腺病毒介导的LacZ基因在大鼠坐骨神经的表达

目的 :观察腺病毒介导的LacZ基因在大鼠坐骨神经雪旺细胞 (Schwanncells ,SCs)的表达。方法 :大鼠坐骨神经内直接注射报告基因LacZ重组腺病毒 (Ad LacZ) ,X gal组织化学染色检测LacZ基因的表达 ,采用LEICAM 5 5 0型图像分析仪对坐骨神经切片X gal染色强弱进行定量评价。结果 :将滴度为 1× 10 8PFU /ml的Ad LacZ病毒液 10 μl注入坐骨神经 2d后即可检测到LacZ的表达 ,7～ 14d表达显著增加 (与 2d组比较P <0 .0 1) ,7d组与 14d组表达量无显著差异 (P >0 .0 5 ) ,2 8d时SCs蓝染又减弱 (与 7d组和 14d组比较P <0 .0 1)。注射生理盐水的对照组X gal染色阴性。结论 :腺病毒介导的LacZ基因可转入活体动物坐骨神经内并高效表达 ,表明腺病毒介导神经营养因子等基因治疗有促进周围神经损伤再生的作用。     

腺病毒介导的外源基因转移至供心的实验研究

目的探讨大鼠心脏移植过程中,重组腺病毒介导的外源基因转移至供心的可行性及安全性。方法取健康雄性Wistar大鼠140只,10周龄左右,体重200-250g。平均分为供、受体各70只,受体大鼠又随机分为重组腺病毒载体（recombinant adenoviral vector encoding the β-galactosidase gene.Ad-LacZ）基因转移组35只,对照组35只。手术制备建立同系大鼠腹腔异位心脏移植模型,在取出供心后,经供心冠脉循环系统于低温下（4℃）将Ad-LacZ 800μl灌注入供心,30min后进行异位心脏移植;对照组则灌注等量生理盐水。分别在移植术后3、5、7、14及28d取供心,经X-gal染色检测Ad-LacZ基因的表达情况和规律。术后第28天同时取受体移植心、肝、肾、肺和自体心脏组织进行组织学观察,并以腺病毒E1A区引物行组织RT-PCR检测,验证腺病毒是否具有复制可能性。结果在Ad-LacZ基因转移组移植心脏内检测到Ad-LacZ基因的表达,对照组未检测到Ad-LacZ基因的表达;Ad-LacZ基因转移组基因表达的高峰时间为术后3、5及7d（平均LacZ阳性染色细胞数/切片分别为66.4±23.1,91.3±32.4,68.7±22.7）组间比较,无统计学意义（P〉0.05）;14d（32.1±13.9）后逐渐下降,与3、5、7d时比较有统计学意义（P〈0.05）;28d（3.9±3.4）仅有极少表达,与3、5、7及14d时比较有统计学意义（P〈0.05）。术后28d各组受体重要脏器及自体心脏组织学检查无明显变化,RT-PCR扩增未见腺病毒E1A区mRNA产物。结论在心脏移植中,经供心冠状动脉系统以重组腺病毒为载体进行基因转移可以将目的基因有效且安全地转入供心内。     

可调控性人PTEN基因重组腺病毒的构建与表达

目的　体外构建和表达可调控性人抑癌基因PTEN重组腺病毒。方法　将人PTEN基因全长cDNA约 1.4kb经过穿梭载体 ,与可调控性腺病毒载体骨架连接 ,得到重组人PTEN基因腺病毒 (Ad PTEN) ,酶切与聚合酶链反应 (PCR)鉴定后 ,在HEK2 93细胞包装、扩增 ,空斑试验测定病毒滴度 ,逆转录 聚合酶链反应 (RT PCR)、Westernblot法分别在mRNA、蛋白水平检测PTEN的表达。Ad X TRE βgal病毒作为对照。 结果　构建的Ad PTEN病毒滴度为 1.8× 10 7pfu/ml ,转染前列腺癌细胞株PC 3后RT PCR扩增出特异条带 ( 4 62bp) ,Westernblot检测PTEN蛋白 ( 60×10 3 )有高表达 ,对照病毒转染后未测到PTEN的表达。结论　用体外连接法成功地构建了可调控性人抑癌基因PTEN重组腺病毒载体 ,并得到了正确、特异的表达。     

大鼠弹力蛋白原基因重组腺病毒载体的构建及在血管平滑肌细胞中的表达

目的构建携载大鼠弹力蛋白原（tropoelastin）基因的重组腺病毒载体，并在体外培养大鼠血管平滑肌细胞（VSMC）中表达。方法利用基因重组技术将腺病毒骨架质粒pAdEasy-1以及线性化的重组穿梭质粒pShuttleTropoelastin-GFP进行同源重组，筛选出重组黏粒pAdTropoelas-tin-GFP，经过包装、扩增、纯化后获得重组腺病毒AdTropoelasfin-GFP，测定病毒滴度。腺病毒体外感染大鼠主动脉平滑肌细胞，一步法提取细胞总RNA，逆转录后，采用实时荧光定量聚合酶链反应（real-timePCR）检测tropoelastin的mRNA。结果得到了携载tropoelastin基因的重组腺病毒，纯化后滴度为5×10^11pfu／ml，腺病毒转染VSMC后1、3dtropoelastinmRNA表达较空病毒明显增高（P〈0．01），并超出空病毒转染组2倍以上。结论成功构建了携带tropoelastin的重组腺病毒载体，体外转染的VSMC有效表达目的基因。     

人白细胞介素-10和Bcl-2基因重组腺病毒经冠状动脉转染大鼠心肌的可行性

目的研究人白细胞介素-10(IL-10)、Bcl-2基因重组腺病毒经冠状动脉转染大鼠心肌的可行性。方法以细胞内同源重组法构建复制缺陷型重组腺病毒Ad-EGFP、Ad-hIL-10、Ad-hBcl-2,在293细胞内分别扩增,应用氯化铯密度梯度离心法纯化病毒。105只雄性SD大鼠,随机分为5组: Ad-EGFP组(Ⅰ组,n=5)、PBS对照组(Ⅱ组,n=25)、Ad-hBcl-2组(Ⅲ组,n=25)、Ad．hIL-10组(Ⅳ组,n =25)、Ad-hIL-10+Ad-hBcl-2组(Ⅴ组,n=25)。采用左心室腔注射,同时阻断主动脉、肺动脉10 s的方法来实施冠状动脉转染。Ⅰ组于转染后3 d处死大鼠,取心、肝、肺、肾、脑,作快速冰冻切片,光镜下观察绿色荧光蛋白(EGFP)表达情况。其余各组于转染后1、3、7、14、28 d各随机处死5只大鼠,用ELISA法测定静脉血浆及心肌组织IL-10、Bcl-2表达水平;取心、肝、肺、肾组织,光镜下观察炎性反应;测定血常规、肝功能指标、肾功能指标及心肌酶。结果Ad-EGFP、Ad-hIL-10、Ad-hBcl-2经氯化铯纯化滴度分别为1．99×109、2．10×1010、1．70×1010 pfu／ml。Ⅰ组于转染后3 d心肌组织可见大量EGFP表达,其它器官未检测到EGFP的表达。Ⅲ组-Ⅴ组心肌组织目的基因蛋白含量于转染后3 d达高峰,并持续至转染后14 d,Ⅲ组、Ⅴ组心肌组织Bcl-2峰含量分别为(71．6±17．9)×104、(95．5±25．7)×104 pg/g,Ⅳ组、Ⅴ组心肌组织IL-10峰含量分别为(16．8±3．7)×104、(19．3±3．3)×104 Pg／g,Ⅲ组-Ⅴ组转染后1-14 d心肌组织目的基因蛋白含量均高于Ⅱ组,Ⅴ组转染后3d心肌组织目的基因蛋白含量高于Ⅲ组、Ⅳ组(P<0．05)。Ⅲ组-Ⅴ组血浆IL-10、Bcl-2浓度与Ⅱ组比较差异无统计学意义。光镜下各组心、肝、肺、肾组织未见明显炎症反应。与Ⅱ组比较,Ⅲ组-Ⅴ组血常规、肝功能指标、肾功能指标、心肌酶差异无统计学意义。结论重组腺病毒介导人IL-10、Bcl-2基因经冠状动脉转染大鼠后,心肌能够高效地表达目的基因蛋白,且局限在心肌内,没有产生炎性反应和免疫反应。     

腺病毒介导的LacZ基因在培养许旺细胞中的表达

目的 观察腺病毒介导的LacZ基因在培养许旺细胞中的表达。方法 用报告基因LacZ重组腺病毒感染原代培养的许旺细胞，X-gal组织化学染色检测LacZ基因的表达。结果 用LacZ重组腺病毒感染培养的许旺细胞时，有较好的量效关系和时效关系。当感染增殖率分别为200、100时，24、48h后接近100％的许旺细胞被感染。而且感染后许旺细胞的形态无明显异常，增殖能力也没有受到影响。结论 腺病毒介导的LacZ基因可转入体外培养的许旺细胞并高效表达，同时许旺细胞的生长特性并不受影响，为腺病毒介导神经营养因子等基因治疗促进外周周围神经损伤再生奠定了基础。     

应用Cre/loxP系统构建含人PTEN基因的重组腺病毒载体

目的　构建含人PTEN基因的重组腺病毒载体。方法　将 PTEN cDNA定向克隆至穿梭质粒 pDC315 上,然后与骨架质粒 pBHGloxΔE1、3Cre共转染 293 细胞,产生重组腺病毒 AdC- MV- PTEN并进行鉴定、扩增后测定重组病毒的滴度。结果　重组腺病毒 AdCMV- PTEN的滴度为5×1010 pfu/L,PCR扩增出目的片断。结论　成功构建了含人 PTEN基因的重组腺病毒载体,为进一步研究其功能奠定基础。     

冠状动脉灌注TGF-β1基因对异基因大鼠心脏移植物急性排斥反应的影响

目的 探讨经冠状动脉灌注重组腺病毒载体介导转化生长因子-β1(TGF-β1)基因转染对异基因大鼠心脏移植物急性排斥反应的影响.方法 建立大鼠颈部心脏移植模型,转基因组供心切取后经冠状动脉缓慢灌注含携带TGF-β1基因腺病毒载体(每克心肌组织5×1010PFU)的Stanford大学液,再植入受体颈部.空载体组灌注腺病毒空载体(每克心肌组织5 × 1010PFU)的Stanford大学液,对照组灌注无病毒的Stanford大学液.结果 转基因组的移植物内外源性TGF-β1基因和蛋白表达,移植物内CD68表达减少,心肌细胞凋亡减少,移植物急性排斥反应的始发时间明显推迟,程度较轻.结论 经冠状动脉灌注重组腺病毒载体介导TGF-β1基因转移可明显减轻异基因大鼠心脏移植物急性排斥反应.     

腺病毒介导的人血管抑素基因治疗胰腺癌

目的观察腺病毒介导的人血管抑素基因对胰腺癌的治疗作用。方法通过病毒重组技术将人血管抑素基因克隆入增殖缺陷型腺病毒基因组中,获得腺病毒滴度达5．5×10~(10) pfu/ ml,观察转染表达后的生物学活性,通过建立裸鼠动物模型(每组数n=15例),分析基因转导后胰腺癌组织中血管抑素的表达情况及对肿瘤血管的抑制作用。结果构建了血管抑素的重组腺病毒载体pCA13-hAG；检测到血管抑素在体外mRNA水平和蛋白质水平表达率分别为87%和81%,得到279 bp电泳条带和38 000大小的蛋白条带；荷瘤裸鼠体内肿瘤体积显著低于对照组(P＜0．05),治疗组MVD为9．85±1．20,两对照组肿瘤微血管密度(MVD)分别为20．35±2．15、17,66±2．34 (P＜0．05)。结论所构建的pCA13-hAG重组腺病毒载体可有效表达具有生物学活性的血管抑素,使肿瘤内微血管生成减少,肿瘤细胞增殖减慢,为抗血管生成治疗实体瘤的临床应用奠定基础。     

血管内皮生长因子反义核酸对胰腺癌细胞增殖、凋亡和血管生成的影响

目的探讨腺病毒介导的血管内皮生长因子(VEGF)反义核酸对胰腺癌细胞增殖、凋亡和血管生成的作用。方法构建反向插入VEGF165基因的复制缺陷型腺病毒载体(Ad-αVEGF)。18只裸鼠皮下接种人胰腺癌细胞株SW1990,随机分成3组(n=3),1周后瘤体内分别注射磷酸盐缓冲液(PBS,100μl,PBS对照组)、报告基因LacZ重组腺病毒(100μl,Ad-LacZ对照组)、反义VEGF重组腺病毒(100μl,Ad-αVEGF治疗组),隔日1次,共4次。1个月后处死动物。PCNA染色、TUNEL法和CD31染色观察反义VEGF165基因转染对胰腺癌细胞增殖、凋亡和血管生成的影响。结果Ad-αVEGF治疗组PCNA阳性表达率为(38.1±6.8)%,较LacZ组(89.6±4.3)%、PBS对照组(92.1±5.2)%明显降低(P<0.01),LacZ组与PBS对照组之间差异无统计学意义(P>0.05)。Ad-αVEGF治疗组细胞凋亡率(32.3±3.8)%,明显多于LacZ组(8.6±7.6)%和PBS对照组(9.9±4.2)%(P<0.01),LacZ组与PBS对照组之间差异无统计学意义(P>0.05)。Ad-αVEGF治疗组肿瘤微血管密度(12±3),明显少于LacZ组(26±5)和PBS对照组(25±4)(P<0.01),LacZ组与PBS对照组之间差异无统计学意义(P>0.05)。结论反义VEGF165基因转染可以抑制肿瘤细胞增殖,增加细胞凋亡,减少了肿瘤内微血管数量,从而抑制肿瘤生长。     

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.     

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.     

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.     

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.     

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.     

Reduction of Plasma Fibrinogen, Immunoglobulin G, and Immunoglobulin M Concentrations by Immunoadsorption Therapy with Tryptophan and Phenylalanine Adsorbents

Abstract Immunoadsorption (1A) therapy with tryptophan (TR-350) or phenylalanine (PH-350) adsorbents has been used to reduce the concentration of serum antibodies in human lymphocyte antigen (HLA)-immunized patients. Other forms of plasma purification have been reported to reduce the level of fibrinogen, which affects the blood properties. In this study we investigated the effects of IA therapy using both adsorbents on plasma fibrinogen and immunoglobulins G and M in 13 patients (8 patients were treated with TR-350, and 5 patients were treated with PH-350). During each session 1 plasma volume (2.8 ± 0.4 L of plasma) was processed through the immunocolumn and then returned to the patient together with the blood cells. Compared with the pretreatment values, the plasma fibrinogen, IgG, and IgM concentrations were significantly reduced after IA therapy (p < 0.01 for TR-350; p < 0.04 for PH-350). There was a positive correlation between the degree of reduction of plasma proteins and the number of IA treatments given. A nonpara-metric test (Wilcoxon's signed-rank test or the Mann-Whitney test) was used for statistical analysis. We conclude from our study that IA therapy effectively lowers the plasma levels of fibrinogen, IgG, and IgM and thus can be considered a valuable alternative to other blood purification methods.     

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.     

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.