近五年来中医体质类型与骨质疏松症相关性研究的现状

目的探析近五年来中医体质类型与骨质疏松症(OP)的相关性研究的现状,探讨OP患者的中医体质分布规律,更好地为中医药防治OP提供一定的基础数据。方法对2013年1月～2017年12月在国内外期刊发表的有关OP与中医体质相关性的调查文献,以"骨质疏松、中医体质"为检索词进行检索,并将最终纳入的文献根据类型分为病例对照研究和横断面研究,分别进行综合分析。结果共检索105篇全文文献,其中11篇文献符合要求,调查范围涉及全国9个省市自治区,单个调查样本量80～1 957例,研究类型中横断面研究为6篇(54.55%),病例对照研究为5篇(45.45%)。提取两种研究中OP患者在样本中所占人数,发现在横断面研究中气虚型体质OP患者占6项总样本量3 251人的9.07%,阳虚型体质为7.90%,阴虚型体质为9.25%,同时基于1 992人的大样本人群病例对照研究的Meta分析发现,OP患者为气虚型体质、阳虚型体质、阴虚型体质的发病风险的OR值分别为1.29(95%CI:1.00～1.65),1.90(95%CI:1.44～2.49)和1.95(95%CI:1.47～2.59)。并发现华北地区、华东地区OP患者多以气虚型体质与阴虚型体质为主,而中南地区、西北地区OP患者多以气虚型体质与阳虚体质为主。结论气虚型体质、阳虚型体质、阴虚型体质以及血瘀型体质是OP患者的主要体质类型,通过大样本量的分析,期望为未来中医药防治OP,提供一定的参考价值,但目前的文献仍然缺乏多种相关因素的研究,这可能会对判断OP患者的中医体质出现偏颇,有待进一步提高。     

中医导引术防治肩周炎的研究进展

运动疗法是防治肩周炎的有效手段,而中医导引术作为一种动静结合、内外兼修的运动疗法,因其简便易学、成本低廉、疗效显著、绿色环保等优点深受人们的青睐.结合近些年来各类导引术防治肩周炎的相关报道,探索其疗效及作用机制.太极拳、八段锦、易筋经、五禽戏等中医导引功法可增加肩周运动肌肌力,协调肩周组织的生物力学;加快血液、淋巴液的...     

三种健身气功练习对老年女性骨密度的影响

目的探讨定期的健身气功易筋经、五禽戏和八段锦练习对老年女性腰椎和股骨近端骨密度(BMD)的影响。方法年龄、身高和体重相匹配的易筋经组(n=22)、五禽戏组(n=22)、八段锦组(n=21)和对照组(n=25)参与研究,三种健身气功组进行为期24周(5次/周,70 min/次)的健身气功练习。测试4组受试者腰椎L_(2-4)和股骨近端BMD。结果 24周后组内比较:易筋经组和八段锦组腰椎L_(2-4)的BMD分别显著增加12.0%和11.0%(P0.05),五禽戏组腰椎L_(2-4)的BMD虽有增加(5.6%)但无显著变化(P0.05);组间比较:易筋经组和八段锦组腰椎L_(2-4)的BMD分别大于对照组12.0%和9.8%(P0.05)。结论 24周易筋经和八段锦练习增加了老年女性腰椎L_(2-4)的BMD,且效果优于五禽戏。三种健身气功对股骨近端BMD影响均不明显。     

海口市老年骨质疏松症患者生活质量状况及影响因素分析

目的调查海口市老年骨质疏松症(osteoporosis,OP)患者的生活质量状况并分析其危险因素,为提高OP患者的生活质量提供依据。方法对904例海口市老年OP患者进行问卷调查,收集患者的生活质量相关资料,采用多元Logistic回归分析老年OP患者生活质量的影响因素。应用ROC曲线评价Logistic回归模型的预测效果。结果将患者的性别、年龄、居住情况、劳动类型、体质量指数(bone mass index,BMI)、病程、睡眠情况、家庭经济情况、骨折史、每天运动时间、关节疼痛和驼背情况的生活质量得分比较,差异有统计学意义(P0. 01)。多元Logistic回归分析显示,年龄(OR=2. 604,95%CI:1. 702～3. 913)、病程(OR=5. 205,95%CI:3. 705～8. 614)、家庭经济情况(OR=2. 411,95%CI:1. 518～3. 361)、每天运动时间(OR=4. 216,95%CI:3. 102～6. 104)、关节疼痛(OR=7. 115,95%CI:5. 283～13. 726)、驼背(OR=5. 702,95%CI:4. 108～8. 263)是影响老年OP患者生活质量的危险因素。ROC曲线评价Logistic回归模型效果,其AUC及95%CI为0. 925(0. 861～0. 984)。结论海口市老年OP患者的生活质量水平较低,影响其生活质量的危险因素较多,应针对相关的危险因素采取有效的干预措施,改善OP患者的生活质量。     

形形色色的非药物疗法

△体育疗法:我国是世界上最早应用体育疗法的国家之一,比如汉末医学家华佗创造并推广的“五禽戏”,唐代人们用舞蹈运动治疗关节疾病等。后来又出现太极拳、气功、易筋经、八段锦等体育疗法,随着医学的发展,体育疗法也更加多样化和科     

传统功法治疗原发性骨质疏松症临床研究进展

原发性骨质疏松症是以骨组织微结构破坏、骨量减少、骨脆性增加、易发生骨折为特征的一类全身慢性退行性疾病。使用抗骨质疏松药物周期长、费用高、存在不良反应等,影响患者的生活质量。本文通过检索知网、万方、PubMed等相关数据库,对应用太极拳、八段锦、五禽戏、易筋经等四种传统功法治疗原发性骨质疏松症引起的骨密度下降、疼痛、平衡协调功能等临床问题进行总结,分析现存问题,进一步明确传统功法最优化的干预方案。     

炎症性肠病男性患者中勃起功能障碍患病率的meta分析

目的:系统评价成年男性炎症性肠病(IBD)患者中ED的患病率。方法:计算机检索PubMed、The Cochrane Library、Embase、万方数据库和中国知网,搜集并筛查关于IBD患者中ED患病率的相关文献。采用Meta-Analyst软件行meta分析。结果:共纳入9篇文献,包括734例男性IBD患者,男性IBD患者中ED的患病率为34.4%(95%CI 30.8%～38.1%)。亚组分析显示:ED在克罗恩病(CD)的患病率(36.3%, 95%CI 30.1%～42.9%)高于溃疡性结肠炎(UC, 26.8%, 94%CI 21.9%～32.3%),活跃期IBD患者中ED的患病率(47.6%, 95%CI 38.3%～57.2%)明显高于缓解期(26.4%, 95%CI 22.0%～31.4%),差异均有统计学意义(P0.05);全结直肠切除并回肠储袋肛管吻合术后的男性UC中患病率最低,为17.2%(95%CI 11.5%～24.9%)。结论:IBD男性患者常伴有ED,疾病活动增加其患病风险,而疾病缓解可降低风险。     

Meta分析抗生素对TURP术后感染性并发症的预防效果

目的　分析预防性抗生素能否减少术前为清洁尿、行经尿道前列腺切除术 (TURP)患者的术后感染性并发症。　方法　制定原始文献的纳入标准、排除标准及检索策略 ,在美国医学索引(MEDLINE)、荷兰医学文摘 (EMBASE)药理学分册、中国生物医学文摘 (CBMA)、及Cochrane图书馆(CL)内进行相关的随机对照试验的检索、质量评价和资料提取。应用RevMan软件进行数据处理 ;计数资料的效应尺度以相对危险度 (RR)及其 95 %可信区间 (95 %CI)表示 ;计量资料的效应尺度以加权均数差 (WMD)及其 95 %CI表示。　结果　共检索到相关随机对照试验 5 3篇 ,排除 2 6篇 ,符合纳入标准 2 7篇进入Meta分析。结果表明 :术前清洁尿的患者 ,预防性抗生素能显著降低TURP术后 1周内菌尿、术后发热、菌血症的发生率和术后需继续抗生素治疗的比率 ,RR值及其 95 %CI分别为 0 .36(0 .2 8～ 0 .4 6 )、0 .83(0 .71～ 0 .97)、0 .4 3(0 .2 2～ 0 .86 )及 0 .2 6 (0 .2 0～ 0 .33) ;但尚不能确定预防性抗生素能否缩短患者住院时间 ,其WMD及 95 %CI为 - 0 .31(- 0 .78～ 0 .35 )。　结论　术前为清洁尿的患者 ,预防性应用抗生素能减少TURP术后菌尿、发热、菌血症的发生率和术后需继续抗生素治疗的比率 ;尚不能确定能否缩短术后住院时间。     

胆管癌肝移植有效性与安全性的meta分析

目的 评估胆管癌患者肝移植的有效性和安全性.方法 检索1995年至2009年相关英文文献,对符合纳入标准的临床试验用Stata 10软件对其1、3、5年有效生存率及并发症发生率进行meta分析.结果 有14项独立的临床研究的17篇文献入组,共纳入605例胆管癌肝移植患者.1、3、5年总体有效生存率分别为73%(95%CI:0.65～0.80)、42%(95%CI:0.33～0.51)和39%(95%CI:0.28～0.51).其中,新辅助放化疗组(OLT-PAT组)的1、3、5年有效生存率达到83%(95%CI:0.57～0.98)、57%(95%CI:0.18～0.92)和65%(95%CI:0.40～0.87).并发症总体有效发生率为62%(95%CI:0.44～0.78).与单纯肝移植组(61%,95%CI:0.33～0.85)和肝移植合并部分胰十二指肠切除组(78%,95%CI:0.55～0.94)相比,OLT-PAT组(58%,95%CI:0.20～0.92)的并发症有效发生率可以接受.结论 与传统手术局部切除治疗胆管癌5年生存率比较,肝移植治疗胆管癌的总体有效率并无明显优势;新辅助放化疗联合肝移植治疗胆管癌的近、远期有效生存率较高.

Abstract：

Objective To evaluate the therapeutic efficacy and safety of liver transplantation for patients with cholangiocarcinoma. Methods According to the requirements of Cochrane systematic review, a thorough literature search was performed in Pubmed/Medline, Embase and Cochrane Central Register electronic databases ranged between 1995 and 2009 in terms of the key words "liver transplantation", and "cholangiocarcinoma" or "cholangiocellular carcinoma" or "bile duct cancer" . And restricted the articles published in the English language. Two reviewers independently screened the studies for eligibility,evaluated the quality and extracted the data from the eligible studies with confirmation by cross-checking.Data were processed for a meta-analysis by Stata 10 software with 1-, 3-, 5-year survival rates and incidence of complications. Results A total of 14 clinical trials containing 605 patients were finally enrolled in this study. The overall 1-, 3-, 5-year pooled survival rates were 73% (95% CI: 0. 65 -0. 80), 42% (95% CI:0. 33 -0. 51 ) and 39% (95% CI: 0. 28 - 0. 51 ), respectively. Of note, preoperative adjuvant therapies (OLT-PAT group) rendered the transplanted individuals comparably favorable outcomes with 1-, 3-, 5-year pooled survival rates of 83 % (95 % CI: 0. 57 - 0. 98 ), 57 % ( 95 % CI: 0. 18 - 0. 92 ) and 65 % ( 95 % CI:0. 40 -0. 87), respectively. In addition, the overall pooled incidence of complications was 62% (95% CI:0. 44 - 0. 78 ), among which that of OLT-PAT group ( 58%, 95% CI: 0. 20 - 0. 92 ) was relatively acceptable compared to those of liver transplantation alone (61%, 95% CI: 0. 33 - 0. 85 ) and liver transplantation with extended bile duct resection ( 78%, 95% CI:0.55-0.94). Conclusions In comparison to curative resection of cholangiocarcinoma with the 5-year survival rate reported from 20% to 40%, the role of liver transplantation alone is so limited, but neoadjuvant radiochemotherapy combined with liver transplantation can bring better short- and long-term prognosis.     

运动平板试验与冠状动脉CTA诊断冠状动脉粥样硬化性心脏病的Meta分析

目的比较运动平板试验(TET)和冠状动脉CTA(CCTA)对冠状动脉粥样硬化性心脏病的诊断价值。方法检索Pubmed、Embase、Cochrane Library、Web of Science、万方、维普、中国知网及中国生物医学数据库,筛选文献,评估文献质量,提取数据进行分析。分别对采用TET和CCTA检查的研究数据加权定量合并,计算汇总敏感度、特异度及其95%可信区间(95%CI)。绘制ROC曲线,计算并比较曲线下面积。结果最终纳入15篇文献(1 976例患者);CCTA和TET的汇总敏感度分别为0.93(95%CI 0.89~0.95)、0.65(95%CI 0.58~0.71),汇总特异度分别为0.86(95%CI 0.76~0.92)、0.58(95%CI 0.47~0.69),ROC曲线下面积分别为0.96(95%CI 0.93~0.97)、0.66(95%CI 0.62~0.70)。结论TET对于冠状动脉粥样硬化性心脏病的诊断效能低于CCTA。     

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.     

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.     

Intravenous endotoxin does not increase tissue extravasation of albumin in rats

Background : It is unclear whether activation of the inducible nitric oxide synthase (iNOS) increases or decreases the extravasation of plasma.
Methods : Chloralose anaesthetised male Wistar rats received E. coli lipopolysacharide (LPS), 3 mg kg^-1 i.v., or the corresponding volume of saline, 3 or 5 h before the end of the experiment. Mean arterial pressure (MAP) and heart rate (HR) were recorded. Tissue clearance of radio-labelled albumin, during the last 2 h of each experiment, was determined by a double-isotope method. In separate animals, the serum concentration of nitrite and nitrate was determined, 5 h after LPS or the solvent.
Main Results : LPS initially decreased MAP and lastingly increased HR. In the 3-h LPS animals (n=8), tissue plasma clearance was lower in the heart and calf muscle and increased only in diaphragm, compared to corresponding control animals (n=8). In the 5-h LPS rats, clearance was lowered (n=8) in the entire gastrointestinal tract and in testes, compared to controls (n=8). The serum nitrite/nitrate concentration was higher in animals given LPS (n=6) than in controls (n=6).
Conclusion : After LPS, tissue clearance of albumin was not increased in any major tissue, in spite of increased serum levels of NO end products. Apparently, after activation of iNOS, the augmented release of NO is not necessarily associated with increased albumin extravasation.