hBMP-7基因在脂肪源性干细胞中的表达及对其向成骨细胞分化的影响

目的构建hBMP-7基因真核表达载体,观察其在兔脂肪源性干细胞(adipose-derived stem cells,ADSCs)的表达,并观察其对ADSCs向成骨细胞分化的影响。方法 3月龄清洁级健康日本大耳白兔,雌雄不限,体重3～4 kg。取兔皮下脂肪约5 mL,采用胶原酶消化离心贴壁培养法培养ADSCs,取第3代细胞进行实验;CD44、CD49d、CD106免疫荧光染色鉴定ADSCs。构建真核表达载体pcDNA3.1-hBMP-7,经鉴定后利用LipofectamineTM 2000介导转染ADSCs,免疫组织化学染色检测hBMP-7在ADSCs中的表达;ALP定量测定、Ⅰ型胶原免疫荧光检测hBMP-7基因转染对ADSCs向成骨细胞分化的影响。结果倒置相差显微镜观察示ADSCs呈梭形、多角形分布;表面抗原标志CD44、CD49d呈阳性表达,CD106呈阴性表达。成功构建pcDNA3.1-hBMP-7真核表达载体,并利用脂质体介导的方法成功导入ADSCs中,免疫组织化学染色提示hBMP-7能在ADSCs中表达。ALP定量测定示,转染后7、10、14 d pcDNA3.1-hBMP-7转染组(实验组)ALP活性明显高于pcDNA3.1空载体转染组(对照组),差异有统计意义(P<0.05);转染后7、14 d,实验组Ⅰ型胶原表达量均高于对照组(P<0.05)。结论构建的真核表达载体pcDNA3.1-hBMP-7可在兔ADSCs中表达,且转染后的ADSCs ALP定量测定、成骨标志物Ⅰ型胶原的表达均高于pcDNA3.1空载体转染细胞,为开展以干细胞为载体的局部基因治疗奠定了基础。     

2型糖尿病性骨质疏松大鼠ADSCs成骨能力的研究

目的探讨2型糖尿病性骨质疏松(DOP)大鼠自身脂肪干细胞(ADSCs)的体外成骨分化能力。方法将60只SD大鼠分为对照组、骨质疏松组(OP组)及2型糖尿病性骨质疏松组(DOP组),每组20只。DOP组大鼠喂食高脂高糖饲料后于左下腹部经腹腔注射STZ先建立2型糖尿病大鼠模型,再行卵巢切除术建立2型糖尿病性骨质疏松模型;OP组大鼠行卵巢切除术建立骨质疏松大鼠模型,对照组仅切除卵巢周围脂肪。对照组随机选取10只大鼠,DOP组及OP组从建模成功的大鼠中各随机选取10只作研究。从各研究大鼠腹股沟区脂肪组织中分离脂肪干细胞,培养并传代,取第3代细胞作成骨结节染色及定量分析,PCR检测成骨基因RUNX2、OCN、OPN、ALP mRNA的表达。结果造模后DOP组大鼠BMD明显低于对照组及OP组(P0.05);三组大鼠ADSCs细胞形态学及增殖情况无显著性差异;显微镜下观察见DOP组与OP组ADSCs的钙化结节量较对照组少,DOP组钙化结节最少,并且缺少大片状结节,染色较浅;成骨定量分析结果可得DOP组ADSCs的OD值低于对照组及OP组,差异有统计学意义(P0.05);RT-PCR检测成骨基因的表达,DOP组与OP组RUNX2、OCN、OPN、ALP mRNA的表达量均低于对照组(P均0.05),DOP组与OP组相比较,DOP组RUNX2与ALPmRNA的表达量明显低于OP组(P0.05),而OCN与OPNmRNA的表达量两组无明显差异(P0.05)。结论 DOP大鼠ADSCs成骨分化能力较弱,弱于单纯骨质疏松大鼠,原因可能与高血糖状态下其ADSCs中ALP和RUNX2的表达减少有关。     

负载人骨形态发生蛋白-7基因的兔脂肪干细胞向成骨细胞分化的实验研究

目的 探讨人骨形态发生蛋白-7(hBMP-7)基因修饰对兔脂肪干细胞(ADSCs)成骨能力的影响. 方法 原代培养兔脂肪干细胞,免疫组织化学方法检测细胞表面抗原CD44、CD49d、CD106的表达,对细胞进行鉴定;阳离子脂质体介导hBMP-7基因转染ADSCs,绿色荧光蛋白表达观察转染效率、逆转录-聚合酶链反应(RT-PCR)检测目的基因hBMP-7的表达;ALP定量测定,Western blot检测Ⅰ型胶原、骨钙素的表达,以评价转基因ADSCs向成骨细胞分化的情况. 结果 从兔脂肪组织中分离出来的ADSCs CD44、CD49d表达呈阳性,CD106表达呈阴性.RT-PCR检测筛选后的ADSCs稳定表达hBMP-7.转染后7、10、14 d ALP定量测定转染组明显高于未转染组,差异有统计学意义(P<0.05);成骨标志物Ⅰ型胶原、骨钙素的表达转染组明显高于未转染组.结论 从脂肪组织中分离出的ADSCs是一种较好的组织工程种子细胞.hBMP-7重组质粒转染ADSCs后表达目的蛋白,并诱导ADSCs向成骨细胞分化.     

重组pcDNA3.1-hBMP-2转染人骨髓基质干细胞和对其增殖及血管内皮生长因子表达的影响

目的构建人骨形成蛋白-2(hBMP-2)真核表达载体pcDNA3.1-hBMP-2,转染人骨髓基质干细胞(MSCs),探讨基因转染对其增殖和血管内皮生长因子(VEGF)表达的影响. 方法利用重组DNA和基因克隆技术构建重组载体pcDNA3.1-hBMP-2;细胞培养和基因转染技术体外转染人MSCs;免疫细胞化学、原位杂交和蛋白印迹法检测细胞BMP-2的表达;通过流式细胞仪和VEGF探针原位杂交分析其对细胞增殖和VEGF表达的影响. 结果转染后细胞在mRNA水平和蛋白质水平均表达BMP-2;转染后S期细胞比例增多,提示细胞DNA的合成增加;BMP-2基因转染上调细胞VEGF的表达. 结论在脂质体介导下,pcDNA3.1-hBMP-2转染MSCs获得成功.基因转染后能促进细胞增殖并将通过使VEGF的表达增加促进血管再生,为进一步骨缺损的基因治疗及构建组织工程骨奠定了实验基础.     

hBMP-7基因转染修复骨缺损的实验研究

目的：探讨利用人骨形态发生蛋白7(hBMP-7)基因转染骨髓基质干细胞(BMSc)构建组织工程化骨组织并修复兔桡骨骨缺损的可行性。方法：制备含hBMP-7真核细胞表达载体的逆转录病毒液PT-PLNCX2-hBMP-7并转染BMSc．使用免疫组织化学的方法检测hBMP-7在BMSc中的表达。兔挠骨1.5cm骨缺损修复实验分为4组：转染组，未转染组，单纯PLLA组和对照组．每组6个样本。分别于术后3周，6周采用大体观察，X线、组织学检测、免疫组织化学检测等方法对骨缺损修复情况进行对比。结果：免疫组织化学检测显示经PT-PLNCX2-hBMP-7病毒液转染的BMSc中有较强的阳性结果出现。定量检测分析结果证实经转染的BMSc修复骨缺损的成骨速度和成骨量均优于未转染组，单纯PLLA组和对照组中均未见骨缺损得到修复。结论：hBMP-7基因转染能够提高BMSc形成组织工程化骨组织和修复骨缺损的能力，可用于BMSc为种子细胞的组织工程化骨组织的构建。     

血管内皮生长因子基因修饰脂肪干细胞对糖尿病骨质疏松性骨缺损的修复作用

我们建立糖尿病大鼠骨质疏松骨缺损模型,利用血管内皮生长因子(VEGF)基因修饰大鼠脂肪干细胞(ADSCs)对此类骨缺损进行修复,观察VEGF基因修饰脂肪干细胞对糖尿病骨质疏松性骨缺损修复作用的效果.     

葛根素诱导脂肪干细胞成骨分化的实验研究

目的观察葛根素诱导卵巢切除后骨质疏松大鼠模型的脂肪干细胞(adipose-derived stem cells,ADSCs)成骨分化的能力。方法分离、培养、传代及鉴定去卵巢骨质疏松模型大鼠ADSCs;含葛根素培养基诱导去卵巢骨质疏松大鼠ADSCs成骨分化,并测定最大有效浓度。结果去卵巢骨质疏松大鼠ADSCs成骨分化能力与加入含葛根素培养基的时间和培养基中葛根素的浓度呈正向相关,浓度为12 mmol/L时呈现无毒剂量下促进成骨分化最显著作用。结论葛根素具有较强促进去卵巢骨质疏松大鼠ADSCs成骨分化的诱导能力。     

重组pcDNA3.1-hBMP-7真核表达载体的构建及转染兔骨髓基质干细胞的实验研究

[目的]构建人骨形态发生蛋白-7（human bone morphogenetic protein-7，hBMP-7）基因真核表达载体，评价其转染兔骨髓基质干细胞（bone marrow stromal cells，BMSCs）的诱导成骨能力。[方法]从人类胎盘组织中克隆出hBMP-7基因，与真核表达载体pcDNA3．1连接，成功构建了重组pcDNA3．1-hBMP-7真核表达载体；从兔骨髓中分离培养BMSCs，分为3组：ApcDNA3，1-hBMP-7转染组；B空载体pcDNA3．1转染组；C未转染组。使用RT-PCR、免疫组织化学等方法检测hBMP-7在BMSCs中的表达。检测各组细胞碱性磷酸酶，胶原，骨钙蛋白合成情况。[结果]RT．PCR、免疫组织化学检测显示经hBMP-7转染的BMSCs中有BMP-7表达。经hBMP-7转染BMSCs的碱性磷酸酶于转染后第2d显著增高，到第8d达到最高；经hBMP-7转染的BMSCs合成胶原、骨钙蛋白能力也显著提高，与转染空载体、未转染的BMSCs相比有显著性差异（P〈0.05）。[结论]成功构建了pcDNA3，1-hBMP-7真核表达载体；外源的hBMP-7基因可在兔BMSCs中充分、高效的表达，并且这种外源性hBMP-7基因具备了促进兔骨髓基质干细胞向成骨细胞转化的能力，这为hBMP-7的基因治疗提供了坚实的理论基础。     

VEGF165基因修饰脂肪干细胞对糖尿病大鼠骨缺损的修复研究

目的 :探讨采用基因转染大鼠脂肪干细胞构建血管化组织工程的方法对糖尿病骨质疏松性骨缺损的修复效果。方法:选取雄性Wistar大鼠78只,体重180~220 g,其中72只通过化学药物(STZ)诱导法建立糖尿病动物模型,成模大鼠血糖值均≥16.7 mmol/L。将实验动物随机分为5组,正常对照组6只,其他实验组各18只。正常对照组:在正常大鼠骨缺损内植入经VEGF165基因修饰的脂肪干细胞;糖尿病组:单纯糖尿病骨缺损大鼠;生长因子组:在糖尿病大鼠骨缺损内单纯植入VEGF生长因子;干细胞组:在糖尿病大鼠骨缺损内单纯植入脂肪干细胞;实验组:在糖尿病大鼠骨缺损内植入经VEGF165基因修饰的脂肪干细胞。将5×106个VEGF165-ADSCs细胞与凝胶海绵结合后,植入到糖尿病大鼠骨缺损模型中,在植入后第4周时,采用光学显微镜观察缺损修复组织大体形态;采用免疫组化SP法测定骨缺损区修复后局部微血管密度;应用美国IRIS IntrepidⅡXSP电感耦合等离子体发射光谱仪对修复骨痂内钙/磷含量和碱性磷酸酶(ALP)含量测定;统计分析上述测量结果验证VEGF165-ADSCs对糖尿病大鼠骨缺损的修复作用。结果:荧光染色结果显示,VEGF165表达定位于ADSCs的细胞浆,表达率在87﹪以上;大体组织学观察结果显示:实验组修复区内骨痂生成范围和质量接近正常组,糖尿病组、生长因子组、干细胞组修复效果欠佳。植入后第4周,实验组单位体积的修复组织钙、磷含量和ALP含量明显高于生长因子组、干细胞组(P0.05),与正常对照组组比较差异无统计学意义(P0.05);第4周时,实验组修复局部的血管密度低于正常对照组(P0.05),而显著高于其他组(P0.05)。结论 :VEGF165基因修饰的脂肪干细胞在糖尿病大鼠体内具有良好的成骨及成血管作用,有望成为修复糖尿病特定骨质条件下骨缺损的一种有效手段。     

过表达miR-664a-5p激活Wnt/β-catenin信号通路促进骨质疏松大鼠骨重建

目的 探究过表达miR-664a-5p的脂肪间充质干细胞（miR-664a-5p-ADSCs）通过激活Wnt/β-catenin信号通路对骨质疏松（OP）大鼠骨重建的促进作用。方法 将大鼠分为Sham组、OVX组、ADSCs组和miR-664a-5p-ADSCs组。切除卵巢建立OP大鼠模型,Sham组仅切除脂肪组织。3个月后,ADSCs组和miR-664a-5p-ADSCs组分别尾静脉注射miR-664a-5p-ADSCs及其阴性对照ADSCs;Sham组和OVX组注射等量生理盐水。1个月后进行指标检测。micro-CT、HE染色、TRAP染色检测OP大鼠骨重建情况;免疫组化染色、RT-qPCR、Western blot检测Runx2、ALP、OCN、Wnt、β-catenin mRNA和蛋白的表达。结果 Sham组骨小梁完整,破骨细胞较少;与Sham组相比,OVX组骨小梁稀疏且变薄,破骨细胞较多;Runx2、ALP、OCN、Wnt、β-catenin mRNA和蛋白水平明显降低（P<0.05）;与OVX组相比,ADSCs组、miR-664a-5p-ADSCs组骨小梁增加且增厚,破骨细胞较少;Runx2、ALP、OCN、Wnt、β-catenin mRNA和蛋白水平明显升高,且miR-664a-5p-ADSCs组上述效果强于ADSCs组（P<0.05）。结论 过表达miR-664a-5p的ADSCs通过激活Wnt/β-catenin信号通路促进OP大鼠骨重建。     

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.