富血小板血浆对光老化皮肤成纤维细胞增殖的影响

目的探讨梯度浓度的富血小板血浆对光老化皮肤成纤维细胞增殖能力的影响。方法采用二次离心法制备富血小板血浆,利用紫外线照射的方法体外构建鼠的真皮成纤维细胞光老化模型,倒置相差显微镜观察在不同浓度富血小板血浆作用下,正常成纤维细胞以及光老化成纤维细胞的增殖情况。利用cck-8法测定不同浓度富血小板血浆培养条件下,正常成纤维细胞的生长曲线;利用细胞计数法计数不同时间段各组细胞数目。结果正常成纤维细胞在1%、5%及10%浓度富血小板血浆作用下,细胞增殖量明显多于阴性对照组。而对于光老化成纤维细胞,在加入低浓度的富血小板血浆(1%)后细胞数量增加,凋亡细胞数量减少;在加入高浓度的富血小板血浆(5%及10%)后,光老化成纤维细胞数量明显减少,凋亡细胞数量增加。结论在一定浓度范围内富血小板血浆对正常的成纤维细胞具有促进细胞增殖的作用,并且这种作用具有浓度依赖性。但对于光老化成纤维细胞,低浓度的富血小板血浆表现为减少光老化所致的细胞凋亡,而高浓度的富血小板血浆会加速光老化对成纤维细胞所造成的损伤。     

鱼藤素对胃癌细胞MKN-45增殖及凋亡的影响

目的:研究鱼藤素对胃癌细胞增殖及凋亡的影响。方法:利用CCK8检测不同浓度(0、1、10和25μmol/L)鱼藤素作用于胃癌细胞MKN-45 24、48、72和96 h后对其增殖的影响;AnnexinⅤ-FITC/PI检测细胞凋亡;流式细胞仪检测细胞周期;利用倒置相差显微镜观察鱼藤素作用后细胞形态的变化;DAPI及Hoechst染色观察细胞核变化。结果:1μmol/L鱼藤素作用于MKN-45细胞24 h后抑制率为(28.82±0.002)%。随着鱼藤素浓度(10、25μmol/L)增加,作用时间(48、72、96 h)延长,其抑制作用增加,表明其抑制作用呈时间-剂量依赖关系。不同浓度(1、10和25μmol/L)鱼藤素作用于细胞48 h后,早期凋亡率、晚期凋亡率和总凋亡率显示鱼藤素显著促进细胞凋亡。细胞周期检测发现,与对照组比较,1μmol/L鱼藤素作用于细胞48 h后,S期细胞比例升高,G_0/G_1期及G_2/M期细胞比例下降;10μmol/L鱼藤素作用于细胞48 h后,G_2/M期细胞比例升高,G_0/G_1期细胞比例下降(P     

17-DMAG体外对结肠癌HT-29细胞增生和凋亡的影响

目的 观察17-二甲胺乙胺基-17-去甲氧基格尔德霉素(17-dimethylaminoethylamino-17-demethoxygeldanamyein,17-DMAG)对人结肠癌HT-29细胞增生抑制及诱导其凋亡的作用.方法 用CCK-8检测17-DMAG对结肠癌HT-29细胞增生的影响;DAPI染色在倒置荧光显微镜下观察17-DMAG作用于HT-29细胞24 h后细胞核的形态;AnnexinV-FITC/PI双染法流式细胞检测细胞凋亡率;免疫印迹实验分析Caspase-3蛋白表达水平变化.结果 17-DMAG呈时间-剂量-依赖性抑制HT-29细胞增生.0.1μmol/L、0.25μmol/L 、0.5μmol/L、1.0μmol/L、2.5μmol/L和0.5μmol/L作用于HT-29细胞24 h后,细胞增生抑制率分别为(14.36±0.95)％、(22.17±1.15)％、(28.45±1.16)％、(35.04±1.58)％、(46.85±2.44)％和(57.19±2.06)％;作用48h后,细胞增生抑制率分别为(20.80±1.17)％、(27.55±0.65)％、(33.33±1.23)％、(46.20±4.76)％、(55.45±4.47)％和(61.75±2.72)％;作用72h,细胞增生抑制率分别为(29.62±2.27)％、(39.19±1.74)％、(44.29±2.00)％、(50.66±2.17)％、(58.84±3.18)％和(70.74±2.65)％.DAPI染色倒置荧光显微镜观察0.25μmol/L、0.5μmol/L、1.0μmol/L与2.5μmol/L的17-DMAG作用HT-29细胞24h,均可见到细胞凋亡的改变.AnnexinV-FITC双染法检测结果显示,正常对照组HT-29细胞24h的自然总凋亡率(早期+晚期)为(2.72±0.57)％,0.25μmol/L、0.5μmol/L、1.0μmol/L和2.5μmol/L 17-DMAG干预24 h后细胞总凋亡率分别为(5.38±0.46)％、(6.88±0.52)％、(10.44±0.32)％与(17.87±4.66)％,不同浓度组的细胞凋亡率比较差异有统计学意义(P＜0.05).17-DMAG药物作用HT-29细胞24h,随着药物剂量的增加,cleaved Caspase-3的表达有增加趋势.结论 17-DMAG体外呈时间-剂量依赖性抑制HT-29细胞增生,诱导其通过Caspase-3途径凋亡.     

褪黑素对老化卵母细胞体外发育能力的改善效果评价

目的探讨体外培养阶段(IVC)添加褪黑素(MT)对卵母细胞老化引起发育受损的改善效果。方法采用不同浓度的过氧化氢(H_2O_2)处理小鼠MII期卵母细胞诱导老化,浓度分别为0(对照组)、10、50、100、150μmol/L,体外受精(IVF)后统计各组二细胞率、囊胚形成率,检测老化卵母细胞的线粒体活性及丰度(Mitotracker Red、JC-1)、活性氧(ROS)水平、线粒体拷贝数等指标;在100μmol/L H_2O_2处理条件下,老化卵母细胞在IVF后的培养阶段分别添加不同浓度褪黑素(10-5、10-7、10-9 mol/L),统计二细胞率、囊胚率,并且分别检测各组获得囊胚的细胞数及凋亡率。结果不同浓度H_2O_2诱导卵母细胞老化后,囊胚发育率随H_2O_2浓度的升高而降低,50μmol/L和100μmol/L H_2O_2组囊胚形成率分别为(26.27±0.06)%和(28.46±3.45)%,相比对照组的(34.90±1.77)%显著降低,差异有统计学意义(P0.05);在H_2O_2诱导老化卵母细胞中,100μmol/L、150μmol/L H_2O_2浓度时,ROS水平相比对照组显著升高,差异具有统计学意义(P0.05);而活性线粒体的丰度及拷贝数呈现下降趋势,膜电位呈上升趋势,但相比对照组无显著性差异(P0.05);100μmol/L H_2O_2处理诱导卵母细胞老化后,在培养液中添加10-9 mol/L褪黑素组与老化对照组相比,囊胚率[(29.42±2.39)%vs.(20.87±4.12)%]、囊胚细胞数(39.36±9.78vs.37.91±4.25)均显著升高,凋亡率显著下降(2.57%vs.3.18%),差异均有统计学意义(P0.05);并且这些指标均达到与未经老化处理组的相似发育水平。结论老化卵母细胞体外受精后发育率和发育质量偏低的现象,可以通过在受精后体外培养阶段添加褪黑素得到改善。     

冬凌草甲素对瘢痕疙瘩成纤维细胞增殖和凋亡的影响

目的 探讨冬凌草甲素对瘢痕疙瘩成纤维细胞增殖和凋亡的影响及其诱导凋亡的机制.方法 采用不同浓度的冬凌草甲素作用于体外培养的成纤维细胞,在不同的时间用MTT法检测冬凌草甲素对瘢痕疙瘩成纤维细胞的增殖抑制作用,用Hoechst染色、流式细胞仪检测细胞凋亡及线粒体膜电位的变化,用比色法检测Caspase-3活性变化.结果 浓度为20、40、80 μmol/L冬凌草甲素加入瘢痕疙瘩成纤维细胞中48 h,其抑制率[(20.47±2.29)%、(25.44 d-2.62)%、(44.37±0.59)%]和凋亡率[(10.23±1.83)%、(16.03±2.21)%、(30.83 4-3.43)%]呈明显的浓度依赖性,与空白对照组比较,其差异有统计学意义(P<0.01);而线粒体膜电位的荧光强度(564.43±27.17、421.54±18.94、288.43±15.29)呈明显下降趋势,与空白对照组(757.24±28.86)比较,其差异有统计学意义(P<0.01);Caspase-3活性(33.46±3.97、45.43±10.87、68.44±15.32)呈明显增强趋势,与空白对照组(19.76±2.43)比较,其差异有统计学意义(P<0.01).结论 冬凌草甲素可抑制瘢痕疙瘩成纤维细胞的增殖,并呈明显的时间和浓度依赖性.其机制与降低线粒体膜电位继而诱导瘢痕疙瘩成纤维细胞凋亡有关.     

蛋白酶体抑制剂MG132诱导骨肉瘤细胞凋亡及其对p27Kip1蛋白表达的影响

目的探讨蛋白酶体抑制剂Z-LLL-CHO(MG132)对人骨肉瘤MG-63细胞诱导凋亡的作用及其对p27Kip1蛋白表达的影响。方法分别以不同浓度的蛋白酶体抑制剂MG132培养p53突变型人骨肉瘤MG-63细胞、正常二倍体成纤维细胞WI-38和p53野生型人骨肉瘤U2OS细胞。通过MTT法检测不同培养时间的细胞增殖活力、琼脂糖凝胶电泳检测细胞凋亡、流式细胞仪定量检测不同时间的细胞凋亡发生率、Westernblot检测p27Kip1表达情况。结果MG132能选择性抑制人骨肉瘤MG-63和U2OS细胞生长,IC50分别为(0.92±0.06)μmol/L及(0.33±0.05)μmol/L,均低于二倍体成纤维WI-38细胞(9.13±0.12)μmol/L。1μmol/LMG132处理MG-63细胞24h后,DNA琼脂糖凝胶电泳可检测到典型的“阶梯状”DNA条带,而WI-38细胞则为基因组DNA。流式细胞仪于1μmol/LMG132作用12h后检测到明显的亚G1峰(凋亡细胞峰),且存在时效关系。Westernblot发现,处理后p27Kip1蛋白表达明显上调。结论蛋白酶体抑制剂MG132在体外可选择性诱导人骨肉瘤MG-63细胞凋亡。p27Kip1蛋白在诱导MG-63细胞凋亡中可能起重要作用。     

环巴胺对人前列腺癌LNCaP细胞增殖和凋亡作用及对PCA3基因表达的影响

目的:探讨环巴胺对人前列腺癌LNCaP细胞增殖和凋亡的作用及对PCA3基因表达的影响。方法:不同浓度环巴胺(1、5、10、15μmol/L)干预LNCaP细胞,以只加入RPMI 1640培养液为空白对照组,分别在不同作用时间(24、48、72h),用MTT法检测其对细胞增殖的抑制、流式细胞术观察细胞凋亡率变化、Hoechst染色观察凋亡细胞形态变化、实时荧光定量逆转录聚合酶链反应(FQ-RT-PCR)观察对PCA3基因表达的影响。结果:5、10、15μmol/L环巴胺对LNCaP细胞增殖均有显著抑制作用,与空白对照组相比差异有显著性(P0.01),10μmol/L组于48h达到半数抑制量(IC50);10、15μmol/L组24、48、72hLNCaP细胞的凋亡率分别为37.21%、57.38%、57.98%和21.16%、71.31%、72.90%,与空白对照组相比差异均有显著性(P0.01)。随着环巴胺浓度增大和作用时间的延长,LNCaP细胞凋亡显著增加。PCA3基因的表达随着环巴胺浓度的上升呈现明显的递减趋势,较空白对照组显著降低(P0.01)。浓度为10μmol/L时,不同作用时间PCA3基因的表达均极低。结论:环巴胺浓度为10、15μmol/L作用48、72h时能够明显抑制LNCaP细胞的增殖,诱导细胞凋亡,并显著下调LNCaP细胞PCA3基因的表达。     

AMPK激动剂干预瘢痕疙瘩形成过程的实验研究

目的探索AMPK激动剂对瘢痕疙瘩(Keloid)形成过程的干扰作用,为瘢痕疙瘩的临床治疗提供新的思路。方法通过缺氧环境及不同浓度(0 ng/m L、2.5 ng/m L、5 ng/m L、10 ng/m L和20.0 ng/m L)TGF-β1诱导人皮肤成纤维细胞表型向瘢痕疙瘩相关细胞表型转化,并通过细胞形态学及Western blot检测来验证诱导结果。随后加入不同剂量(2.5μmol、5μmol、10μmol和20μmol)AMPK激动剂(A769662),通过细胞形态学观察、Western blot检测及ELISA检测,观察AMPK激动剂对人皮肤成纤维细胞表型向瘢痕疙瘩相关细胞表型转化的干预作用。结果在缺氧条件下及加入不同浓度TGF-β1后,人皮肤成纤维细胞形态会发生改变,纺锤形态丧失;在TGF-β1浓度不断增加至10 ng/m L的过程中,TGF-β1刺激人皮肤成纤维细胞增殖并向肌成纤维细胞转化;而浓度继续增加时,效果出现停滞并有逆转趋势;在同一TGF-β1浓度诱导下,随着加入AMPK激动剂剂量的增加,人皮肤成纤维细胞表型向瘢痕疙瘩相关细胞表型转化过程被逐步干预;在缺氧环境下,人皮肤成纤维细胞中VEGF和IL-6的表达均明显提高,在TGF-β1诱导下,VEGF和IL-6的合成进一步增加,而随着AMPK激动剂的添加,VEGF和IL-6的表达逐步减少。结论 AMPK激动剂能干预由缺氧及TGF-β1诱导的人皮肤成纤维细胞表型向瘢痕疙瘩相关细胞表型转化的过程。     

红景天对大鼠动脉内皮细胞及阴茎海绵体平滑肌细胞NO生成作用的研究

目的探索中药红景天有效成分—红景天甙在促进NOS的活性及增加老龄大鼠阴茎组织NO含量中的作用。方法通过对不同年龄大鼠主动脉内皮细胞(RAEC)和大鼠阴茎海绵体平滑肌细胞(RPCSMC)的培养及鉴定,综合运用不同方法测定NO、NOS在不同细胞、不同年龄阶段、不同药物干预浓度和时间作用下的表达。结果以48h为例,2、8、12月龄大鼠阴茎海绵体平滑肌细胞NO含量和NOS活性以及大鼠动脉内皮细胞NO含量和NOS活性间存在显著差异(P<0.01)。在红景天有效药物作用浓度(2.5mg)和有效作用时间(48h、12月龄为72h)下,老龄大鼠(8、12月龄)RPCSMC和RAEC释放NO的量(97.677±5.153)μmol/L,(97.457±3.594)μmol/L及(98.248±5.0851)μmol/L和NOS的量(1.778±0.066)U/mL,(1.738±0.074)U/mL,(1.773±0.044)U/mL和(1.792±0.046)U/mL,较正常年龄(2月龄)大鼠NO和NOS的量还略有升高(P<0.01)。结论(1)阴茎组织中海绵体平滑肌细胞中存在大量NOS,说明阴茎勃起与其自身海绵体产生NO有关;(2)年龄相关性ED与NOS不断减少从而引起NO释放减少密切相关;(3)红景天对AEC及SMC产生NO有积极促进作用,特别是对老龄大鼠细胞作用显著。     

一氧化氮合酶对增生性瘢痕影响意义的研究

目的观察一氧化氮合酶（Nitrogen oxide synthetase，NOS）在增生性瘢痕与正常皮肤组织及细胞中的表达特征及其差别．并通过应用NO供体或NOS抑制剂对培养的瘢痕成纤维细胞进行体外药物干扰，探索NO、NOS在增生性瘢痕形成中的作用。方法取临床增生性瘢犍下．术病人的瘢痕组织及周围少许正常皮肤，体外培养获得皮肤和穰痕成纤维细胞．通过免疫细胞化学及RT—PCR方法比较两种组织及细胞中NOS的表达及分布的差异。分别以100～500μM的NO供体硝普钠（Sodium nitroprusside，SNP）、NOS抑制剂N-硝基-L-精氨酸甲酯（L—Arginine methyl，L-NAME）作用于瘢痕成纤维细胞，观察细胞增殖的变化；并用免疫细胞化学和RT—PCR方法比较作用前后成纤维细胞中Ⅰ、Ⅲ型胶原表达的变化。结果免疫组化检测及RT—PCR方法检测显示增生性瘢痕组织及细胞中NOS表达相对于皮肤组织及成纤维细胞中明显减少（p〈0．05）。瘢痕细胞经SNP作用后，细胞增殖显著降低。免疫细胞化学方法和RT-PCR方法检测Ⅰ、Ⅲ型胶原结果显示，从SNP200μM组开始Ⅰ、Ⅲ型胶原表达显著降低（p〈0．05）。经L—NAME200μM作用后，Ⅰ、Ⅲ型胶原表达显著增加（p〈0．05）。结论增生性瘢痕组织及细胞中NOS含量较正常皮肤组织及细胞明显减少，NO供体SNP对体外培养的增生性瘢痕成纤维细胞增殖以及胶原表达起到抑制作用，NOS抑制剂L—NAME对其胶原表达则起到促进作用，结果提示NOS表达降低可能与瘢痕增生密切相关，因此改变NO的产生及NOS的活性可望调控瘢痕成纤维细胞的生物学行为．     

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.