结合半乳糖基抗CD3单抗的肿瘤浸润淋巴细胞对自体肝癌细胞杀伤的形态学研究

目的　获取与半乳糖基抗CD3 单抗结合的肿瘤浸润淋巴细胞 (McAb TIL)杀伤自体肝癌细胞的形态学证据 ,并进行杀伤机制探讨。方法　制备McAb TIL ,将其与H2 2 小鼠肝癌细胞共同孵育 ,于不同时间在倒置显微镜和透射电镜下观察。结果　McAb TIL呈增殖活化状态 ,与靶细胞共同孵育 0 .5h即可导致靶细胞严重损伤。杀伤靶细胞后的McAb TIL结构清晰、完整。凋亡与坏死形态学改变可共存于同一个被杀伤靶细胞。结论　偶联了大量半乳糖基的抗CD3 单抗仍具有很强的肿瘤浸润淋巴细胞 (TIL)活化作用。McAb TIL通过多种杀伤机制杀伤自体肝癌细胞 ,杀伤力极强 ,具有连续杀伤靶细胞的能力。     

肾癌树突状细胞疫苗的体外活性研究

目的 探讨负载人肾癌细胞抗原肽制备树突状细胞(DC)疫苗体外杀伤肾癌细胞的作用.方法 利用细胞膜酸洗脱法获得人肾透明细胞癌细胞株786-0细胞表面抗原肽.外周血单个核细胞在体外经人粒细胞一巨噬细胞集落刺激因子,白细胞介素4和脂多糖诱导获得成熟的DC,并负载分离到的抗原肽制备DC疫苗.利用疫苗体外诱导出特异性细胞毒性T淋巴细胞(CTL)作为实验组.同时设置4个对照组,对照组1用未负载抗原肽的DC和单个核细胞混合培养,对照组2用单个核细胞进行培养,对照组3用抗原肽与单个核细胞混合培养,对照组4用未负载抗原肽的DC单独培养.4个对照组也加入同实验组相同的各种因子进行培养.51Cr释放法检测特异性CTL的杀伤活性.结果 疫苗诱导的特异性CTL对肾癌细胞的杀伤活性为(31.93±5.05)%,与对照组(5.88±2.26)%、(8.03±6.70)%、(9.70±2.09)%、(9.35±3.58)%相比差异有统计学意义(P<0.05).结论 负载抗原肽的DC疫苗体外试验有高效的抗肾癌细胞活性.     

可溶性Fas阻断肝癌细胞通过Fas/FasL 途径触发T淋巴细胞的凋亡

目的　通过阻断Fas介导T细胞凋亡 ,建立快速大量激活制备肿瘤特异性细胞毒性T淋巴细胞 (CTL)的方法。方法　分离肝癌细胞和肿瘤浸润淋巴细胞 (TIL)。选择FasL表达阳性的肝癌标本 ,在体外将两者混合 ,并在CD2 8单抗共刺激下 ,激活制备特异性CTL。应用可溶性Fas受体阻断肝癌细胞通过Fas FasL途径触发激活T细胞凋亡 ,与对照组比较观察阻断凋亡作用 ,通过3H掺入法和51 Cr释放法了解T细胞增殖杀伤活性。结果　流式细胞术仪检测未阻断组较阻断组和未阻断对照组凋亡率明显升高 ,未阻断组凋亡率达 4 7 82 %± 0 13% ,静息性T淋巴细胞组为 3 76 %± 0 2 5 % ,阻断组为 8 2 2 %± 0 2 6 % (P <0 0 1) ,DNAladder显示未阻断组T淋巴细胞出现明显梯状条带 ,阻断组为阴性。51 Cr释放法表明阻断后T淋巴细胞杀伤活性增加 ,较未阻断组及未阻断对照组差异有显著性 (P<0 0 1)。3H掺入法检测证实可溶性Fas受体阻断激活T细胞凋亡后 ,细胞增殖明显升高 ,较未阻断组差异有显著性 (P <0 0 1)。结论　体外实验可获得大量激活T细胞 ,并可杀伤肿瘤细胞 ,     

腺病毒介导G250基因转染树突状细胞激活免疫效应细胞治疗肾癌的实验研究

目的 探讨以腺病毒(Ad)载体介导肾癌相关抗原G250基因转染制备树突状细胞(DC)瘤苗.体外诱导自体T淋巴细胞特异性抗肾癌免疫效应. 方法 自健康人外周血中提取单核细胞,将贴壁细胞分为3组(Ad-G250基因转染组、G250蛋白致敏组、未致敏组),用粒细胞-巨噬细胞集落刺激因子和诱导活化;3组DC细胞中分别加入自体T淋巴细胞,获得细胞毒性T淋巴细胞(CTL).RT-PCR检测G250在DC细胞内的转录情况;流式细胞仪检测DC表面标志分子和G250抗原蛋白的表达情况;四甲基偶氮唑盐法检测3组CTL对肾癌细胞株786-0和肺癌细胞株A549的杀伤活性. 结果 Ad-G250高效转染DC,G250阳性细胞率为(52.2±1.5)%,G250蛋白在DC:内成功表达:基因转染组DC中成功扩增出G250产物;Ad-G250转染的DC表面标志CD_(80)、CD_(83)、CD_(86)、CD_(1a)、HLA-DR表达高于其他2组.差异均有统计学意义(P<0.05).Ad-G250基因转染组、G250蛋白致敏组、未致敏组诱导的3组CTL对786-0靶细胞杀伤活性分别为(83.4±2.8)%、(79.6±2.4)%、(77.3±2.1)%,组间比较差异有统计学意义(F=69.172,P=0.000);3组CTL对A549靶细胞杀伤活性差异无统计学意义(F=0.373,P=0.693). 结论 以Ad为载体介导抗原基因转染DC,并诱导特异的CTL,技术上可行,所诱导的CTL杀伤活性强,有望成为一种肿瘤免疫治疗方法.     

活化性杀伤细胞免疫球蛋白样受体阳性的NK细胞对靶细胞的杀伤作用

目的 研究活化性杀伤细胞免疫球蛋白样受体(KIR)KIR2DS1阳性的自然杀伤(NK)细胞对急性髓系白血病(AML)靶细胞的杀伤作用;并探讨NK细胞KIR及人类白细胞抗原Cw位点(HLA-Cw)与靶细胞HLA-Cw错配对靶细胞的杀伤机制.方法 获取健康供者的外周血,经Dnyal磁珠负选高纯度NK细胞;取初治确诊的AML患者新鲜骨髓液,分离后的白血病细胞作为靶细胞.用抗CD158a和CD158b单克隆抗体封闭NK细胞抑制性KIR(如:KIR2DL1、KIR2DL2和KIR2DL3),并用噻唑蓝(MTT)比色法分别检测抑制性KIR封闭前和封闭后NK细胞对靶细胞的杀伤作用.采用聚合酶链反应和顺序特异性引物(PCR-SSP)基因分型技术分别检测NK细胞及靶细胞的KIR基因和HLA-Cw;根据HLA-Cw将NK细胞和靶细胞分别分为C1组(表达HLA-Cw 01、03、07、08、12、14、16分子)、C2组(表达HLA-Cw02、04、05、06、15、17、18分子)和C1/C2组(既表达C1组的等位基因又表达C2组的等位基因).结果 分选后的NK细胞经流式细胞仪检测,其纯度为(90.8±6.08)%;NK细胞抑制性KIR封闭后与封闭前比较,其对靶细胞的杀伤作用明显增强(t=-3.00,P=0.005);KIR2DS1阳性的NK细胞C1组对靶细胞C2组的杀伤作用高于靶细胞C1及C1/C2组,杀伤率分别为(57.370±1.400)%、(44.190±4.666)%和(36.770±6.560)%(F=11.87,P=0.021);NK细胞抑制性KIR封闭后,其对各组靶细胞的杀伤率更高(F=18.72,P=0.009).结论 NK细胞抑制性KIR封闭后其活性增强,KIR2DS1阳性的NK细胞对靶细胞的杀伤率高于KIR2DS1阴性的NK细胞;NK细胞KIR及HLA-Cw与靶细胞HLA-Cw错配,能够介导KIR2DS1阳性的NK细胞C1组抗原的异源反应性,实现"丢失自我"的识别作用,从而使NK细胞对靶细胞杀伤率增强.     

三氧化二砷联合顺铂抗人骨肉瘤细胞株MG-63的实验分析

目的:探讨三氧化二砷(Arsenic Trioxide,As2O3)对人成骨肉瘤细胞株MG-63的抑制作用及机制.方法:将MG-63细胞于37℃,5％ CO2等实验条件下传代培养,等细胞进入对数生长期后再进行操作.采用方法:MTT法检测AsaO3、CDP对MG-63细胞的IC50及两药联合时的抑制率.结果:计算得As2O3和CDP对MG-63细胞的IC50分别为2.15μmol/ml和1.13μg/ml.IC50浓度的As2O3、IC50浓度的CDP、1/2IC50(CDP)+ 1/2IC50(As2O3)对MG-63细胞的抑制率分别为(52.20±019)％,(57.11±0.64)％,(71.10±0.25)‰结论:说明低浓度的As2O3与CDP联合应用时,抑制率均较单用其中一种IC50浓度的药物时有明显提高,差异有显著性.     

负载肿瘤抗原的DC疫苗体外诱导的特异性抗膀胱癌效应研究

目的 探讨负载膀胱癌抗原成分树突状细胞(dendritic cells,DC)疫苗的制备和体外诱导T淋巴细胞特异性杀伤膀胱癌细胞的作用.方法 冻融法制备EJ细胞裂解物抗原成分,体外培养的人外周血单个核细胞(hu-PBMC)在rhGM-CSF、rhIL-4、TNF-α诱导下分化出DC,负载EJ细胞裂解物抗原后制备膀胱癌DC疫苗;免疫磁珠分离法从人免疫重建Balb/c裸小鼠脾脏组织中分离CD3+ T淋巴细胞,3H-TdR掺入试验测定DC疫苗刺激自体T淋巴细胞增殖的能力,51Cr释放试验检测DC疫苗诱导的T细胞对EJ细胞的杀伤作用.结果 Hu-PBMC在细胞因子rhGM-CSF、rhIL-4和TNF-α的刺激下分化为成熟DC,负载EJ抗原的DC疫苗体外可使同源T淋巴细胞活化,增殖指数增加,活化的T淋巴细胞对EJ细胞的杀伤率为(62.58±6.13)%,和对照组比较差异有统计学意义(P＜0.05).结论 负载膀胱癌冻融抗原的DC疫苗体外可诱导人T淋巴细胞活化增殖,对EJ细胞有明显的杀伤作用.     

125I偶联Ki-67反义核酸对人肾癌细胞生长及凋亡的调控作用

目的　探讨12 5I偶联Ki 67基因反义寡核苷酸 (12 5I ASODN)对人肾癌细胞生长及凋亡的调控作用。方法　采用氯胺 T法将 10 μmol/L浓度的Ki 67反义寡核苷酸 (ASODN)与12 5I偶联 ,12 5I ASODN放射浓度为 2 .5 9MBq/L ,脂质体包装后转导肾癌 786 0细胞系。采用免疫组织化学、Western印迹技术检测Ki 67表达 ,四甲基偶氮唑蓝 (MTT)法检测细胞增殖 ,免疫组织化学脱氧核苷酸末端转移酶介导的缺口末端标记 (TUNEL)法检测细胞凋亡。结果　12 5I ASODN处理组肾癌细胞Ki 67表达阳性率 (2 1.5± 1.2 ) %降低 ,Ki 67蛋白 (4 9.9± 4.5 ) %降低 ,与ASODN处理组(2 9.9± 0 .4) %、(82 .1± 1.9) %比较差异有非常显著性 (P均 <0 .0 1)。细胞增殖抑制率12 5I A SODN处理组 (4 7.9± 3 .6) %与ASODN处理组 (2 1.8± 2 .5 ) %比较差异有非常显著性 (P <0 .0 1)。凋亡细胞阳性率12 5I ASODN处理组 (2 8.9± 1.3 ) %与ASODN处理组 (15 .7± 0 .5 ) %比较差异有非常显著性 (P <0 .0 1)。结论　12 5I ASODN较之ASODN具有更强的抑制肾癌细胞增殖、促进凋亡作用。     

白细胞介素-2基因修饰树突状细胞体外增强其诱导的抗肝癌免疫反应

目的探讨腺病毒介导的白细胞介素(IL)-2基因修饰能否使抗原冲击的树突状细胞(DC)在体外诱导出更强的抗肝癌免疫反应。方法IL-2的重组腺病毒载体体外转染经肝癌细胞株HepG2冻融抗原致敏的DC(AdIL-2-HepG2/DC),FACS分析AdIL-2-HepG2/DC表面分子的表达,酶联免疫吸附试验法(ELISA)检测IL-2水平,3H-TdR掺入法检测T淋巴细胞增殖分化能力,噻唑蓝(MTT)法检测细胞毒性T淋巴细胞(CTL)效应。结果AdIL-2-HepG2/DC能高水平的表达CD1a(61.7±8.1)%,CD11c(72.9±6.2)%,CD80(81.1±7.1)%,CD86(76.4±6.8)%以及HLA-DR(90.6±6.4)%,并分泌较高水平的IL-2(6.78±0.18)mq/L。AdIL-2-HepG2/DC能非常显著地刺激自体T细胞增殖(CPM值为21 878±1089),当靶细胞为HepG2时,其诱导的CTL杀伤活性(74.5±3.8)%显著高于其他各组,并且其杀伤能力与效应细胞数量成正比。结论AdIL-2- HepG2/DC可以增强体外诱导的特异性抗肝癌免疫反应。     

趋化因子RANTES快速募集DCs及DCs疫苗的抗结肠癌作用

目的 观察RANTES促进小鼠外周血Des前体细胞动员及DCs疫苗对结肠癌细胞的体外杀伤作用.方法 C57BL/6J(B6)小鼠静脉注射RANTES,不同时间间隔(0、4、8、16、24、48、72 h)采集外周血分离单个核细胞(PBMNCs),通过流式细胞仪分选出F4/80-B220-CD11c+细胞并其进行检测.反复冻融法制备结肠癌可溶性抗原,将其与RANTES动员的DCs共同培养,制备成DCs疫苗以激活T细胞,MTT法检测活化的T细胞在体外对结肠癌细胞的杀伤作用.γ干扰素(IFNγ)酶联免疫吸附试验(ELISA)试剂盒检测IFNγ的分泌情况.结果 B6小鼠外周血中F4/80-B220-CD11c+细胞数量随着注射时间的延长逐渐增多,大约在24 h达到高峰,占PBMNCs(13.45±1.25)%.新鲜分离的F4/80-B220-CD11c+细胞为DCs前体细胞.负载结肠癌抗原的DCs激活的T细胞表现出对结肠癌细胞的特异性杀伤作用,产生高水平的IFNγ(1595.00±38.03)ng/L,而对B16黑色素瘤细胞没有杀伤作用,不产生高水平的IFNγ(175.44±6.55)ng/L.结论 RANTES动员的DCs在体外可以诱导出针对结肠癌细胞的特异性杀伤作用.     

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.     

Immunomodulation in Transplantation with Photopheresis

Abstract: Photopheresis is a technique in which peripheral blood mononuclear cells, in the presence of a photoacti-vatable compound, are exposed extracorporeally to ultraviolet A light and reinfused, inducing a host autoregula-tory immune response. Experimental work and ongoing clinical studies are helping to define the role of this novel, safe, and non-toxic immunomodulating technology in the field of transplantation.