静脉注射骨髓间质干细胞对脊髓损伤修复作用的实验研究

目的探讨静脉注射大鼠骨髓间质干细胞(MSCs)对脊髓损伤后神经修复和功能恢复的影响。方法32只SD大鼠,体重约300g,雌雄不限。体外分离、培养、纯化MSCs,应用流式细胞技术检测MSCs表面细胞标志CD34、CD45、CD29、CD90。根据改良Allen法制备大鼠脊髓损伤模型。暴露T10段脊髓,将一直径为3mm的圆形薄铜垫片置于T10段脊髓表面,以重量为10g的砝码,从5cm高度自由坠落打击该垫片,造成T10段脊髓冲击伤,损伤组24只,假手术组8只。模型建立后24h,损伤组随机分为实验组14只,对照组10只。实验组及假手术组经尾静脉注射Brdu标记的MSCs,对照组经静脉注射PBS。损伤后24h、注射MSCs后1、3、5周评价各组大鼠的神经功能状况,并检测MSCs在体内迁移、存活以及分化情况。结果细胞CD34、CD45阴性表达,CD29、CD90阳性表达。实验组运动功能改善,BBB评分高于对照组(P<0.05)。注射的MSCs在宿主损伤脊髓中聚集并存活,注射MSCs3～5周后部分细胞表达微管相关蛋白2(MAP2)、神经元特异性烯醇化酶(NSE)染色的Brdu阳性细胞。结论MSCs经静脉注射后可向脊髓损伤处聚集并存活,促进神经修复及神经功能的恢复。     

胃肠道恶性肿瘤术后腹腔内温热化疗灌注的应用

目的:探讨胃肠道恶性肿瘤术后采用腹腔内温热化疗的疗效。方法:选择Ⅱ～Ⅳ期胃肠道恶性肿瘤术后患者60例,32例作为治疗组,采用腹腔内温热化疗 静脉化疗,28例作为对照组,采用常规静脉化疗。结果:治疗组腹腔复发率及转移率明显低于对照组(P<0.01)。治疗组3年及5年的生存率明显高于对照组(P<0.01)。结论:胃肠道恶性肿瘤术后腹腔内温热化疗 静脉化疗,不但能有效降低胃肠道恶性肿瘤术后腹腔复发及转移,而且能提高3年及5年的生存率。     

Quantification of exhaled propofol is not feasible during single-lung ventilation using double-lumen tubes: A multicenter prospective observational trial

Background

Volatile propofol can be measured in exhaled air and correlates to plasma concentrations with a time delay. However, the effect of single-lung ventilation on exhaled propofol is unclear. Therefore, our goal was to evaluate exhaled propofol concentrations during single-lung compared to double-lung ventilation using double-lumen tubes.

Methods

In a first step, we quantified adhesion of volatile propofol to the inner surface of double-lumen tubes during double- and single-lumen ventilation in vitro. In a second step, we enrolled 30 patients scheduled for lung surgery in two study centers. Anesthesia was provided with propofol and remifentanil. We utilized left-sided double-lumen tubes to separately ventilate each lung. Exhaled propofol concentrations were measured at 1-min intervals and plasma for propofol analyses was sampled every 20 min. To eliminate the influence of dosing on volatile propofol concentration, exhalation rate was normalized to plasma concentration.

Results

In-vitro ventilation of double-lumen tubes resulted in increasing propofol concentrations at the distal end of the tube over time. In vitro clamping the bronchial lumen led to an even more pronounced increase (Δ AUC +62%) in propofol gas concentration over time. Normalized propofol exhalation during lung surgery was 31% higher during single-lung compared to double-lung ventilation.

Conclusion

During single-lung ventilation, propofol concentration in exhaled air, in contrast to our expectations, increased by approximately one third. However, this observation might not be affected by change in perfusion-ventilation during single-lung ventilation but rather arises from reduced propofol absorption on the inner surface area of the double-lumen tube. Thus, it is only possible to utilize exhaled propofol concentration to a limited extent during single-lung ventilation.

Registration of Clinical Trial

DRKS-ID DRKS00014788 ( www.drks.de ).     

Gamma-hydroxybutyric acid: an emerging recreational drug

Gamma-hydroxybutyric acid (GHB) is no longer used as an anaesthetic induction agent because of the high incidence of myoclonic seizures and vomiting. However, it is used occasionally in Europe for the treatment of narcolepsy, alcohol dependence and opiate dependence. Since the early 1990s, GHB has become a drug of abuse in youths for its euphoric, sedative and anabolic effects. Common adverse effects include a rapid onset of drowsiness, nausea, vomiting, myoclonic seizures and coma of short duration. Clinicians should be alert for these adverse effects and consider the possibility of GHB abuse in young adults with unusual clinical presentations in the emergency department.     

Middle-ear pressure variations during total intravenous anesthesia with propofol, fentanyl, and ketamine

Purpose As the middle-ear cavity is one of the noncompliant gas-filled cavities, an increase in middle-ear pressure (MEP) instead of volume expansion is observed with inhalation of nitrous oxide (N₂O). Changes in MEP cause many complications, such as ear pain, temporary hearing impairment, and postoperative emesis. Therefore, we investigated changes in MEP during total intravenous anesthesia (TIVA) with propofol, fentanyl, and ketamine (PFK) and inhalation of N₂O. Methods Twelve patients were anesthetized with PFK until 60 min after the induction of anesthesia, and then N₂O (60%) inhalation was started. MEP was measured by impedance audiometry (ranging from −300 daPa to +200 daPa) at 10-min intervals during PFK, and at 2-min intervals after the inhalation of N₂O. Results MEP gradually but significantly increased from the preanesthetic value of 16±8 to 34±12 (SEM) daPa 50 min after the induction of PFK. However, MEP did not exceed the normal limit. The values of MEP in all patients were more than 200 daPa within 36 min after the start of inhalation of N₂O in oxygen. Conclusion PFK had a minimal effect on MEP, whereas addition of N₂O to PFK increased MEP dramatically. Therefore, TIVA, or at least PFK, would be a better choice for patients with middle-ear or upper-airway diseases.     

Midazolam-flumazenil versus propofol anaesthesia for scoliosis surgery with wake-up tests

Background : Wake-up tests may be necessary during scoliosis surgery to ensure that spinal function remains intact.
Methods : Intra- and postoperative wake-up tests were performed together with somatosensory cortical evoked potentials (SCEPs) monitoring in 40 patients randomized to either midazolam (M) or propofol (P) infusions for scoliosis surgery. Other anaesthetic medication was similar in both groups. At the surgeon's request, N₂O was turned off and midazolam or propofol infusions were discontinued. In the M group, flumazenil was given in refracted doses. Patients were asked to move hands and feet. The test was repeated immediately after the end of surgery.
Results : The median intraoperative wake-up times were 2.9 min in the M group and 16.0 min in the P group. The respective postoperative wake-up times were 1.8 and 13.9 min. The quality of both intra- and postoperative arousals was significantly better in the M group. Twelve patients in the P group could not be awakened intraoperatively within 15 min and were given nalox-one. One of these patients woke up violently and dislodged the endotracheal tube. Another patient in the P group had explicit recall of the test, but no pain. Five patients in the M group became resedated in the recovery room. Cost of anaesthetic drugs was similar in both groups. Satisfactory intraoperative SCEPs were recorded from 17 patients in each group. There were no neurological sequelae.
Conclusions : Wake-up tests can be conducted faster and better with midazolam-flumazenil sequence compared with propofol.     

Inhibition by midazolam of the adrenergic function in the isolated canine mesenteric vein

Background: Midazolam has been reported to cause hypotension or to depress sympathetic activity following intravenous injection. However, little information is available concerning the mechanism of these effects. The aim of the present study was to determine the effects of midazolam on release of noradrenaline (NA) at nerve terminals and on receptors in the venous smooth muscle. Methods: The effect of midazolam at nerve terminals was examined by measuring the amount of NA release from superfused canine mesenteric vein helical strips during electrical stimulation (ES; 5 Hz, 2 ms, 9V). The NA was quantified by high-performance liquid chromatography with electrochemical detection; tension development evoked by ES was also recorded simultaneously. In a separate series of experiments, ring preparations from the isolated vein were mounted in Krebs-Ringer solution for isometric tension recording to assess the effect of midazolam on α-adrenoceptors. Results: Application of tetrodotoxin (10^?6 M) or replacement of superfusate with Ca²⁺-free solution decreased both the release of NA and the tension development evoked by ES. Yohimbine (5X10^?8 M) increased the ES-evoked release of NA, whereas it decreased tension development in the vein strips. Midazolam (10^?4 M) did not affect either the basal release of NA or the basal tension, but inhibited both the NA release (P<0.01) and the tension development (P<0.01) during ES; midazolam at 10^?5 M inhibited the tension development (P<0.05) but had no effect on NA release. In the ring preparations, midazolam (10^?5 and 10^?4 M) attenuated responses to NA (a mixed α_1- and α₂-adrenoceptor agonist, 10^?8 to 10^?3 M), phenylephrine (the α₁-adrenoceptor agonist, 10^?8 to 10^?3 M) and 5-bromo-6-[2-imidazolin-2yl-amino]-quinoxaline (UK14304; the α₂-adrenoceptor agonist, 10^?7 to 10^?3 M) in a dose-dependent manner. Conclusion: The data obtained in the present study suggest that midazolam at 10^?4 M may reduce venous tone by inhibiting the release of NA from sympathetic nerve endings and both α₂- and α₂-adrenoceptor mediated smooth muscle contractions. It is also postulated that a stage of the post-receptor transduction mechanism linked to the venous smooth muscle contraction may be more sensitive to midazolam than the NA release mechanism at nerve terminals since midazolam at the low concentration tested inhibited ES-evoked tension development with no effect on the release of NA.