静电纺丝聚乳酸聚乙醇酸/聚乙二醇纳米纤维作为组织工程支架的体外细胞相容性研究

目的 探讨静电纺丝聚乳酸聚乙醇酸(PLGA)/聚乙二醇(PEG)共聚物纳米纤维作为组织工程支架的可行性,及其与大鼠骨髓基质干细胞(BMSCs)的体外相容性. 方法 静电纺丝法分别制备PLGA/PEG和PLGA纳米纤维支架,扫描电镜(SEM)观察材料结构;分离培养大鼠BMSCs,取第3代BMSCs分别接种于PLGA/PEG纳米纤维支架和PLGA纳米纤维支架进行培养,噻唑蓝(MTT)法测定其细胞毒性及细胞增殖;接种后2、4、6h血球计数板计数法测定其黏附率;DAPI荧光染色观察细胞核形态;SEM观察细胞和支架的形态、黏附及生长情况. 结果 SEM观察显示两组支架呈相互交联的多孔网状无纺结构.PLGA/PEG组和PLGA组纤维直径分别为(655±57)nm和(539±48)nm;孔隙率分别为86.8％±1.5％和84.7％±1 2％.MTT检测BMSCs在两组支架中生长良好,OD值均随时间延长而增大,两组各时间点比较差异均有统计学意义(P＜0 05).各时间段PLGA/PEG组的细胞黏附率明显高于PLGA组,差异均有统计学意义(P＜0.05).DAPI染色示各组细胞核形态正常,核质均染,未见明显凋亡及坏死细胞;PLGA/PEG组细胞较PLGA组明显增多.SEM观察显示,PLGA/PEG组BMSCs在支架上生长良好,基质分泌、生长情况优于PLGA组. 结论 采用静电纺丝法制备的PLGA/PEG纳米纤维支架安全无毒,具备合适的孔径和孔隙率,适合BMSCs生长,细胞相容性良好,是一种组织工程良好的支架载体.     

骨骺干细胞复合壳聚糖/纳米羟基磷灰石支架体外培养的实验研究

目的 探讨免疫磁珠分选的骨骺干细胞(PSCs)经诱导后向软骨细胞方向分化的性能,及其与壳聚糖/纳米羟基磷灰石(CS/nHA)支架材料复合培养构建组织工程化软骨的可行性.方法 用显微手术器械剪取新生24 h内的清洁级SD大鼠股骨下端骺板两端的La Croix环处组织,应用免疫磁珠分选系统分离纯化PSCs,免疫荧光染色观察PSCs成纤维细胞生长因子受体-3(FGFR-3)的表达情况.体外培养并诱导PSCs向软骨细胞特性方向分化,免疫细胞化学、甲苯胺兰及番红O染色检测诱导后细胞Ⅱ型胶原及软骨基质的表达情况.以诱导后接种于CS/nHA支架培养的PSCs为实验组,以诱导后未接种支架的细胞为对照组.扫描电镜观察细胞的黏附及形态学改变,MTT法检测细胞增殖情况,阿辛蓝法测定细胞合成的糖胺多糖(GAG)情况.对两组间不同培养时间的吸光度值及GAG进行比较.结果 免疫磁珠分选的PSCs体外培养增殖迅速,免疫荧光染色显示FGFR-3阳性表达.诱导后的PSCsⅡ型胶原免疫细胞化学染色、甲苯胺兰染色及番红O染色均旱阳性.细胞接种CS/nHA支架后1、4 d,实验组与对照组吸光度值比较差异无统计学意义(P>0.05),而7 d实验组与对照组吸光度值比较筹异有统计学意义(t=-2.786,P=0.024).培养14 d后培养液GAG含量为(89.66±6.52)μg/106个细胞,高于对照组[(78.62±4.63)μg/106个细胞)],差异有统计学意义(t=-3.084,P<0.05).结论 免疫磁珠分选的PSCs经诱导后可向软骨细胞功能方向分化,诱导后的PSCs与CS/nHA分层支架复合有望构建组织工程化软骨.     

不同持续时间的周期性压力对构建组织工程软骨的影响

目的 探讨在周期性压力条件下构建组织工程软骨每天加压的最佳持续时间.方法 构建自行没汁的生物反应器和往复式加压泵组成的"周期性压力场培养系统",将体外培养的第二代乳兔关节软骨细胞接种到聚乳酸-聚羟幕乙酸共聚物(PLGA)支架上,随机分成四组.第一、二、三组分别在每天持续时间为4、8、12 h的周期性压力(强度0～200 kPa,频率为0.1 Hz)下培养,第四组(对照组)为不加压的静态培养,各组培养时间均为2周.2周后肉眼人体观察,HE染色组织学观察工程软骨细胞增殖及分布;甲苯胺蓝染色法规察硫酸糖氨多糖(GAG)的分泌及分布,并用1,9.二甲基亚甲蓝法定量检测GAG的含接;采用Ⅱ型胶原免疫绀织化学法观察Ⅱ型胶原的分泌及分布,并用image-pro plus图像分析系统对Ⅱ型胶原染色面积行半定量分析.结果 在强度0～200 kPa,频率为0.1 Hz周期性压力作用下,8 h组支架-细胞复合体体积最大,表面光滑、有光泽、有弹性,支架内软骨细胞数量最多,排列最为规则,Ⅱ胶原和GAG含量也最高(P<0.01).结论 软骨细胞的新陈代谢受周期件压力持续时间的影响,在0～200 kPa、0.1 Hz频率作用下,每天持续8 h的周期性压力能更好地促进软骨细胞增殖,合成Ⅱ型胶原、GAG等细胞外基质.     

胶原凝胶复合骨胶原基质(BCM)负载关节软骨细胞的实验研究

目的 探讨胶原凝胶包埋软骨细胞接种BCM支架的三维培养对软骨细胞生长及功能的影响.方法 将胶原凝胶包埋的关节软骨细胞接种BCM支架并在体外培养,应用倒置相差显微镜和扫描电镜观察软骨细胞的粘附、生长和增殖情况,培养14d,行苏木精-伊红、甲苯胺蓝染色观察软骨组织形成情况.结果 软骨细胞在支架上粘附、生长和增殖良好,体外培养14d能形成较成熟的软骨组织.结论 胶原凝胶复合BCM支架具有良好的细胞相容性,可作为负载生长因子的载体.     

胰岛素样生长因子-Ⅰ促进体外组织工程软骨形成

目的　探讨胰岛素样生长因子 - (IGF- )体外促进以透明质酸 (HA)为支架材料的组织工程软骨形成的能力。　方法　分离培养人关节软骨细胞 ,分为 3组 :1IGF- 组 :HA支架材料 软骨细胞 IGF- ;2细胞组 :HA支架材料 软骨细胞 ;3对照组 :单纯 HA支架材料。各组在 DMEM中培养 ,3、6周停止培养 ,取组织块通过 HE染色判断培养组织的形态 ,采用甲苯胺蓝染色、 型胶原免疫组织化学及 、 型胶原 RT- PCR判断体外组织形成软骨的能力。　结果　 IGF- 组和细胞组在第 6周均能形成典型的软骨组织陷窝 ,细胞组的陷窝数量明显低于 IGF- 组 ;对照组不能形成软骨组织。 型胶原免疫组织化学示 IGF- 组阳性表达强于细胞组 ;RT- PCR示 IGF- 组的 型前胶原量明显高于细胞组 (P<0 .0 5 ) ,而 型前胶原的表达量明显低于细胞组 (P<0 .0 5 ) ,差异具有统计学意义。　结论　 IGF- 能促进体外构建的组织工程软骨形成 ,并提高其质量。     

取向聚乙醇酸聚乳酸共聚物支架的制备及初步实验观察

目的 研制聚乙醇酸聚乳酸共聚物(PLGA)材料的纵向取向支架,观察体外生物相容性、细胞在支架内分布等特性,探讨其作为关节软骨组织工程支架的可能性.方法 相分离法制备纵向取向PLGA支架,等离子改性、胶原包埋处理,体外接种关节软骨细胞,在环境扫描电镜下观察细胞生长、分布情况.结果 研制的PLGA取向支架生物相容性明显提高,细胞沿纵向管道垂直排列,细胞分布均匀,单侧加载细胞进入深度可达2.5 nlln.结论 取向支架能明显改善细胞在载体内的分布,细胞纵向排列接近关节软骨细胞排列方式.     

软骨细胞外基质/壳聚糖复合多孔支架和骨髓间充质干细胞构建组织工程软骨

[目的]探讨软骨细胞外基质和壳聚糖制备复合多孔支架,同时并对小鼠骨髓间充质干细胞构建组织工程软骨的可行性进行观察.[方法]以猪关节软骨细胞外基质和壳聚糖为原料,采用冷冻干燥法制备软骨细胞外基质/壳聚糖复合多孔支架.通过扣描电镜观察材料内部结构及孔径大小,液体位移法测定材料的孔隙率,MTT方法检测支架浸提液毒性.将小鼠的骨髓间充质干细胞(BMSCs)分离培养并用TGF-β1成软骨诱导后,与材料复合培养,扫描电镜观察细胞在材料上的生长粘附情况.[结果]软骨细胞外基质/壳聚精复合支架具有疏松多孔结构,孔径大小(159±36)μm,孔隙率为90.5%±2.3%,复合支架中的软骨细胞外基质成分甲苯胺蓝染色、番红O染色均呈阳性,MTT结果显示支架无细胞毒性.诱导的骨髓间充质干细胞在支架表面生长良好.[结论]软骨细胞外基质/壳聚糖复合材料具有合适的孔径和孔隙率,生物相容性良好,是组织工程软骨的良好支架载体.     

医用多孔钽材料对大鼠软骨细胞增殖、细胞周期及凋亡的影响

[目的]观察国产多孔钽材料对大鼠软骨细胞增殖、细胞周期及凋亡的影响,为其作为软骨组织工程支架材料临床应用提供实验依据。[方法]选用3周龄SD大鼠双侧股骨头、膝关节分离软骨组织,经Ⅱ型胶原酶消化,饱和湿度培养,传代。倒置显微镜下逐日观察细胞生长状态。待第2代细胞生长至80%左右时,通过甲苯胺蓝染色、番红O-固绿染色以及Ⅱ型胶原免疫细胞化学染色进行软骨细胞鉴定。以F12-DMEM为浸提介质分别制备100%、50%、25%多孔钽浸提液,软骨细胞加不同浓度多孔钽浸提液作为实验组,未加浸提液的软骨细胞作为对照组;MTT法检测多孔钽浸提液对软骨细胞增殖的影响及细胞毒性检测。将第2代软骨细胞接种到多孔钽支架上进行体外三维培养,而对照组是将软骨细胞接种到无支架的培养板上,倒置相差显微镜观察两组软骨细胞生长状态;胰酶消化复合于材料上的软骨细胞,流式细胞仪检测软骨细胞的细胞周期变化及细胞凋亡。[结果]软骨细胞接种初期大小不等,呈圆形悬浮于培养液中,24 h后贴壁细胞伸展呈三角形、多角形等。第7⁹ d待细胞生长呈现融合时即可传代。甲苯胺蓝染色显示软骨细胞胞浆内可见蓝紫色颗粒,番红O-固绿染色显示胞浆呈绿色、细胞核呈紫红色,Ⅱ型胶原免疫细胞化学染色显示阳性信号位于胞浆及部分胞膜,以上方法证实了分离培养的细胞为软骨细胞;MTT法检测显示随着培养时间的延长,各浓度浸提液组细胞生长与对照组无明显差异,软骨细胞形态正常,贴壁增殖良好,相同时间点不同浓度的浸提液与对照组间细胞增殖差异无统计学意义(P>0.05),提示软骨细胞在多孔钽浸提液中生长、增殖状态良好且多孔钽材料无毒性。多孔钽支架材料外观灰色光亮,表面及断面可见分布均匀的蜂窝状孔隙,孔径针尖大,支架材料不透光,将分离培养的第2代软骨细胞接种到多孔钽支架上后,复合培养24 h后,倒置相差显微镜可见材料边缘有少量软骨细胞黏附,细胞呈多角形;随着培养时间增加,材料边缘及培养板底部细胞黏附的数量逐渐增多,边缘软骨细胞生长良好;流式细胞仪检测显示实验组与对照组细胞均为正常二倍体细胞,两组细胞周期分布相似,实验组及对照组的细胞凋亡率及坏死细胞率差异均无统计学意义(P>0.05)。[结论]国产多孔钽材料无毒性,对软骨细胞增殖、细胞周期及凋亡无明显影响,适合作为软骨组织工程支架材料。     

聚乳酸-聚羟基乙酸/Ⅰ型胶原复合支架的生物相容性研究

目的观察聚乳酸-聚羟基乙酸(poly-lactide-co-glycolide,PLGA)/Ⅰ型胶原复合支架的生物相容性,探讨其作为组织工程阴道支架的可行性。方法取经多聚赖氨酸包被的PLGA置于含0.25%Ⅰ型胶原的醋酸水溶液,制备PLGA/Ⅰ型胶原复合支架。取10~12周龄雌性SD大鼠阴道组织,采用酶消化法分离培养阴道上皮细胞,取第2代细胞进行实验。取复合支架浸提液培养阴道上皮细胞,观察材料细胞毒性。将阴道上皮细胞与复合支架共培养48 h(实验组),检测细胞黏附率;以单纯PLGA支架接种细胞作为对照组。将细胞-支架复合物埋植至SD大鼠皮下,于2、4、8周取材行HE染色、免疫组织化学染色,观察细胞在支架上生长情况。将细胞-支架复合物移植至6只切除阴道组织的SD大鼠阴道部位,于术后3、6个月观察阴道生长情况,6个月后取阴道组织进行组织学观察。结果大鼠阴道上皮细胞在PLGA/Ⅰ型胶原复合支架材料浸提液中生长、增殖良好,细胞毒性为1级。实验组细胞黏附率为71.8%±9.2%,显著高于对照组的63.4%±5.7%(t=2.195,P=0.005)。阴道上皮细胞能在PLGA/Ⅰ胶原复合支架材料上黏附、生长;大鼠皮下埋植2周后,细胞在支架孔隙内生长增殖,成纤维细胞生长;4周支架材料表面形成1~3层上皮;8周后支架材料部分降解,上皮层次增加,呈极性排列,角蛋白免疫组织化学染色呈阳性。细胞-支架复合物原位移植3个月后,大鼠阴道黏膜呈粉红色,有光泽,支架材料大部分降解;6个月时阴道深约1.2 cm,无明显狭窄,阴道黏膜外观类似正常阴道黏膜,皱襞较少,组织学观察示上皮层与正常阴道无明显区别,基底层可见钉状突起,数量少于正常阴道,角蛋白免疫组织化学染色呈阳性。结论 PLGA/Ⅰ型胶原复合支架具有良好的生物相容性,可作为构建组织工程阴道的支架材料。     

新型丝素蛋白多孔支架复合兔髓核细胞体外构建组织工程化髓核的实验研究

[目的]观察以新型丝素蛋白多孔支架复合兔髓核细胞体外构建组织工程化髓核的可行性。[方法]分离培养兔髓核细胞,与丝素蛋白多孔支架在体外复合培养,建立组织工程化髓核模型,通过扫描电镜、HE染色、甲苯胺蓝染色、Ⅱ型胶原免疫组化以及酶联免疫吸附测定观察细胞在支架上1周和3周的生长及增殖情况。[结果]培养1周后,扫描电镜显示细胞呈球状均匀地贴附在支架内部。细胞-支架复合体HE染色可见支架内部有大量髓核细胞,甲苯胺兰染色阳性,Ⅱ型胶原免疫组化染色阳性。培养3周后,扫描电镜显示细胞成层黏附于支架表面,细胞重叠生长,分泌大量细胞外基质,HE染色可见支架内部有大量髓核细胞填满支架孔隙并分泌大量细胞外基质,甲苯胺兰染色阳性,Ⅱ型胶原免疫组化染色阳性。酶联免疫吸附测定:3周组蛋白多糖含量(52.4±4.5)ng/ml明显高于1周组(29.3±3.6)ng/ml,P<0.05,3周组的II型胶原含量(24.3±1.8)ng/ml明显高于1周组(15.16±1.5)ng/ml,P<0.05。[结论]新型丝素蛋白多孔支架复合兔髓核细胞体外培养生长良好,分泌大量类似髓核样细胞外基质,可以用于体外构建组织工程化髓核。     

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.     

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.     

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.