健脾方对去势大鼠维生素D代谢的影响

目的采用放射免疫方法与分子生物学方法从VitD代谢的角度探讨健脾方防治原发性骨质疏松症的机制。方法建立卵巢切除致骨质疏松大鼠模型,运用骨组织病理学、血液生物化学等方法综合观察健脾方对模型大鼠骨密度、尿吡啶酚（PYD）和血清骨钙素（BGP）的影响;同时应用放射免疫方法与逆转录聚合酶链式反应观察健脾方对模型大鼠血清1,25（OH）2D3和小肠、肾脏组织维生素D受体基因（VDR mRNA）表达的影响。结果健脾方能升高模型大鼠的骨密度,降低模型大鼠血清1,25（OH）2D3的含量（P〈0.05）,同时能上调模型大鼠小肠、肾脏VDR mRNA的表达。结论健脾方能增强机体对血清1,25（OH）2D3反应敏感性,上调小肠与肾脏VDR mRNA的表达,调节VitD代谢。     

1，25（OH）2D3对脂多糖作用下大鼠腹膜间皮细胞维生素D受体及肿瘤坏死因子α、转化生长因子β1表达的影响

目的 研究脂多糖（LPS）对大鼠腹膜间皮细胞（RPMC）维生素D受体(VDR)及肿瘤坏死因子α（TNF-α）、转化生长因子β1（TGF-β1）表达的影响,从而为1,25（OH）2D3在腹膜透析相关腹膜炎中的应用提供理论依据。 方法 胰蛋白酶消化法原代培养腹膜间皮细胞、传代、经鉴定后分组：(1)正常对照组;(2)脂多糖组：不同浓度的脂多糖（1、10、100 mg/L）分别作用6 h;10 mg/L脂多糖分别作用2、6、12 h;(3)1,25（OH）2D3作用组：10 mg/L脂多糖预孵育2 h后,加1,25（OH）2D3(10－8 mol/L、10－7 mol/L、10－6 mol/L)再作用6 h。RT-PCR法检测VDR mRNA的表达;Western印迹法检测VDR蛋白表达;ELISA法检测上清液TNF-α、TGF-β1的表达。 结果 与对照组相比,LPS组RPMC VDR mRNA和蛋白表达均显著下调（均P < 0.05）。与LPS组相比,1,25（OH）2D3组VDR mRNA和蛋白表达均显著上调（均P < 0.01）。LPS组上清液中TNF-α、TGF-β1浓度均显著高于对照组（均P < 0.01）;1,25（OH）2D3组上清液中TNF-α、TGF-β1浓度均显著低于LPS组（均P < 0.01）。 结论 LPS能下调RPMC VDR mRNA和蛋白的表达,上调TNF-α、TGF-β1表达。1,25（OH）2D3可逆转LPS的作用,上调RPMC VDR mRNA和蛋白的表达,并下调TNF-α、TGF-β1表达。VDR对腹膜透析相关腹膜炎具有一定的保护作用,并具有抑制腹膜纤维化的作用。     

纳米钙补肾中药对骨质疏松症大鼠肠黏膜中 1，25(OH)2D3受体的mRNA和蛋白表达影响

目的研究骨质疏松症大鼠肠黏膜中维生素1,25(OH)2D3受体的mRNA和蛋白表达,揭示骨质疏松症的发病机制;同时,阐述纳米钙补肾中药的调节作用机制。方法切除大鼠双侧卵巢的方法复制骨质疏松症模型,采用纳米钙组及具有益肾填精、补钙壮骨作用的纳米钙补肾中药(大、中、小)剂量对实验大鼠治疗12周,以骨疏康颗粒剂、雌二醇(E2)及钙尔奇D600作为阳性对照组,正常大鼠和模型空白组为空白对照组;用PCR法、Western印迹法检测骨质疏松症大鼠肠黏膜中维生素1,25(OH)2D3受体的mRNA和蛋白表达。结果RT-PCR及Western方法检测,正常大鼠肠黏膜中含有维生素1,25(OH)2D3受体的mRNA和蛋白表达;模型空白组大鼠肠黏膜组织中的mRNA和蛋白表达水平有明显的下降。纳米钙、纳米钙补肾中药各剂量组、钙尔奇D600组、骨疏康和雌二醇E2组用药后12周,与模型空白组比较,可不同程度上调肠黏膜组织中的mRNA和蛋白表达水平。但其中各治疗用药组的效果有所不同,一般表现为纳米钙补肾中药剂量组作用较好。结论①正常大鼠肠黏膜组织可以在基因、蛋白水平表达维生素1,25(OH)2D3受体,而且在肠钙吸收中可能起到重要作用。②大鼠骨质疏松症的发生,与肠黏膜组织中维生素1,25(OH)2D3受体的mRNA和蛋白表达的变化有关,从而影响肠钙的吸收。③纳米钙补肾中药通过调控大鼠肠黏膜维生素1,25(OH)2D3受体的mRNA和蛋白表达,促进肠钙的吸收,对于骨质疏松症有一定的防治作用。     

健骨颗粒对去卵巢骨质疏松模型鼠钙调节激素的影响

目的:探讨健骨颗粒对骨质疏松模型鼠三种主要钙调节激素水平的影响.方法:切除雌性大鼠卵巢建立绝经后骨质疏松症病理模型,分别喂服健骨颗粒、骨松宝和生理盐水,用放射免疫测定法检测血清甲状旁腺激素(PTH)、1,25-二羟维生素D3[1,25-(OH)2D3]、降钙素(CT)和雌二醇(E2)水平.结果:卵巢切除后随着血清E2水平的下降,1,25-(OH)2D3、CT含量明显下降(P＜0.01或P＜0.05),而PTH却显著上升(P＜0.01).用药后健骨颗粒组血清1,25-(OH)2D3、CT水平显著回升(P＜0.01或P＜0.05),而PTH浓度出现下降(P＜0.01).E2与CT、1,25-(OH)2D3呈正相关,而与PTH呈负相关;PTH与1,25-(OH)2D3、CT呈负相关,1,25-(OH)2D3与CT呈正相关.结论:健骨颗粒能通过协调骨质疏松模型鼠血清PTH、1,25-(OH)2D3、CT三种钙调节激素浓度,改善因E2下降对骨代谢产生的副作用,这可能是健骨颗粒有效防治骨质疏松症的主要作用机制之一.     

维生素D分子机制及其与成纤维生长因子23、Klotho 相关性的新进展

维生素D（ VD）的经典作用为调节钙磷和骨代谢,同时还与免疫系统、细胞增殖和分化等有重要联系。1α,25－羟基维生素D（1,25（OH）D）配体结合维生素D受体（VDR）引发VDR与维甲酸X受体（RXR）紧密结合,且配体结合的VDR－RXR异二聚体识别VD调控基因序列中的维生素D应答元件（VDREs）。虽然1,25（OH）D－VDR可通过非基因机制快速发挥作用,但1,25（OH）D－VDR主要通过基因机制实现功能。1,25（OH）D－VDR可控制基因转录,VD配体、VDRE的DNA序列以及招募的共激活因子／共阻遏因子都能影响基因表达。1,25（OH）D－VDR调节基因的VDREs具有重要功能。通过推测RANKL基因染色质成环模型表明DNA成环和染色质的结构在VD调节基因表达的作用中发挥主要作用。1,25（OH）D－VDR调节基因表达可以延缓衰老和老年性疾病,比如癌症、2型糖尿病和心血管疾病。针对VD在磷酸盐代谢与衰老方面的关系已有了新的认识,认为1,25（OH）D－VDR诱导的骨骼中FGF23和肾脏中Klotho蛋白在该代谢途径中发挥重要作用,VD调节磷酸盐稳态可能是延缓衰老及相关慢性疾病的机制。     

Effects of donkey-hide glue reinforcing bone oral solution on serum 25-OH-VD3、1，25-(OH )2-VD3 concentration and the expression of VDR in rats

目的 研究阿胶强骨口服液(donkey-hide glue reinforcing bone oral solution, DGRBOS) 对SD大鼠血液25-羟基维生素D3 (25-OH-VD3)、1,25-羟基维生素D3(1,25-(OH)2-VD3)和肝脏VDR基因表达的影响,探讨DGRBOS治疗骨质疏松的疗效机制.方法 6月龄SD大鼠36只, 随机分为A组(假手术组),B组(卵巢切除+生理盐水组),C组(卵巢切除+阿胶强骨口服液组),每组12只.6个月后取材检测.采用ELISA法对去势大鼠血清25-OH-VD3和1,25-(OH)2-VD3进行研究,用荧光定量PCR对肝脏VDR基因进行定量分析.结果 C组(卵巢切除+阿胶强骨口服液组)血液中25-羟基维他命D3浓度和1,25-羟基维他命D3浓度与B组(卵巢切除+生理盐水组)比较明显增高,其中对25-羟基维他命D3浓度增高尤为明显,已接近A组(假手术组),P=0.002(P＜0.01),差异有明显的统计学意义.荧光定量PCR(FQ-PCR)结果B 组与C组相比,P=0.004(P＜0.01),说明扩增效率的差异有明显的统计学意义.结论 阿胶强骨口服液增加去势大鼠血液中25-OH-VD3、1,25-(OH)2-VD3的浓度,同时上调肝脏中VDR的表达水平,是阿胶强骨口服液治疗骨质疏松的机制之一.     

硫化氢在肠缺血-再灌注损伤大鼠肠黏膜屏障功能障碍中的作用

目的 观察硫化氢(H_2S)在肠缺血.再灌注损伤大鼠肠黏膜屏障功能障碍中的作用.方法 雄性Wistar大鼠24只,分为S(假手术)组、Ⅰ(缺血-再灌注)组,N(缺血-再灌注+NaHS)组(n=8),N组在再灌注前10 min静脉注射100 μmol/kg NaHs后按每小时1 mg/kg持续静脉注射直到再灌注2 h,S和Ⅰ组静脉注射相同体积的生理盐水.采用改良的酶学分光光度法测定血浆D-乳酸水平,采用分光光度法检测小肠黏膜超氧化物歧化酶(SOD)和髓过氧化物酶(MPO)、丙二醛(MDA)、黄嘌呤氧化酶(XO)水平,敏感硫电极法检测硫化氢(H_2S)浓度.电镜下观察肠黏膜形态学改变,TUNEL染色观察小肠上皮细胞凋亡指数(AI),逆转录.聚合酶链反应(RT-PCR)法检测小肠黏膜组织胱硫醚-γ-裂解酶(CSE)、胱硫醚-β-合酶(CBS)、多聚ADP核糖合成酶(PARP)和细胞凋亡蛋白酶(Caspase)-3 mRNA的表达,蛋白质印迹法检测小肠黏膜PARP和Caspase-3蛋白水平.结果 N组D-乳酸含量、AI分别为(2.35±0.26)mg/L、(24.41±2.76)%,低于Ⅰ组、高于S组(P<0.01),两者正相关(r=0.892,P<0.01);N组MDA、XO分别为(9.17±0.35)nmol/mg、(9.94±0.41)U/g,低于Ⅰ组、高于S组(P<0.01),两者正相关(r=0.995,P<0.01);N组CSE mRNA、H_2S、SOD、MPO分别为(0.33±0.02)μmol/L、(35.27±3.14)μmol/L、(8.83±0.29)U/mg、(5.95±0.49)U/mg;N组CSE mRNA、H_2S、SOD水平均低于S组(P<0.01),N组H2S、SOD水平均高于Ⅰ组(P<0.01),N组MPO水平高于S组、低于Ⅰ组(P<0.01);N组活化的Caspase-3、PARP蛋白表达量分别为11.50±1.25、9.37±1.18,高于s组、低于Ⅰ组(P<0.01),两者正相关(r=0.785,P<0.01).结论 H_2S对肠缺血再灌注损伤大鼠肠黏膜屏障功能障碍有保护作用,其机制之一是减少中性粒细胞浸润和激活、肠上皮细胞氧化损伤水平,增加SOD清除氧自由基的活性,下调活化的Caspase-3和PARP蛋白表达.     

儿童高钙尿症的临床意义

高钙尿症,特别是特发性高钙尿症是儿童尿路疾患的一种病因。Rofer和Maly报告正常儿童尿钙排钙<4 mg/kg体重/24小时。作者从随机尿标本中测定尿钙/肌酐(Ca/Cr)含量比率(mg/kg),发现3个月～18岁儿童正常Ca/Cr比率为0.06±0.06。此值与Stapelton对6～13岁儿童研究结果相似。比率大于0.18将初步诊断为高钙尿症,如尿钙排泄量>4毫克/公斤体重/24小时则可确诊。儿童高钙尿症常见病因是:制动、速尿或利尿酸     

活性维生素D3及其类似物的足细胞保护作用研究进展

近年来研究发现1,25-二羟维生素D3（1,25-（OH）2D3）及其类似物具有独立于钙磷调节之外的许多功能,这些功能是结合细胞内维生素D受体（vitamin D receptor,VDR）后发挥作用的.而足细胞是维持肾小球功能的重要细胞,足细胞上表达VDR.因此1,25-（OH）2D3及其类似物与足细胞功能之间的相互关系值得探索.本文就近年来活性维生素D3及其类似物对足细胞的保护作用研究进展作一介绍.     

1,25-(OH)2D3对小鼠皮肤移植后脾T细胞亚群、MLR及NK细胞活性的影响

目的探讨1,25-二羟维生素D3[1,25-(OH)2D3]抑制机体免疫功能的机理,为用于临床抗排斥治疗提供实验依据.方法建立不同系小鼠间皮肤移植的动物模型.术日将实验小鼠随机分为四组,均用小鼠灌胃器给药.对照组:每日20ml/kg生理盐水; 维生素D3(VD3)组:单独应用1,25-(OH)2D3 2.5μg*kg-1*d-1; 环孢素A(CsA)组:单独应用CsA 25mg*kg-1*d-1; VD3+CsA组:联合应用VD3+CsA,按VD3组和CsA组用药剂量给药.术后10d,测定小鼠脾的T细胞亚群、单向混合淋巴细胞反应(MLR)、自然杀伤细胞(NK)活性.结果 VD3组的移植皮片存活时间(13.13±1.13)d,明显长于对照组的(9.75±0.89)d;CD3+、CD4+ T细胞百分率40.19%±4.25%、24.65%±3.47%均明显低于对照组48.70%±7.19%、 33.55%±4.34%,P<0.01;对BALB/C鼠的MLR(0.95±0.12)明显低于对照组(1.19±0.22),P<0.05; NK细胞的活性与对照组小鼠比较, 差异无显著性.结论 1,25-(OH)2D3能延长小鼠皮肤移植的存活时间,其抑制机体免疫功能的作用是通过减少CD3+、CD4+ T细胞的数量及抑制T细胞功能而发挥的,对NK细胞活性无明显影响.     

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.