与成骨分化能力。     

LncRNA MEG3调控miR-133a-3p/TGF-β1/Smads轴促进骨髓间充质干细胞成骨分化的作用机制

目的 探究LncRNA MEG3调控miR-133a-3p/TGF-β1/Smads信号轴对人骨髓间充质干细胞(human bone marrow mesenchymal stem cell, hBMSC)成骨分化中的影响。方法 通过构建慢病毒载体及慢病毒包装,将含有目的基因的慢病毒感染细胞。将hBMSC分为Control组、NC组、MEG3、sh-MEG3、MEG3+miR-133a-3p sponge及MEG3+miR-133a-3p组,成骨诱导后,采用碱性磷酸酶(alkaline phosphatase, ALP)染色和茜素红染色检测ALP活性及钙盐沉积,qRT-PCR检测各组细胞中MEG3、miR-133a-3p、TGF-β1、TGF-βR1、smad2、smad3、smad4、Runx2及OPN mRNA表达水平,Western blot检测TGF-β1、TGF-βR1、smad2、smad3、smad4、Runx2及OPN蛋白表达量。结果 与NC组比较,MEG3组的ALP活性及茜素红钙盐沉积明显减弱,MEG3 mRNA上调,miR-133a-3p mRNA表达显著升高,TG...     

miR-187-5p 对骨髓间充质干细胞成骨分化能力的调控作用

目的利用小鼠骨髓间充质干细胞(BMSCs)的成骨分化模型,探讨miR-187-5p在成骨分化中的表达趋势及调控作用。方法通过切除雌性小鼠双侧卵巢构建小鼠骨质疏松模型;应用qRT-PCR技术检测组织和细胞中miR-187-5p的表达;应用基因转染技术观察过表达或敲减miR-187-5p对BMSCs向成骨分化的影响;应用茜素红和碱性磷酸酶染色检测BMSCs中矿化结节的数量和矿化区域的染色面积。结果 qRT-PCR结果显示miR-187-5p在骨质疏松模型小鼠的骨组织及BMSCs中均表达下降。过表达miR-187-5p可提高ALP、Collagen-1、Runx2、BMP4、OCN和OPN等成骨分化相关基因mRNA的表达,促进BMSCs向成骨分化;而敲减miR-187-5p降低ALP等成骨分化相关基因mRNA的表达,抑制BMSCs向成骨分化。在体实验同样证实,过表达miR-187-5p可以显著促进骨质疏松小鼠BMSCs向成骨分化,改善小鼠的骨质疏松表型。结论过表达miR-187-5p促进BMSCs向成骨分化,敲减miR-187-5p抑制BMSCs向成骨分化。     

LncRNA DANCR靶向调控对绝经后骨质疏松BMSCs成骨分化的作用

目的 研究长链非编码RNA（lncRNA）分化非蛋白编码 RNA（DANCR）靶向微小RNA（miR）-19a-3p对绝经后骨质疏松（PMOP）骨髓间充质干细胞（BMSCs）成骨分化的调控作用。方法 选择健康女性志愿者4例和PMOP患者4例，分离培养BMSCs；PMOP患者BMSCs进行分组，转染阴性对照（NC）siRNA、lncRNA DANCR siRNA、miR-NC抑制物、miR-19a-3p抑制物。检测lncRNA DANCR、miR-19a-3p、PTEN的表达水平，成骨诱导分化后检测茜素红染色的OD405水平、碱性磷酸酶（ALP）活力、骨钙素（OCN）及骨桥蛋白（OPN）的mRNA表达水平。结果 PMOP患者BMSCs中lncRNA DANCR、PTEN的表达水平高于健康女性，miR-19a-3p的表达水平及成骨诱导后的OD405水平、ALP活力、OCN及OPN的表达水平均低于健康女性。在PMOP患者BMSCs中，si-DANCR组的lncRNA DANCR、PTEN的表达水平低于si-NC组，成骨诱导后的OD405水平、ALP活力及miR-19a-3p、OCN、OPN的表达水平高于si-NC组；si-DANCR+miR-19a-3p抑制物组成骨诱导后的OD405水平、ALP活力及miR-19a-3p、OCN、OPN的表达水平低于si-DANCR+miR-NC抑制物组，PTEN的表达水平高于si-DANCR+miR-NC抑制物组。结论 LncRNA DANCR靶向miR-19a-3p调控PMOP患者BMSCs的成骨分化。     

miR-381-3p通过靶向ERK1/2/ETS1信号通路影响MC3T3-E1细胞成骨分化

目的 探讨miR-381-3p对MC3T3-E1细胞成骨分化的影响和作用机制。方法 慢病毒转染细胞后实验分为NC mimic miR-381-3p组、mimic miR-381-3p组、NC inhibitor miR-381-3p组和inhibitor miR-381-3p组;运用实时荧光定量PCR(qR T-PCR)法检测不同组miR-381-3p的表达水平以验证转染效率;诱导MC3T3-E1细胞成骨分化后,检测各组细胞中碱性磷酸酶(ALP)活性水平;茜素红染色法检测各组细胞的成骨矿化能力; qR T-PCR测定各组细胞中ALP、Runx2、PPARγ和ETS1 mR NA表达水平;蛋白免疫印迹法测定各组细胞中collagenⅠ、ALP、Runx2、PPARγ、ETS1、P-ERK1/2水平;并用MAPK/ERK通路抑制剂(PD98059)干预各组细胞后进行目的蛋白检测。结果 与NC mimic miR-381-3p组、mimic miR-381-3p组及NC inhibitor miR-381-3p组比较,inhibitor miR-381-3p组中细胞中ALP、Runx2、ET...     

核因子-κB信号通路在股骨头坏死发病机制中的作用

目的观察核因子-κB(NF-κB)信号通路在股骨头坏死(ONFH)发病中的作用及其分子机制。方法髋关节置换术中对股骨头坏死患者的骨髓(实验组)和非股骨头坏死患者的骨髓(对照组)进行采样, 利用密度梯度离心法分离提取实验组和对照组的骨髓间充质干细胞(BMSCs), 并进行纯化和培养。应用实时荧光定量聚合酶链反应(RT-PCR)检测BMSCs成骨分化关键因子Runx2表达情况。采用蛋白质印迹法(Western blot)检测实验组和对照组BMSCs中NF-κB信号通路p65蛋白磷酸化水平及Runx2的表达差异。采用噻唑蓝法(MTT)和半胱氨酰天冬氨酸特异性蛋白酶(Caspase)-3/7活性细胞凋亡检测法分别检测实验组和对照组BMSCs的增殖活性及凋亡情况。对实验组和对照组的BMSCs进行成骨诱导后, 进行茜素红染色, 检测BMSCs成骨分化水平的差异。通过雷公藤甲素(Triptolide)抑制经脂多糖(LPS)预处理的实验组BMSCs, 观察磷酸化p65及Runx2的表达水平, 同时, 应用茜素红染色, 验证抑制磷酸化p65对NF-κB信号通路对成骨分化的作用。采取单因素方差分析和t检验...     

健骨颗粒含药血清调控miR-141对小鼠骨髓间充质干细胞成骨分化的影响

目的观察健骨颗粒含药血清对去卵巢模型小鼠BMSCs成骨分化的影响,并研究其调控miR-141影响BMSCs分化的可能机制。方法流式细胞计数法鉴定BMSCs;含药血清和空白血清分别干预体外培养的BMSCs;显微镜下观察细胞形态结构,碱性磷酸酶染色、定量检测,茜素红染色;RT-PCR检测miR-141及DLx5、Msx2、Runx2的基因表达情况;Western blot检测DLx5、Msx2及Runx2的蛋白表达情况。结果流式细胞计数法鉴定提取细胞符合实验要求;镜下观察发现两组细胞有差异,含药血清组细胞群落间结晶更为密集;ALP染色及定量、茜素红染色结果含药血清组均优于空白血清组;RT-PCR检测Dlx5、Msx2、Runx2及miR-141的基因表达结果:含药血清组miR-141和Msx2基因表达较空白血清组显著降低(P<0.01),而Dlx5、Runx2的基因表达显著升高(P<0.01);Western blot检测DLx5、Msx2、Runx2的蛋白表达结果:含药血清组较空白血清组相比,Msx2的蛋白表达略微下降(P<0.05),而Dlx5、Runx2的蛋白表达相对升高(P<0.01)。结论健骨颗粒可以调低miR-141的表达,进而调高Dlx5的表达,削弱Dlx5的同源异形基因Msx2对Runx2抑制作用,通过miR-141调控Dlx5/Msx2/Runx2信号通路促进BMSCs成骨分化达到预防和治疗绝经后骨质疏松的目的。     

MicroRNA-196a靶向调节HDAC9对MC3T3-E1细胞成骨分化的影响

目的 探究微小RNA（miR）-196a靶向调节组蛋白去乙酰化酶9（HDAC9）对MC3T3-E1细胞成骨分化的影响。方法 将MC3T3-E1细胞分为对照组（Cont）组、诱导组、miR-196a-mimics-NC组、miR-196a-mimics组、miR-196a-inhibitor-NC组、miR-196a-inhibitor组、miR-196a-mimics+pCMV-HDAC9-NC组、miR-196a-mimics+pCMV-HDAC9组,根据分组转染后进行成骨诱导。定量荧光PCR检测MC3T3-E1细胞中miR-196a、HDAC9表达量;试剂盒检测碱性磷酸酶（ALP）活性;茜素红染色观察矿化程度;Western blot检测HDAC9、ALP、Runt相关转录因子2（Runx2）、胶原蛋白I（COL1）、骨桥蛋白（OPN）、Histone H3、Histone H3（acetyl K9、K14和K23）表达量。结果 与Cont组相比,诱导组MC3T3-E1细胞中miR-196a表达、ALP、Runx2、COL1、OPN蛋白表达、ALP活性、矿化程度及Histone H3 K9、K14、K23位点乙酰化水平增高（P＜0.05）,HDAC9 mRNA和蛋白表达降低（P＜0.05）。转染miR-196a-mimics可明显增加miR-196a表达,降低HDAC9表达,并增加ALP、Runx2、COL1、OPN蛋白表达、ALP活性、矿化程度及Histone H3乙酰化,转染miR-196a-inhibitor则作用相反。miR-196a可靶向下调HDAC9表达,过表达HDAC9可部分逆转miR-196a mimics对MC3T3-E1细胞成骨分化的促进效应。结论 miR-196a可靶向下调HDAC9表达,增加组蛋白乙酰化水平,促进MC3T3-E1细胞成骨分化。     

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.     

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.