RNA干扰阻断BT／CD28共刺激通路在小鼠心脏移植中的抗排斥作用

目的探讨RNA干扰（RNAi）技术阻断B7／CD28共刺激通路对小鼠异体心脏移植排斥反应的影响及其机制。方法经体外转录合成针对CD80 mRNA和CD86 mRNA序列特异性小片段干扰RNA（siRNA），转染供者骨髓来源的树突状细胞（DC），半定量逆转录聚合酶链反应、流式细胞仪检测DC转染CD80siRNA、CD86siRNA前后CD80 mRNA和CD86 mRNA的表达水平以及细胞表面CD80及CD86的表达情况。在小鼠异位心脏移植前7d，经静脉给受者输注经siRNA干扰后的DC（干扰DC组），同时设立同种异体对照组、环孢素A（CsA）治疗组（术后皮下注射CsA 5mg／d）、同系移植对照组和未干扰DC组（移植前输注未转染DC），观察各组移植心脏的存活时间，对移植物的排斥反应进行病理分级，并测定移植物组织中白细胞介素2（IL-2）、γ干扰素（IFN-γ）及IL-10的mRNA表达水平。结果siRNA转染DC后，其CD80 mRNA及CD86 mRNA的表达受到明显抑制，CD80、CD86的阳性率分别由84％和67％下降至35％和30％。与同种异体对照组和未干扰DC组比较，干扰DC组移植心脏存活时间明显延长（P〈0．01），组织排斥反应病理分级显著降低（P〈0．01），移植心脏组织中IL-2 mRNA和IFN-γ mRNA的表达水平明显降低（P〈0．01），而IL-10 mRNA的表达水平明显升高（P〈0．01）。结论利用RNAi敲减供者骨髓来源的DC表面B7分子的表达，以阻断BT／CD28共刺激通路，具有抑制小鼠心脏移植排斥反应的作用，其机理可能是通过诱导T淋巴细胞无能并使T辅助细胞分化向Tn2型方向偏移。     

RNA干扰技术阻断CD40/CD40L共刺激通路对小鼠移植心存活时间的影响

目的 探讨慢病毒介导RNA干扰(RNAi)技术阻断CD40/CD40L共刺激通路对小鼠移植心存活时间的影响.方法 以针对小鼠CD40基因的RNAi慢病毒载体在体外感染供者骨髓来源的树突状细胞(DC),制备低表达CD40的耐受性DC(Tol-DC).荧光实时定量聚合酶链反应及流式细胞术检测DC感染前后CD40 mRNA及DC表面抗原CD40、CD11c和MHCⅡ的表达.建立小鼠异位腹腔心脏移植模型.在小鼠异位心脏移植前7 d,经静脉给受者输注体外制备的低表达CD40的Tol-EC(慢病毒感染DC注射组),并设置单纯移植对照组和未感染DC注射组作为对照.观察各组移植心的存活时间,评定各组术后第7天移植心排斥反应的病理分级.结果 CD40-RNAi慢病毒载体在体外感染DC 48 h后,CD40 mRNA表达明显受到抑制,抑制率为80.9%;CD40表达明显下降,由(74.37±4.08)%降至(40.07±4.03)%(P＜0.05).单纯移植对照组、未感染DC注射组和慢病毒感染DC注射组移植心存活时间分别为:(8±2)d、(9±1)d和(14±4)d,慢病毒感染DC注射组移植心存活时间明显延长,并且移植心排斥反应病理分级显著降低,差异有统计学意义(P＜0.05).结论 阻断CD40/C40L共刺激通路可抑制异系T淋巴细胞的活化,从而抑制急性排斥反应,延长小鼠移植心的存活时间.     

核因子κB诱骗剂处理的树突状细胞延长小鼠移植心脏存活时间

目的探讨核因子κB（NF-κB）诱骗剂处理供者树突状细胞（DC）对同种异体小鼠移植心脏存活时间的影响。方法在体外以NF-κB诱骗剂处理供者骨髓来源的DC，并于心脏移植术前7d经门静脉输注2×10^6个DC给受者，术后1～7d受者接受亚治疗量的环孢素A（10mg·kg^-1·d^-1）腹腔注射（联合方案组），并设不作任何处理（对照组）、单用环孢素A（CsA组）、单纯输注未经处理DC（DC对照组）和单纯输注经处理DC（DC实验组）的对照组，另设接受来自第三方供者的对照组（第三供者组，受者的处理同联合方案组），所有受者均接受腹腔心脏移植。观察各组移植心脏的存活时间；采用酶联免疫吸附法检测术后第7天受者血清白细胞介素2（IL-2）、IL-4、IL-10和γ干扰素（IFN-γ）的含量。结果移植心脏平均存活时间（MST），对照组为7d，CsA组为10．3d，DC对照组为7．6d，DC实验组为21．4d，联合方案组为53．6d，第三供者组为9d，DC实验组移植心脏MST明显长于对照组和DC对照组，差异有统计学意义（P〈0．01）；联合方案组移植心脏MST明显长于CsA组、DC实验组及第三供者组，差异有统计学意义（P〈0．01）。联合方案组IL-2和IFN-γ的含量最低，而IL-4和IL-10的含量最高，与其它各组比较，差异均有统计学意义（P〈0．05）；与对照组、DC对照组及CsA组相比，DC实验组IL-2及IFN-γ的含量也显著降低（P〈0．05），而IL-4和IL-10则升高（P〈0．05）。结论术前输注经NF-κB诱骗剂处理的供者DC可延长同种小鼠移植心脏的存活时间，若术后加用短程亚治疗量CsA，则移植心脏的存活时间得到进一步延长。     

CXC趋化因子受体6在小鼠心脏移植排斥反应中的表达及意义

目的 研究CXC趋化因子受体6(CXCR6)在同种异体小鼠心脏移植中的表达及CXC趋化因子配体16(CXCL16)与CXCR6相互作用对移植物存活时间的影响.方法 以野生型Balb/c小鼠(H-2d)为供者(同种移植组),或以野生型C57BL/6小鼠(H-2b)为供者(同系移植组),以野生型C57BL/6小鼠为受者分别行小鼠腹腔异位心脏移植.测定同系和同种移植组小鼠移植心脏CXCR6mRNA的表达,并测定受者脾脏CD8+T淋巴细胞CXCR6的表达.另制作小鼠同种异位心脏移植模型(Balb/c小鼠为供者,C57BL/6小鼠为受者),将其分为实验组和对照组,实验组受者移植当天至发生排斥反应时腹腔注射抗CXCL16抗体,对照组受者同期注射对照抗体.记录两组移植心脏存活时间.进行CD8+T淋巴细胞的细胞毒试验,即用Balb/c小鼠脾细胞免疫C57BL/6小鼠后,获取C57BL/6小鼠脾脏CD8+T淋巴细胞,将Balb/c小鼠脾细胞与C57BL/6小鼠CD8+T淋巴细胞混合培养,分别加入抗CXCL16抗体、小鼠IgG(对照抗体)和抗CD40L抗体.结果 同种移植组移植心脏中CXCR6 mRNA的表达以及脾脏CD8+T淋巴细胞上CXCR6的表达均高于同系移植组和正常对照组.抗CXCL16抗体对CD8+T淋巴细胞的细胞毒活性无影响.与对照组相比较,实验组小鼠移植心脏存活时间并未明显延长.结论 小鼠心脏移植排斥反应中CD8+T淋巴细胞CXCR6的表达上升,阻断CXCL16/CXCR6相互作用并不能延长移植心脏的存活时间.     

CXC趋化因子受体6在小鼠心脏移植排斥反应中的表达及意义

目的 研究CXC趋化因子受体6(CXCR6)在同种异体小鼠心脏移植中的表达及CXC趋化因子配体16(CXCL16)与CXCR6相互作用对移植物存活时间的影响.方法 以野生型Balb/c小鼠(H-2d)为供者(同种移植组),或以野生型C57BL/6小鼠(H-2b)为供者(同系移植组),以野生型C57BL/6小鼠为受者分别行小鼠腹腔异位心脏移植.测定同系和同种移植组小鼠移植心脏CXCR6mRNA的表达,并测定受者脾脏CD8+T淋巴细胞CXCR6的表达.另制作小鼠同种异位心脏移植模型(Balb/c小鼠为供者,C57BL/6小鼠为受者),将其分为实验组和对照组,实验组受者移植当天至发生排斥反应时腹腔注射抗CXCL16抗体,对照组受者同期注射对照抗体.记录两组移植心脏存活时间.进行CD8+T淋巴细胞的细胞毒试验,即用Balb/c小鼠脾细胞免疫C57BL/6小鼠后,获取C57BL/6小鼠脾脏CD8+T淋巴细胞,将Balb/c小鼠脾细胞与C57BL/6小鼠CD8+T淋巴细胞混合培养,分别加入抗CXCL16抗体、小鼠IgG(对照抗体)和抗CD40L抗体.结果 同种移植组移植心脏中CXCR6 mRNA的表达以及脾脏CD8+T淋巴细胞上CXCR6的表达均高于同系移植组和正常对照组.抗CXCL16抗体对CD8+T淋巴细胞的细胞毒活性无影响.与对照组相比较,实验组小鼠移植心脏存活时间并未明显延长.结论 小鼠心脏移植排斥反应中CD8+T淋巴细胞CXCR6的表达上升,阻断CXCL16/CXCR6相互作用并不能延长移植心脏的存活时间.     

CXC趋化因子受体6在小鼠心脏移植排斥反应中的表达及意义

目的 研究CXC趋化因子受体6(CXCR6)在同种异体小鼠心脏移植中的表达及CXC趋化因子配体16(CXCL16)与CXCR6相互作用对移植物存活时间的影响.方法 以野生型Balb/c小鼠(H-2d)为供者(同种移植组),或以野生型C57BL/6小鼠(H-2b)为供者(同系移植组),以野生型C57BL/6小鼠为受者分别行小鼠腹腔异位心脏移植.测定同系和同种移植组小鼠移植心脏CXCR6mRNA的表达,并测定受者脾脏CD8+T淋巴细胞CXCR6的表达.另制作小鼠同种异位心脏移植模型(Balb/c小鼠为供者,C57BL/6小鼠为受者),将其分为实验组和对照组,实验组受者移植当天至发生排斥反应时腹腔注射抗CXCL16抗体,对照组受者同期注射对照抗体.记录两组移植心脏存活时间.进行CD8+T淋巴细胞的细胞毒试验,即用Balb/c小鼠脾细胞免疫C57BL/6小鼠后,获取C57BL/6小鼠脾脏CD8+T淋巴细胞,将Balb/c小鼠脾细胞与C57BL/6小鼠CD8+T淋巴细胞混合培养,分别加入抗CXCL16抗体、小鼠IgG(对照抗体)和抗CD40L抗体.结果 同种移植组移植心脏中CXCR6 mRNA的表达以及脾脏CD8+T淋巴细胞上CXCR6的表达均高于同系移植组和正常对照组.抗CXCL16抗体对CD8+T淋巴细胞的细胞毒活性无影响.与对照组相比较,实验组小鼠移植心脏存活时间并未明显延长.结论 小鼠心脏移植排斥反应中CD8+T淋巴细胞CXCR6的表达上升,阻断CXCL16/CXCR6相互作用并不能延长移植心脏的存活时间.     

转染IL-12亚基干扰RNA的供者树突状细胞延长同种小鼠移植心脏存活时间

目的探讨预输注转染白细胞介素12p35亚基干扰RNA(Ib-12p35siRNA)的供者来源树突状细胞对移植心脏存活时间的影响。方法制备供者BALB/c小鼠骨髓来源的树突状细胞,培养7d后,根据实验设计,分别以携带IL-12p35siRNA或HKsiRNA的重组腺病毒载体转染树突状细胞。移植前7d,经受者C57BL/6小鼠尾静脉注射转染IL-12p35siRNA的树突状细胞(p35组)和转染HKsiRNA的树突状细胞(HK组),并设未转染的对照组(未转染组),然后进行供、受者间的异位(颈部)心脏移植。术后观察移植心脏的存活情况,术后第14d采取静脉血,以酶联免疫吸附试验测定血清中自细胞介素2(IL-2)、IL-4、IL-10和γ干扰素(INF-γ)的水平。结果术后未转染组移植心脏的存活时间为(7．83±1．61)d,HK组为(7．17±1．60)d,p35组移植心脏存活时间明显延长,为(20．17±2．71)d,与HK组和未转染组相比,差异有统计学意义(P＜0．01)。p35组IL-2和INF-γ的水平明显低于HK组和未转染组(P＜0．01),而IL-4和IL-10的水平明显高于HK组和未转染组(P＜0．01)。结论预输注转染IL-12p35siRNA的供者树突状细胞能延长同种小鼠移植心脏的存活时间。     

Rel-A siRNA对大鼠树突状细胞的影响

目的 探讨siRNA沉默Rel-A基因表达对大鼠树突状细胞(DC)生物学效应的影响.方法 采用细胞因子诱导培养法体外扩增大鼠骨髓DC,经免疫磁珠纯化获得高纯度DC后, 针对Rel-A基因,采用半定量RT-PCR及Western blot分别从mRNA和蛋白质水平检测Rel-A的表达情况,筛选一对高效RNA干扰(RNAi)行慢病毒载体包装并转染DC(RNA干扰组), 以未转染RNAi的DC作为对照组.分别给予1mg/L的脂多糖(LPS)刺激,透射电镜观察RNAi对LPS促DC成熟的影响,并利用流式细胞术(FCM)检测DC表面CD80,CD86及MHC Ⅱ分子的变化;混合淋巴细胞反应(MLR)法检测T细胞增殖能力;ELISA法检测DC分泌肿瘤坏死因子α(TNF-α)、干扰素γ( IFN-γ)和白介素12( IL-12)的浓度.结果 与空白对照组相比, 序列2组降低最明显,抑制率达90%,差异有统计学意义;透射电镜下可见RNAi Rel-A DC内多吞噬泡样结构;RNA干扰组CD80,CD86,MHC Ⅱ分子的表达、T细胞增殖能力及TNF-α,IFN-γ,IL-12的浓度与对照组相比均显著下降. 结论 RNA干扰技术能显著下调大鼠Rel-A基因的表达, Rel-A基因沉默DC的生物学效应表现为未成熟DC的特点.这种RNAi Rel-A DC可望作为一种新型的致耐受DC,而应用于免疫耐受的诱导研究.     

输注转染FasL基因的供者树突状细胞减轻小鼠心脏移植排斥反应

目的 探讨转染FasL基因的供者树突状细胞(DC)对小鼠心脏移植排斥反应的影响.方法 分离并培养C57BL/6小鼠骨髓DC,然后采用脂质体法以自行构建的pTracer-FasL真核表达质粒转染DC.以C57BL/6小鼠为供者,Balb/c小鼠为受者,将其分为转染组(n=12)、未转染组(n=12)及移植对照组(n=12).转染组小鼠心脏移植前7 d经阴茎背静脉注射1×106个转染FasL基因的供者DC;未转染组小鼠心脏移植前7 d经阴茎背静脉注射1×106个未转染的供者DC;移植对照组仅行心脏移植,不接受供者DC输注.供心均移植于受者腹腔内.各组中,6只小鼠用于观察移植心脏存活时间,另6只于术后7 d处死,取移植心脏,进行组织学观察及移植心脏排斥反应病理分级.结果 转染组、未转染组和移植对照组小鼠移植心脏存活时间的中位数分别为20 d、8.5 d和9 d,转染组移植心脏的存活时间明显长于未转染组和移植对照组(P＜0.01).转染组中,2只排斥反应的病理分级为0级,4只为1级;未转染组中,2只为2级,4只为3级;移植对照组中,1只为2级,5只为3级.转染组排斥反应的病理分级明显低于移植对照组(P＜0.01).结论 受者于心脏移植前输注转染FasL基因的供者DC,可有效延长移植心脏的存活时间,并减轻排斥反应的程度.     

转染IKK2dn的受者树突状细胞回输延长同种异体肾移植大鼠的存活时间

目的 探讨IKK2dn基因转染并负载供者抗原的受者未成熟树突状细胞(imDC)延长同种异体肾移植大鼠的存活时间及其机制.方法 获取和培养Lewis大鼠骨髓源性DC,转染IKK2dn并负载BN大鼠可溶性抗原进行体外实验,检测CD86和主要组织相容性复合物(MHC)Ⅱ的表达及DC刺激T淋巴细胞增殖的能力.肾移植受者为Lewis大鼠,用随即数字表法分DC组、空转染组、转染组、对照组,术前7d分别输注1×10~7个D、Adv-0-DC、负载BN抗原的Adv-IKK2dn-DC和等量生理盐水,供者均为BN大鼠.另设第三方供者组,术前处理同转染组,供者为Wistar大鼠.移植后检测各组受者T淋巴细胞的增殖能力及血清白细胞介素2(IL-2)和γ干扰素(IFN-γ)的表达水平,观察各组大鼠的存活时间和发生排斥反应情况.结果 DC的体外实验结果显示:与转染IKK2dn前相比,转染后DC仍能低水平表达CD86和MHC Ⅱ,负载供者抗原后CD86和MHCⅡ表达均增加,而转染IKK2dn后再负载供者抗原,CD86和MHC Ⅱ的表达未发生明显变化;DC负载供者抗原后,刺激T淋巴细胞增殖的能力明显增强(P<0.05),而转染IKK2dn并负载供者抗原后不能有效刺激T淋巴细胞增殖.肾移植术后的检测结果显示:转染组T淋巴细胞的增殖能力明显低于其他4组(P<0.05或P相似文献   

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.     

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.     

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.     

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.