诱导小鼠破骨前体细胞成熟分化的实验条件探讨

目的探讨小鼠单核细胞RAW264.7能否在RANKL诱导下向破骨细胞成熟分化。方法 RANKL作用RAW264.7细胞7天～9天,光镜、透射电镜、扫描电镜(scanning electron microscope,SEM)分别观察其细胞形态学变化,用抗酒石酸酸性磷酸酶(tartrate-resistant acid phosphatase,TRAP)染色法观察TRAP阳性的多核细胞,RT-PCR检测破骨细胞表型和功能基因表达变化情况,扫描电镜观察破骨细胞在骨片上形成骨吸收陷窝。结果光镜、透射电镜下可见细胞胞体增大,为椭圆形或不规则形,胞核5～10个,扫描电镜下可见细胞表面大量的伪足样突起;此外,RANKL能诱导RAW264.7细胞分化为TRAP染色阳性的多核破骨细胞,细胞多为超过5个核的多核巨细胞;RAW264.7细胞成熟分化后具有骨吸收功能,并且能上调Cathepsin-K、TRAP、RANK等典型破骨细胞表型和功能基因mRNA的表达。结论 RAW264.7细胞是一种较好的破骨前体细胞模型,单用50ng/ml的RANKL体外连续诱导7天以上,能明显促进它向成熟的破骨细胞分化。     

骨保护素体外抑制小鼠单核巨噬细胞 成熟分化的实验研究

目的研究骨保护素（Osteoprotegerin, 0PG)抑制核因子NF-KB受体活化因子配体（Receptor activator of nuclear kappa B ligand,RANKL)诱导小鼠单核细胞RAW264. 7成熟分化而导致的溶骨效 应。方法50 ng/mL RANKL诱导RAW264. 7细胞1 d后,加人100 ng/mL 0PG(实验组,即0PG + RANKL组）或不加人0PG(对照组,即RANKL组）分别培养7 d和9 d,经细胞形态学观察其变化,抗 酒石酸酸性碟酸酶（Tartrate resistant acid phosphatase, TRAP)染色法观察TRAP阳性多核细胞,扫描 电镜下观察在骨片上的破骨细胞所致的骨吸收陷窝形成情况。结果对照组培养7 d时,在倒置相 差显微镜、透射电镜、光镜下可见细胞形状为椭圆形或不规则形,胞体明显较KAW264.7细胞增大, 胞核多为6 ~ 10个,扫描电镜下还可见大量伪足形成,而实验组培养7 d后,细胞形状多为圆形,且扫 描电镜下未见明显伪足形成;对照组9 d时可见大量TRAP染色阳性的多核巨细胞（含3个或3个以 上的细胞核）,而实验组中TRAP染色阳性的多核破骨细胞偶见多核巨细胞,培养9 d时很难找到多 核巨细胞;仅用RANKL诱导RAW264.7细胞分化7 d时,对照组中破骨细胞表面可见大量伪足伸出, 并形成明显的骨吸收陷窝,实验组中破骨细胞见少许伪足突出,不能看到明显的骨陷窝形成。结论 单用50 ng/mL RANKL体外连续诱导RAWM4.7细胞7 d时,可以促进成熟的破骨细胞显著分化。 100 ng/mL 0PG培养9 d能有效地抑制破骨细胞的分化,减少破骨细胞的骨吸收效应。     

复合振动抑制RAW264.7细胞分化成熟

目的研究复合振动对核因子-κB受体活化因子配体(RANKL)诱导的RAW264.7细胞分化的影响,探讨复合振动对破骨细胞分化的影响及机制。方法 RAW264.7细胞RANKL诱导培养3或4d并施加复合振动干预,通过抗酒石酸酸性磷酸酶(TRAP)染色观察TRAP阳性多核细胞形成的变化,real-time RT-PCR分析破骨细胞特异性基因组织蛋白酶K(cathepsin K),金属蛋白酶-9(MMP-9)和TRAP表达的变化。结果复合振动能抑制RANKL诱导破骨细胞形成,下调破骨细胞特异基因cathepsin K,MMP-9和TRAP的表达。结论 RANKL促进RAW264.7细胞向破骨细胞分化,并增加特异基因的表达,但RANKL的促进作用受复合振动抑制。这进一步的阐释复合振动抗骨质疏松的作用机制。     

槲皮苷抑制RANKL诱导的破骨细胞形成及骨吸收

[目的]探讨槲皮苷对核因子κB受体激动剂配体(receptor activator of nuclear factor kappa B ligand,RANKL)诱导的破骨细胞形成及骨吸收功能的影响。[方法]通过CCK-8法观察不同浓度槲皮苷(0~800μmol/L)干预不同时间(48 h、96 h)对RAW 264.7细胞的生存影响,确定合适的体外用药浓度;利用体外RANKL诱导RAW 264.7细胞形成破骨细胞体系,通过抗酒石酸酸性磷酸酶(tartrate resistant acid phosphatase,TRAP)染色计数评价槲皮苷(200、400μmol/L)对破骨细胞形成和生存的影响;通过骨片吸收实验对骨凹陷和骨吸收面积统计分析评价槲皮苷(200、400μmol/L)3 d内对成熟破骨细胞骨吸收功能的影响;釆用实时定量(Real-Time)PCR技术,检测槲皮苷(200、400μmol/L)对RANKL诱导的破骨细胞特异性基因NFATc1、TRAP和c-fos表达水平的影响。[结果]细胞生存实验发现槲皮苷干预96 h后,槲皮苷(0~800μmol/L)对RAW 264.7细胞4 d内生存未发现显著影响;通过TRAP染色发现200、400μmol/L槲皮苷能显著抑制体外RANKL诱导的破骨细胞形成;通过骨片吸收实验发现200、400μmol/L槲皮苷3d内能显著降低骨吸收面积,提示其抑制成熟破骨细胞骨吸收功能;同时,槲皮苷能呈剂量依赖性抑制RANKL诱导活化T细胞核因子(nuclear factor of activated T cells,NFAT)c1、TRAP和c-fos基因表达。[结论]槲皮苷通过抑制NFATc1,TRAP和c-fos的表达,来抑制体外RANKL诱导的破骨细胞形成和骨吸收功能,是一种潜在治疗骨质疏松药物。     

CTGF对破骨前体细胞RAW264.7增殖及碳酸酐酶Ⅱ分化的影响

目的研究结缔组织生长因子(CTGF)对体外培养的破骨细胞前体细胞RAW264.7增殖及对核因子Kappa B配体受体(RANKL)诱导体外培养的破骨细胞前体细胞RAW264.7分化为成熟多核破骨细胞的影响。方法使用200 ng/mLCTGF干预培养的破骨细胞前体细胞RAW264.7,采用3H-TdR掺入法检测RAW264.7细胞增殖率;使用200 ng/mL CTGF与RANKL单独或共同处理RAW264.7细胞,抗酒石酸酸性磷酸酶(TRAP)染色观察TRAP阳性多核细胞,Western blot检测碳酐酶Ⅱ蛋白的表达。结果 CTGF可显著促进RAW264.7细胞增殖;200 ng/mLCTGF与RANKL共同处理RAW264.7细胞可促进RAW264.7细胞分化为成熟多核破骨细胞;200 ng/mL CTGF与RANKL共同处理RAW264.7细胞可促进RAW264.7细胞碳酐酶Ⅱ蛋白的表达。结论 CTGF促进体外培养的破骨细胞前体细胞RAW264.7增殖,促进RANKL诱导的破骨细胞前体细胞RAW264.7分化为成熟多核破骨细胞。     

IL-6对RAW264. 7细胞成熟分化的体外实验研究

目的探讨研究白介素-6(Interleukin-6,IL-6)对核因子NF-κB受体活化因子配体(Receptor activator of nuclear kappa B ligand,RANKL)及对破骨前体细胞的成熟分化和溶骨效应。方法破骨前体细胞RAW264.7细胞经50ng/mL RANKL诱导1 d后将其分为:1、空白对照组(RANKL+PBS)2、低浓度IL-6组(RANKL+50ng/mL IL-6)3、中浓度IL-6组(RANKL+100ng/mL IL-6)4、高浓度IL-6组(RANKL+150ng/mL IL-6)。连续培养9 d后,进行HE染色检测成熟破骨细胞生成量;通过抗酒石酸酸性磷酸酶(Tartrate resistant acid phosphatase, TRAP)染色法观察TRAP阳性多核细胞的情况;运用扫描电镜检测破骨细胞在骨片上的骨吸收陷窝形成情况。结果 HE染色中,成熟破骨细胞生成量中、高浓度IL-6组明显少于低浓度IL-6组(P0.05),低浓度IL-6组和空白对照组间无明显差别(P0.05)。②通过TRAP染色后,经染色阳性区域面积与视野面积的百分比计算,中、高浓度IL-6组与明显少于低浓度和空白对照组(P0.05)。③扫描电镜观察发现骨吸收陷窝面积与视野面积的百分比随着IL-6浓度的增高,相比空白对照组有显著减少,且高浓度IL-6组中陷窝形成最少(P0.05)。结论 IL-6能直接作用于经RANKL诱导的RAW264.7细胞,能明显抑制破骨细胞激活分化,并降低破骨细胞所致的骨吸收效应。当IL-6浓度超过50ng/mL时,其抑制破骨细胞的骨吸收效应更加明显。     

低分子量褐藻糖胶对破骨细胞凋亡的影响

目的探讨低分子量褐藻糖胶(LMWF)对小鼠单核细胞RAW264.7诱导成熟破骨细胞凋亡的影响。方法通过100ng/m L RANKL诱导RAW264.7细胞株分化为破骨细胞,经TRAP特异性染色和骨吸收陷窝对诱导后的细胞进行鉴定。鉴定成功后,用100 ng/m L RANKL诱导RAW264.7细胞株5 d后,使用含有LMWF的培养基继续培养3 d,通过对TRAP阳性细胞计数和分析骨吸收面积来观察低分子量褐藻糖胶对破骨细胞的抑制和骨吸收功能情况;采用流式细胞术检测LMWF对破骨细胞凋亡的影响,capsase-3活性测试试剂盒检测LMWF对capsase-3活性进行测定;RT-PCR检测LMWF对成熟破骨细胞BAX与BCL-2基因表达的影响。结果单纯采用100 ng/m L的RANKL可成功诱导成熟的、有功能的破骨细胞。LMWF可以明显抑制RANKL诱导成熟破骨细胞的形成以及成熟破骨细胞的骨吸收功能;流式细胞术显示LMWF可增加成熟破骨细胞的早期凋亡率;并且能升高capsase-3的活性;PCR显示LMWF可明显下调破骨细胞凋亡相关的BCL-2和上调BAX基因mRNA表达,降低BCL-2/BAX的比值。结论低分子量褐藻糖胶可抑制破骨细胞的活性与骨吸收能力,促进破骨细胞凋亡,其主要机制是通过下调BCL-2和上调BAX mRNA基因表达实现的。     

通过骨基质表面培养板检测RANKL诱导破骨细胞骨侵蚀能力

目的探讨以骨基质表面培养板替代骨磨片鉴定破骨细胞骨侵蚀能力的应用方法。方法通过RANKL诱导破骨前体细胞RAW264. 7建立破骨细胞分化模型,运用TRAP染色检测破骨细胞分化程度,并以骨基质表面培养板替代骨磨片行骨陷窝试验检测破骨细胞骨侵蚀能力,以侵蚀面积反映骨侵蚀能力。结果不同浓度的RANKL因子可有效诱导破骨前体细胞RAW264. 7分化为成熟多核破骨细胞,呈浓度依赖性。成熟破骨细胞在骨基质表面培养板上形成不同面积的不规则侵蚀圆环,趋势与破骨细胞分化程度一致。结论使用骨基质表面培养板可有效反映破骨细胞形成及骨侵蚀能力,与TRAP染色结果一致,并且具有操作简便、结果直观、便于统计分析等优点。     

不同浓度金属磨损颗粒对破骨细胞体外分化的影响

[目的]观察不同浓度金属磨损颗粒对RAW 264.7在体外分化成破骨细胞的影响,明确浓度与破骨细胞分化数量的关系.[方法]真空球磨法制备人工关节磨损颗粒:RANKL诱导RAW 264.7体外分化成破骨细胞,通过TRAP染色,电镜扫描检测骨片吸收陷窝来鉴定破骨细胞;不同浓度人工关节磨损颗粒混悬液作用RAW 264.7,并用RANKL诱导后第7 d,TRAP染色后,光镜下计数破骨细胞数量.[结果]不同浓度磨损颗粒作用于RAW 264.7 7 d后,显微镜下计数破骨细胞数量,结果显示随着磨损颗粒混悬液浓度增加,RANKL诱导生成的破骨细胞增多,低、中、高浓度3组破骨细胞数均显著高于空白对照组(P<0.05),中、高浓度组破骨细胞数均显著高于低浓组(P<0.05),高浓度组破骨细胞数亦显著高于中浓组(P<0.05).[结论](1)RAW 264.7是一种较好的破骨前体细胞模型,RAW 264.7诱导形成破骨细胞的方法简便易行,所获得破骨细胞均一性好;(2)人工关节金属磨损颗粒为RAW264.7细胞向具有骨质吸收功能的破骨细胞转化发挥正向作用,而且与混悬液的浓度有量效关系.     

破骨细胞血系起源的活细胞成像观察

目的:采用活细胞成像技术,观察血系单核细胞诱导形成破骨细胞的全过程,旨在进一步阐明破骨细胞血系起源的发生及其细胞动力学。方法:取成年SPF级纯种雄性SD大鼠1只,体重280 g,腹主动脉采血8 ml,经密度梯度离心分离单个核细胞,在RANKL与M-CSF诱导下,分为倒置相差显微镜观察组、抗酒石酸酸性磷酸酶染色组、噬骨试验扫描电镜观察组、活细胞成像组4组进行培养。倒置相差显微镜观察组从培养开始,在数字显微成像系统下,每天观察记录1次;抗酒石酸酸性磷酸酶染色组培养21 d作酶活性染色鉴定;噬骨试验扫描电镜观察组培养21 d取出骨磨片作扫描电镜观察;活细胞成像组采用多点位缩时电影法对整个培养过程进行长达35 d的连续观察记录。结果:诱导培养2周后,倒置相差显微镜观察可见大量多核细胞形成,外形呈圆形、梭形、扇形、椭圆形及不规则突起状;抗酒石酸酸性磷酸酶染色绝大部分多核细胞与单核细胞均呈阳性反应;骨磨片扫描电镜观察可见较多骨吸收陷窝、坑洼及沟道,还有位于陷窝及沟道内正在行使骨吸收功能的破骨细胞;活细胞成像观察到起源于周围血的多核破骨细胞是由单核细胞、单核细胞与多核细胞及多核细胞之间相互融合而成,其细胞间的融合均发生在贴壁状态,显微缩时电影观察显示破骨细胞形态表现复杂多变。结论:大鼠周围血单核细胞在RANKL和M-CSF诱导下,可以向破骨细胞分化,形成具有骨吸收功能的多核破骨细胞。破骨细胞的形成是发生在贴壁状态下多种形式的细胞融合过程,破骨细胞的粘附特性对其存活及功能发挥至关重要。破骨细胞具有吞噬功能,其形态结构动态多变。破骨细胞不仅是一种多核细胞,还可能包括单核破骨细胞。破骨细胞通过融合形成多核巨细胞的特性,可能是其适应功能需求与骨吸收效率的一种特殊生物学行为。实验结果进一步证实了破骨细胞的血系起源学说,并为深入阐明破骨细胞的细胞动力学与细胞生物学特性提供了新的实验研究依据。     

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 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.     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

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.     

Dilemma of Membrane Biocompatibility and Reuse

Abstract: Numerous articles have been published on the multiple use of dialyzers and on the effect of different reprocessing chemicals and techniques on the dialyzer biocompatibility and performance. The results often appear contradictory, especially those comparing standard biocompatibility parameters. Despite this confusion, a discerning review of the published works allows certain limited conclusions to be drawn. Reprocessing of used hemodialyzers changes the biocompatibility profile of a dialyzer as defined by the parameters complement activation. leukopenia, and cytokine release. The effect of reprocessing depends on the chemicals and reprocessing technique applied and also on the type of membrane polymer being subjected to the reprocessing procedure. Reports of pyrogenic reactions indicate that the flux of the membrane also influences how suitable it is for safe reuse. An increased risk of allergic and pyrogenic reactions appears to be associated with dialyzer reuse. Furthermore, there has been a lack of investigations into the immunologic effect of the layer of adsorbed and chemically altered proteins that remains on the inner surface of reprocessed dialyzers. We conclude that the clinical benefit of dialyzer reuse cannot be generally accepted from a biocompatibility point of view.     

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.     

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.     

The analgesic effect of racemic ketamine in patients with chronic ischemic pain due to lower extremity arteriosclerosis obliterans

Background : Ketamine in sub-dissociative doses has been shown to have analgesic and phantom-Limb pain, where conventional treatment has often failed. Chronic ischemic pain due to lower extremity arteriosclerosis obliterans often responds poorly to analgesics, and the pain-generating mechanisms are not well understood.
Methods : Eight patients with rest pain in the lower extremity due to arteriosclerosis obliterans were given sub-dissociative doses of 0.15, 0.30, or 0.45 mg/kg racemic ketamine and morphine 10 mg as a 5-min infusion on four separate days in a cross-over, double-blind, randomised protocol. Plasma levels of (S)- and (R)-ketamine and their nor-metabolites were analysed with an enantioselective high-performance liquid chromatography (HPLC) method. Pain levels were evaluated with a visual analogue scale (VAS).
Results : Individual pain levels were highly variable during and after all the infusions but the pooled pain levels showed a dose-dependent analgesic effect of ketamine with a transient but complete pain relief in all patients at the highest dose (0.45 mg/ kg). Side-effects, mainly disturbed cognition and perception, were pronounced and dose-dependent. Morphine 10 mg had an analgesic peak at 20 min and 5/8 patients had complete pain relief. The remaining 3 patients also had high baseline pain scores, indicating a higher analgesic potency for the 0.30 and 0.45 mg/ kg ketamine doses than for morphine 10 mg.
Conclusion : We have demonstrated a potent dose-dependent analgesic effect of racemic ketamine in clinical ischemic pain. Due to a narrow therapeutic window, this analgesic effect is probably best utilised in combination with other analgesics.