DNA损伤修复基因XRCC1 rs25487单核苷酸多态性与男性不育关系的Meta分析

目的通过Meta分析系统评价DNA损伤修复基因XRCC1 rs25487基因多态性与男性不育的相关性。方法通过检索PubMed、CBM、中国知网及万方数据库中关于XRCC1 rs25487基因多态性与男性不育相关性的病例对照研究,由两名独立研究者按照纳入及排除标准获取文献,收集相关数据。采用Review Manager 5.3软件对纳入文献进行数据处理,通过5种比较模型分析XRCC1 rs25487多态性与男性不育发生之间的相关性。结果共纳入符合标准的7篇文献,包含病例组1 579例和对照组1 013例。Meta分析结果显示XRCC1 rs25487多态性与男性不育发生之间无明显相关性。5种比较模型中,等位基因模型A vs. G:OR=1.06,95%CI(0.83,1.36),P=0.64;显性模型AA+AG vs. GG:OR=1.08,95%CI(0.76,1.54),P=0.67;隐性模型AA vs. GG+AG:OR=1.03,95%CI(0.77,1.36),P=0.85;纯合模型AA vs. GG:OR=1.03,95%CI(0.77,1.36),P=0.85;杂合模型AG vs. GG:OR=1.04,95%CI(0.72,1.51),P=0.82。以种族和病例数(200或200)进行亚组分析,结果显示5种模型下差异均无统计学意义(P0.05)。结论 DNA损伤修复基因XRCC1 rs25487位点多态性与男性不育发生之间无明显相关性。     

修复基因XRCC4多态性与膀胱癌易感性的Meta分析

目的 探讨XRCC4单核苷酸多态性与膀胱癌发病易感性的关联。方法 通过检索PubMed、CNKI和万方数据库,检索从1960年1月1日至2015年12月31日国内外已经公开发表的中、英文献,筛选合格文献行Meta分析。结果 最终纳入关于XRCC4基因多态性与膀胱癌易感性关联的病例-对照研究10项,计病例组2 689例,对照组2 915例。Meta分析结果显示,XRCC4基因rs28360317和rs1805377多态性位点与膀胱癌显著相关(rs28360317:B vs.A:OR=1.339,95%CI:1.088~1.649,P=0.006;BBvs.AA:OR=1.729,95%CI:1.137~2.629,P=0.010;BBvs.BA+AA:OR=1.638,95%CI:1.144~2.346,P=0.007;rs1805377:BAvs.AA:OR:1.242,95%CI:1.041~1.482,P=0.016;BA+BB vs.AA:OR=1.216,95%CI:1.023~1.445,P=0.027。以种族为依据的亚组分析揭示,XRCC4基因rs1805377多态性在高加索人群中与膀胱癌发病显著相关:B vs.A:OR=1.295,95%CI:1.070~1.566,P=0.008;BAvs.AA:OR=1.362,95%CI:1.101~1.684,P=0.004;BA+BB vs.AA:OR=1.348,95%CI:1.096~1.659,P=0.005。然而,XRCC4基因rs6869366和rs28360071多态性位点与膀胱癌的易感性无关。结论 XRCC4基因rs28360317和rs1805377单核苷酸多态性与膀胱癌发病风险呈显著正相关,可作为膀胱癌患者潜在诊断、筛查分子标志物。     

X线交错互补修复基因1和核苷酸剪切修复基因多态性与前列腺癌发病风险的相关性

目的 探讨DNA损伤修复基因X线交错互补修复基因1(XRCCI)、核苷酸剪切修复基因(XPD)基因多态性与前列腺癌发病风险的关系. 方法 以358例前列腺癌患者和312例健康对照者为研究对象,采用聚合酶链反应一限制性片段长度多态技术检测XRCC1 C26304T、G28152A和XPD A35931C位点基因型,以非条件logistic回归分析计算比值比(OR)及95%可信区间(CI),评估不同基因型与前列腺癌风险之间的相关性. 结果 前列腺癌组XRCC1 28152位点AA基因型者47例(13.1%),对照组24例(7.1%),携带此基因型者患前列腺癌风险显著增加(OR 1.924,95%CI=1.126～3.288,P=0.017).2组间XRCC1 C26304T和XPD A35931C位点基因型分布差异无统计学意义.3个基因位点联合分析结果 显示,个体携带XRCCI 28152AA型及XPD 35931AC+CC型者发生前列腺癌风险显著增加(OR=3.087,95%CI 1.081～8.813;OR=3.376,95%CI 1.067～10.683,OR 3.216,95%CI=1.439～7.188,P=0.004).以患者年龄、PSA值、Gleason评分以及临床分期分层分析结果 显示,携带XRCC1 28152AA及XPD 35931AC+CC基因型者发病年龄明显低于携带野生基因型者(P<0.05). 结论 中国汉族人群XRCCl和XPD基因多态与前列腺癌发病有关,尤其是较年轻者.     

含缬酪肽蛋白基因单核苷酸多态性在肝细胞癌中的研究

目的:探讨含缬酪肽蛋白(valosin containing protein,VCP)基因不同位点单核苷酸多态性(single nucleotide polymorphism,SNP)与肝细胞癌(hepatocellular carcinoma,HCC)的关系。方法:采用病例组与对照组研究,收集122例HCC(HCC组)和120例非HCC(对照组)外周血标本,对VCP基因的4个标签SNPs采用直接测序法进行基因测定分型。采用卡方检验比较基因型及等位基因在HCC组与对照组之间分布的差异,采用非条件Logistic回归分析多态基因型与HCC的关系。结果:rs546982位点等位基因及基因型在HCC组与对照组中的分布具有显著性差异(P<0.05)。携带rs546982位点AA基因型者比GG基因型者发生HCC风险低,而携带AA基因型的HCC病人比携带GG基因型的HCC病人发生脉管癌栓及淋巴结转移的风险高。位点rs2074549、rs607671、rs10972300的基因型在HCC组和对照组之间差异无统计学意义。结论:VCP基因多态性与HCC存在关联,rs546982位点AA基因型可降低HCC发生率,但可增加HCC病人的淋巴结转移及脉管癌栓的风险。     

苏、皖地区汉族人群DNA修复基因XRCC1 Arg399Gln多态性与前列腺癌易感性的关系

目的:研究中国苏、皖汉族人群DNA修复基因X线修复交叉互补基因1(X-ray repair cross complementing group 1,XRCC1)Arg399Gln多态性,并探讨其在吸烟、饮酒与前列腺癌易感性关系中的影响。方法:采用病例-对照研究,提取207例前列腺癌患者(病例组)和235例非肿瘤、非前列腺疾病患者(对照组)外周血中基因组DNA,应用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)分析病例组和对照组的XRCC1基因Arg399Gln位点的多态性,比较不同基因型与前列腺癌易感性的关系,并探讨吸烟、饮酒等因素在其中的影响。结果:XRCC1第399密码子Arg/Gln基因型的个体其前列腺癌发病风险是Arg/Arg基因型的1.55倍(OR=1.55,95%CI:1.01~2.39),携带399Gln等位基因(Arg/Gln及Gln/Gln)的个体发生前列腺癌的风险性是Arg/Arg基因型的1.61倍(OR=1.61,95%CI:1.07~2.44)。在重度吸烟(吸烟指数≥20)人群中,携带399Gln等位基因的个体发生前列腺癌的风险性是Arg/Arg基因型的1.94倍(OR=1.94,95%CI:1.02~3.71)。在浅吸烟(吸烟仅入嘴中)人群中,携带399Gln等位基因的个体发生前列腺癌的风险性是Arg/Arg基因型的2.44倍(OR=2.44,95%CI:1.02~5.80)。结论:XRCC1 Arg399Gln位点多态性可能对前列腺癌遗传易感性产生影响,Arg/Gln、Gln/Gln可能是前列腺癌的易感基因型,并和吸烟在前列腺癌的发病中有一定的协同作用。     

CIGALTl基因多态性与维吾尔族IgA肾病易感性的关联性分析

目的探讨β1,3-转移酶（C1GALTl）基因单核苷酸位点（SNP）rs9639031、rs5882115多态性与新疆维吾尔族IgA肾病（IgA ephropathy,IgAN）遗传易感性的关系。方法选取经肾活检明确诊断为IgAN的90例维吾尔族患者为实验组,以同期在同一医院体检的90例维吾尔族健康体检者作为对照组,2组的性别和年龄等相匹配。采集纳入研究对象的外周血,提取DNA,应用PCR法扩增C1GALT1因上2个SNP分别为rs9639031、rs5882115位点对应的基因片段;采用直接测序法检测2个SNP位点的基因型,分析rs9639031、rs5882115基因型及基因频率在2组间分布的差异,进一步分析C1GAT态性与IgAN发病的关系。结果（1）C1GALT1因SNPrs5882115中各基因型、等位基因频率在IgAN组与对照组的分布有显著性差异（基因型P=0．014,等位基因P=0．005）。IgAN组DI、Ⅱ型频率（32．2％、2．2％）较对照组（14．4％、1．1％）高,对照组DE）型频率（84．4％）较IgAN组（65．6％）高。单因素Logist回归分析显示,rs5882115多态性对IgAN患病风险可能有影响（P=0．005）,携带DI基因型的患病风险为携带DD基因型的2．874倍（OR=2．874,95％CI=1．3756．007）,而携带I等位基因的患病风险亦较携带D等位基因高（OR=2．469,95％CI=1．290～４.728）。（2）C1GALT1基因rs9639031中,IgAN组CC、CT、TT基因型及c、T等位基因频率分别为40．0％、42．2％、17．8％、61．1％、38．9％,对照组分别为32．2％、46．7oA、21．1％、55．6％、44．4％,但差异无统计学意义（P〉0．05）。结论C1GALTl基因上的SNP位点rs5882115多态性可能与维吾尔族IgAN发病风险有一定关系,但未发现C1GALT1基因上的SNP位点rs9639031多态性与维吾尔族IgAN发病风险的关联性。     

IL-17基因rs2275913多态性与胃癌易感性的Meta分析

目的:探讨IL-17基因rs2275913多态性与胃癌易感性的关系。方法:检索多个国内外数据库,收集有关IL-17基因GA多态性位点rs2275913(G197A)与胃癌易感性的病例-对照研究。筛选文献、提取数据和文献质量评价后,采用STATA 12.1统计软件进行Meta分析。结果:最终纳入10个病例-对照研究,其中病例组4 371例,对照组5 345例。Meta分析结果显示,IL-17基因rs2275913位点多态性的等位基因模型(A vs.G)(OR=1.22,95%CI=1.10~1.37)与相加模型(AA vs.GG)(OR=1.58,95%CI=1.23~2.04)胃癌风险增加,显性模型(AG+GG vs.AA)(OR=0.63,95%CI=0.48~0.84)、隐性模型(GG vs.AG+AA)(OR=0.86,95%CI=0.78~0.94)胃癌风险降低(均P0.05),但共显性模型(AG vs.AA+GG)(OR=0.91,95%CI=0.78~1.07)与罹患胃癌的风险无明显关系(P0.05)。结论:IL-17基因rs2275913多态性的与胃癌易感性密切相关。     

Klotho基因多态性与糖尿病肾病中医证候的相关性分析

目的:研究Klotho基因多态性与2型糖尿病、糖尿病肾病发病风险及糖尿病肾病中医证候之间的关联,筛选可能的易感基因型,以期对潜在高危患者及时防治。方法:采用PCR联合直接测序技术检测56例T2DM,67例T2DN,55例健康对照组的Klotho G-395A位点单核苷酸多态性。结果:G-395A不同基因型及等位基因分布频率在病例组和健康对照组间差异无统计学意义(P=0.274;P=0.298);而在T2DM组和T2DN组间比较,差异有统计学意义(P=0.025;P=0.015);Logistic回归分析结果:携带A等位基因、高血压病史、糖尿病病程及糖化血红蛋白与DN的发生有统计学关联(P0.01)。T2DN组三种中医证候间GA+AA基因型及A等位基因频率分布有显著差别,具有统计学意义(P=0.013;P=0.037)。结论:本课题未发现G-395A位点多态性与T2DM的发病风险存在关联性;携带A等位基因可能是湖北地区汉族人群T2DM患者合并肾损害的独立危险因素之一,而GA及AA基因型可能是糖尿病肾病的遗传易感危险基因型。携带A等位基因可能是脾肾阳虚型糖尿病肾病的风险因素之一。     

云南汉族非综合征性唇腭裂与p53基因多态性的相关性研究

目的:分析p53基因单核苷酸多态性(SNPs)位点的多态性,探究云南汉族非综合征性唇腭裂与p53基因的相关性。方法:选取2016年1月-2018年12月于笔者医院就诊的非综合征性唇腭裂患儿100例为试验组,选取医院同期无先天性畸形正常患儿100例为对照组。采用Taqman探针荧光定量PCR法对p53基因的SNPs位点rs12947788和rs1042522进行基因分型,并用χ^2检验和Logistic回归分析多态位点与非综合征性唇腭裂的相关性。结果:p53的基因SNPs位点rs12947788的等位基因变体A携带者(AA+GA vs GG)发生非综合征性唇腭裂的风险增加(OR=1.393,95%CI 1.030~1.884,P=0.032)。rs1042522(CC vs CG+GG)增加吸烟者母亲生下NSCL/P患儿的风险(OR=2.561,95%CI=1.146~5.721,P=0.022)。rs12947788(AA+GA vs GG)可明显增加有饮酒史母亲(OR=3.235,95%CI=1.158~9.040,P=0.025)生下NSCL/P患儿的风险。结论:云南汉族人群非综合征性唇腭裂与p53基因rs1042522、rs12947788多态具有一定的相关性。     

表皮生长因子5'非编码区rs4444903单核苷酸多态性与儿童肾母细胞瘤易感性及预后因素的研究

目的 研究表皮生长因子(epidermal growth factor,EGF)5'非编码区rs4444903单核苷酸多态性(SNP)与儿童肾母细胞瘤易感性及病理分期的关系.方法 采用病例对照研究,收集临床病理确诊的儿童肾母细胞瘤外周血96例,及正常同龄儿童外周血200例,应用聚合酶链反应-连接酶特异检测技术(PCR-LDR)分析两组儿童外周血DNA中EGF rs444490位点的多态性,比较不同基因型与前列腺癌易感性及病理分期的关系.结果 Logistic回归分析显示,儿童携带EGF rs4444903 GG和GG+ GA基因型能增加罹患肾母细胞瘤的风险(OR =2.45,95％CI=1.12～4.87,OR=1.25,95％ CI=1.08～ 2.34,P＜0.05),与患儿病理分期呈正相关(Ⅲ-Ⅴ期vs Ⅰ-Ⅱ期:OR =2.28,95％ CI=1.30 ～4.48,P＜0.01),并且GG/GA携带者其EGF血清表达亦增高(P＜0.05).结论 EGFrs444490位点多态性与肾母细胞瘤易感性及其预后相关,携带GG/GA基因型的肾母细胞瘤患儿预后较差.     

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.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

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.