肝癌中Smac和Caspase-3的表达及在细胞凋亡中的关系

目的探讨Smac和Caspase-3在原发性肝细胞癌(HCC)组织中的表达及二者在肝癌细胞凋亡中的作用和关系.方法免疫组化法检测43例肝癌组织、20例癌旁组织和11例正常肝组织中Smac和Caspase-3蛋白表达情况.RT-PCR检测Smac和Caspase-3 mRNA表达情况.结果43例HCC标本中Smac表达有20例(46.5%),而除2例癌旁组织外,其它癌旁组织和正常肝组织中均见Smac表达;Caspase-3在癌组织、癌旁组织和正常肝组织中分别有18例(41.9%)、15例(75%)和11例(84.6%)表达.Smac和Caspase-3在肝癌组织中的表达具有明显的正相关性(P＜0.05,r=0.6264).Smac mRNA表达阳性的肝癌组织的细胞调亡指数明显升高.结论Smac在肝癌组织中低表达,其表达和Caspase-3呈明显的正相关,二者可能是肝癌细胞凋亡信号传导网络中的重要一环.     

肝细胞癌经导管动脉化疗栓塞术后Survivin, Bax和Caspase-3的表达水平

目的探讨经导管动脉化疗栓塞术(TACE)对肝细胞癌(HCC)癌细胞凋亡的影响及意义。方法取经TACE治疗后手术切除的HCC组织标本24份(TACE组)和未经其他治疗直接手术切除的HCC组织标本30份(单纯手术组),采用免疫组化SP法检测癌组织中Survivin,Bax,Caspase-3的表达水平。结果 TACE组癌组织中Survivin表达阳性率为41.67%,低于单纯手术组(73.33%,P0.05);Bax,Caspase-3表达阳性率分别为54.17%、58.33%,高于单纯手术组(26.67%、30.00%,P均0.05)。TACE组癌组织中Survivin的表达与Bax,Caspase-3的表达分别呈负相关(r=-0.580、-0.829,P均0.05);Bax与Caspase-3的表达呈正相关(r=0.749,P0.05)。结论 TACE可通过抑制Sur-vivin表达,促进Bax,Caspase-3表达诱导癌细胞凋亡,这可能是TACE治疗肝癌的主要机制之一。     

Livin蛋白在原发性肝细胞癌组织中的表达和意义

目的 探讨凋亡抑制蛋白(inhibitor of apoptosis protein,IAP)Livin在人原发性肝癌(HCC)组织中的表达及其与HCC血管生成的关系.方法 应用免疫组织化学法检测42例HCC及对应癌旁组织和12例正常肝组织内Livin的表达情况,观察Livin蛋白与HCC病理学特点及微血管密度(microvessel density,MVD)之间的关系.结果 免疫组织化学(SP)染色结果显示,Livin蛋白在正常肝组织中均不表达,而在42例HCC中的阳性表达率(73.81%)显著高于癌旁组织(4.76%)和正常肝脏组织,有显著统计学意义(X2=39.13,P＜0.05;X2=17.89,P＜0.05);Livin蛋白在病理分级Ⅲ～Ⅳ组阳性表达率(85.12%)强度明显高于病理分级Ⅰ～Ⅱ组(53.33%),两者比较差异有显著统计学意义(X2=4.690,P＜0.05);Livin蛋白在有转移HCC中的阳性表达率(89.47%)明显高于无转移组(60.89%),有统计学意义(X2=4.404,P＜0.05);Livin蛋白阳性表达HCC中的MVD值明显高于Livin蛋白阴性表达HCC中MVD值(23.56±5.12/17.63±4.86;P＜0.05).结论 Livin蛋白基因在原发性肝癌组织中高表达,提示该基因可能参与了肝癌的发生发展过程;Livin蛋白在HCC组织中的表达明显上调且与血管生成和浸润转移有关.     

NF-кB与P-gp在肝细胞肝癌组织中的表达

目的探讨核转录因子（NF-κB）与P糖蛋白（P-gp）在肝细胞肝癌（HCC）及癌旁肝组织的表达及其相互关系。方法采用免疫组织化学S-P法检测30例HCC中NF-κB、P-gp的表达情况，以30例相应癌旁肝组织作为对照组，所得结果用统计学卡方检验及列联表等相关分析进行比较。结果NF-κB蛋白在HCC、癌旁肝组织中阳性表达率分别为63．3％（19／30）、16．7％（5／30），HCC与癌旁肝组织中NF-κB蛋白表达差异有显著性（P〈0.05）；P-gp蛋白在HCC、癌旁肝组织中阳性表达率分别为83．3oA（25／30）、30％（9／30），HCC与癌旁肝组织表达差异有显著性（P〈0.05）。NF-κB蛋白的表达与P-gp蛋白的表达呈正相关（r=0.89，P〈0.05）。结论NF-κB和P-gp在HCC中的表达提示其可能参加了HCC和多药耐药的发生。NF-κB与P-gp在HCC表达中呈正相关，提示NF-κB与P-gp可能介导的多药耐药，共同参与了HCC多药耐药机制。     

原发性肝细胞癌Survivin,CyclinD1的表达及其临床意义

目的：探讨Survivin和CyclinD1在原发性肝细胞癌（HCC）组织中的表达及两者在肝癌发病机制中的作用和临床意义.方法：利用免疫组织化学SP法检测50例原发性肝癌组织、20例正常肝组织中Survivin和CyclinD1蛋白表达情况.结果：Survivin蛋白在肝癌中的阳性表达率为66.0%（33/50）,显著高于正常肝组织组（均为阳性表达）（P＜0.001）,阳性表达与肝癌的肝内转移和肝癌的多发性有关（P=0.019,P=0.030）.CyclinD1蛋白在肝癌中的阳性率为44.0%（22/50）,显著高于正常肝组织组（均为阴性表达）（P＜0.001）,阳性表达与肝癌的肝内转移和肝癌的分化程度有关（P=0.035,P=0.036）.Survivin的阳性表达与CyclinD1的阳性表达呈正相关（r=0.466,P＜0.001）.Survivin和CyclinD1的过表达均与患者术后＜3年生存期相关（P=0.018,P=0.013）.结论：Survivin与CyclinD1在肝细胞癌的发生及发展过程中起着不同程度的作用,联合检测Survivin与CyclinD1对判定原发性肝细胞癌预后可提供一定的依据.     

Survivin在原发性肝细胞癌中的表达及其临床意义

目的 探讨Survivin在原发性肝细胞癌(HCC)组织中的表达及其在肝癌发病机制中的作用和临床意义.方法 利用免疫组织化学S-P法检测50例原发性肝癌组织、20例正常肝组织中Survivin蛋白表达情况.结果 Survivin蛋白在肝癌中的阳性表达率为66.0%(33/50),显著高于正常肝组织组(均为阴性表达;P<0.001),阳性表达与肝癌的肝内转移和肝癌的多发性有关(P=0.019,P=0.030);Survivin的过表达与病人术后<3年生存期相关(P=0.018).结论 Survivin在肝细胞癌的发生及发展过程中起着不同程度的作用,检测Survivin对判定原发性肝细胞癌预后可提供一定的依据.     

肝细胞癌中MyD88和STAT3的表达及其意义

目的 探讨髓样分化因子88(MyD88)和转录激活因子3(STAT3)在肝细胞癌(HCC)组织中的表达及其生物学意义.方法 采用免疫组化方法 检测MyD88和STAT3在82例肝痛组织及其对应的癌旁肝组织中的表达水平.结合肝癌临床病理指标分析它们的相关性.结果 MyD88和STAT3蛋白在癌组织中的阳性表达率分别为67.1%(55/82)和69.5%(57/82),高于癌旁肝组织中的11.0%(9/82)和8.5%(7/82).差异均具有统计学意义(P＜0.05).在肝癌组织中MyD88与STAT3的阳性表达呈正相关(r=0.578,P=0.002).MyD88和STAT3表达与HCC患者的性别、癌的分化程度、有无HBV感染和肝硬化有关;上述4指标分组间差异具有显著性(P＜0.05).而与HCC肿瘤大小及有无静脉浸润无关;该2指标分组间差异无显著性(P＞0.05).结论 MyD88和STAT3表达上调,导致肝癌细胞增殖和免疫逃逸是肝癌发生发展的重要分子机制.     

Survivin和cyclinD1在原发性肝细胞癌中的表达及其相关性研究

为探讨survivin和cyclinD1在原发性肝细胞癌（HCC）组织中的表达及两者在肝癌发病机制中的作用和相关性。笔者利用免疫组织化学S P法检测50例原发性肝癌组织（HCC组）及20例正常肝组织（正常组）中survivin和cyclinD1蛋白的表达情况。 采用Spearman相关分析法分析两种蛋白表达的相关性。结果示，HCC组中survivin蛋白表达的阳性率为66.0%（33/50），显著高于正常组（均为阴性表达）（P<0.001）;其阳性表达与肝癌的肝内转移和癌灶的多发性有关（P=0.019，P=0.030）。 cyclinD1蛋白在HCC组的阳性率为44.0%（22/50），显著高于正常组（均为阴性表达）（P<0.001）;其阳性表达与肝癌的肝内转移和分化程度有关（P=0.035，P=0.036）。两种蛋白的的阳性表达呈正相关（r=0.466，P<0.001）。两者的过表达均与患者术后＜3年生存期有关（P=0.018，P=0.013）。提示survivin与cyclinD1在HCC的发生及发展过程中起着不同程度的作用; 两者的联合检测对判定原发性HCC的预后可提供一定的依据。     

肝癌切除术并肝动脉结扎和门静脉化疗对复发肝癌表达MDR1和MRP的影响及意义

目的探讨肝癌切除并肝动脉结扎和门静脉化疗对复发肝癌多药耐药(multi drug resistance-1,MDR-1)和多药耐药相关蛋白(multidrug resistance associated protein-1,MRP-1)表达的影响。方法应用免疫组化SABC法对23例复发的肝细胞癌(hepatocellular carcinoma,HCC)手术切除的石腊包埋标本切片进行P-gp和MRP-1的蛋白表达测定,以自身原发灶作为对照进行统计学分析。结果P-gp在HCC复发前后的阳性表达率分别为65.2%和52.2%(P>0.05),MRP-1在HCC复发前后的阳性表达率分别为34.8%和69.6%(P<0.05)。结论肝癌切除并肝动脉结扎和门静脉定期化疗后复发肝癌MDR-1的表达受到抑制。     

p27和p-ERK1/2在肝细胞癌中的表达及相关性研究

目的 探讨p27和p-ERK1/2在肝细胞癌(hepatocellular carcinoma,HCC)中的表达、意义及二者间可能的关系.方法 免疫组织化学(S-P)法检测肝癌50例、肝硬化15例及正常肝组织10例中p27和p-ERK1/2的表达.结果 肝癌组织中p27的阳性表达率(42%)明显低于肝硬化(78%)和正常肝组织(90%),表达水平与肿瘤恶性程度、大小、是否广泛转移等有关(P＜0.05);肝癌组织中p-ERK1/2的阳性表达率(36%)显著高于肝硬化(21.5%)和正常肝组织(11.6%),表达与恶性程度、转移等有关;肝癌组织中p27的表达与p-ERK1/2表达呈负相关(rs=-0.4812,P＜0.01).结论 p-ERK1/2基因的激活可以影响p27的表达,二者与肝癌的发生、发展有关.     

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.     

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.     

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.     

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.     

Intraoperative autotransfusion is associated with modest reduction of allogeneic transfusion in prosthetic hip surgery

Background: The efficacy of intraoperative salvage and washing of wound blood and the predictors of allogeneic red cell transfusions in prosthetic hip surgery are insufficiently known.
Methods: In 96 patients, undergoing primary or revision surgery, salvaged and washed red cells and, if necessary, allogeneic blood were used to keep haematocrit not lower than 33%. The bleeding of red cells during hospital stay was calculated from the red cell balance. The preoperative red cell reserve (millilitres of red cells in excess of a haematocrit of 33%) was estimated and the difference between this volume and the total bleeding of red cells was retrospectively used to classify patients with regard to the need for red cells. Stepwise regression analysis was used to define patient-related variables associated with allogeneic blood transfusion.
Results: Preoperative knowledge of the type of operation (primary, revision), the preoperative red cell reserve, and the body mass could predict roughly half of the need for banked blood (r²=0.45). Only one-third of the total bleeding of red cells was retransfused. For complete avoidance of allogeneic blood, autotransfusion was most effective in patients with a moderate need (0–4 u). However, 32% of such patients required allogeneic blood.
Conclusions: Autotransfusion has a limited efficacy to decrease the need for allogeneic blood, and other blood-saving methods should be added for this purpose. It is difficult to predict the need for allogeneic blood preoperatively.     

缺氧对肾小管上皮细胞分泌外泌体的影响

目的    观察缺氧对肾小管上皮细胞分泌外泌体的影响,探讨外泌体在缺氧致肾脏损伤中的作用及机制。 方法    （1）常氧（21% O₂）及缺氧（1% O₂）分别处理大鼠肾小管上皮细胞（NRK-52E）48 h,收集细胞上清液并使用高速梯度离心法分离外泌体。采用透射电镜、纳米示踪分析、Western印迹、蛋白浓度定量鉴定并比较两组外泌体的基本特性。（2）在共培养实验中,以不同浓度（1、10、50、100、300 mg/L）的常氧外泌体、缺氧外泌体分别干预脂多糖（LPS）诱导的大鼠原代腹腔巨噬细胞,使用实时荧光定量PCR与酶联免疫吸附试验（ELISA）法分别检测巨噬细胞白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）、诱导型氮氧化物合酶（iNOS）水平;使用Western印迹法检测巨噬细胞磷酸化（p）STAT/STAT及细胞因子信号传导抑制蛋白1（SOCS1）的蛋白表达;最后,使用实时荧光定量PCR法检测常氧外泌体与缺氧外泌体中炎性反应相关微RNA（microRNA,miR）的表达差异。 结果    （1）离心得到的囊泡具有外泌体典型的结构,粒径小于150 nm,表达外泌体标志蛋白CD63,说明分离得到外泌体。缺氧对肾小管上皮细胞分泌的外泌体形态、粒径分布比例无明显影响,但提高了外泌体的分泌量。（2）缺氧外泌体相比于常氧外泌体促进了LPS诱导的M1型巨噬细胞IL-6、TNF-α、iNOS 的表达和分泌（均P＜0.01）,同时提高STAT的磷酸化水平并减少SOCS1的蛋白表达（均P＜0.01）;对炎性反应相关microRNA检测发现缺氧外泌体中miR-155、miR-27a表达量较常氧外泌体明显升高（P＜0.05）。 结论    缺氧可改变外泌体的生物学功能,表现为协同促进LPS诱导的M1型巨噬细胞的表型转化,这可能是慢性肾脏病微炎性反应状态持续的原因之一。     

In Vitro Function and Durability Assessment of a Novel Polyurethane Heart Valve Prosthesis

Abstract While flexible-leaflet, central-flow prosthetic heart valves promise relief from anticoagulation therapy, they continue to be restricted by inadequate durability. In consequence, a novel trileaflet valve, made entirely from polyurethane, has been developed. A batch of 6 consecutively manufactured polyurethane valves was subjected to hydrodynamic function and accelerated fatigue testing. Computerized data acquisition and control systems have been introduced to improve valve testing methodologies. In terms of hydrodynamic function, the polyurethane valve demonstrates transvalvular pressure gradients similar to those for a bioprosthetic valve (Carpentier-Edwards) and levels of retrograde flow significantly less than those for either the bioprosthetic valve or a bileaflet mechanical valve (St Jude Medical). The equivalent of 10 years of cycling without failure has been exceeded by all 6 polyurethane valves in accelerated fatigue tests with 2 valves remaining intact after 674 million cycles (equivalent to approximately 17 years) in continuing tests. Highspeed photography revealed considerable differences in leaflet motion between valves cycled at accelerated and physiological rates.     

Negative pressure ventilation vs. spontaneous assisted ventilation during rigid bronchoscopy: A controlled randomised trial

Background: Ventilation during interventional rigid bronchoscopy (IRB) under general anaesthesia (jet ventilation, positive pressure ventilation and spontaneous assisted ventilation) may offer some difficulties. This study compares the effectiveness during IRB of intermittent negative pressure ventilation (INPV) and spontaneous assisted ventilation (SAV). Methods: Thirty-eight patients submitted to IRB were randomised into two groups: SAV or INPV. All patients received a total intravenous anaesthesia; INPV patients were paralysed. Pre-and intra-operative arterial blood gases and O₂ flow through a rigid bronchoscope were assessed. The endoscopist applying a subjective score evaluated the operating conditions. Results: Patients of the INPV group, as compared to the SAV group, required a lower dosage of fentanyl (2.6 ± 1.8 (μg · kg^?1· h^?1 vs. 6.6 ± 4.8 μg · kg^?1· h^?1), a lower O₂ supply (3.3 ± 2.8 1/min vs. 11.6 ± 3.4 1/min), a shorter recovery time (5.4 ± 2.9 min vs. 9.8 ± 7.1 min) and no manually assisted ventilation (0 ± 0 vs. 1 ± 1.1 nd?/procedure). Intraoperative PaCO₂ was higher in the SAV (8.1 ± 1.3 kPa) than in the INPV group (5.0 ± 1.6 kPa) and intraoperative pH differed in the two groups (7.26 ± 0.05, SAV vs. 7.47 ± 0.08, INPV). Operating conditions, as assessed by a subjective score, were considered better with INPV than with SAV (4.9 vs. 4.3). Conclusions: As compared to SAV, INPV in paralysed patients during IRB reduces administration of opioids, shortens recovery time, prevents respiratory acidosis, excludes the need for manually assisted ventilation, reduces 02 need and affords optimal surgical conditions. INPV appears a safe, non-invasive and effective ventilatory management during IRB.