Objective To evaluate the efficacy of sufentanil combined with propofol for video-assisted endoscopic transthoracic sympathectomy.Methods Twenty ASA I or II patients of both sexes aged 17-40 yr weighing 52-75 kg undergoing video-assisted endoscopic transthoracic sympathectomy were enrolled in this study.Anesthesia was induced with propofol 2.0-2.5 mg/kg and sufentanil 0.5 μg/kg.Tracheal intubation was facilitated with atracurium 0.6 mg/kg.The patients were mechanically ventilated (VT=8-10 ml/kg,RR=10-12 bpm,I:E =1:2,FiO2=80%).Anesthesia was maintained with infusion of propofol 2-4 mg·kg-1·h-1 and sufentsnil 0.2-0.3/.μg·kg-1 h-1 and intermittent iv boluses of atracurium.At the 30 rain before the end of operation propofol infusion was reduced to 1-2 mg.kg-1·h-1 and sufentanil infusion to 0.1 μg·kg-1 h-1 .BP (SP,DP) and HR were recorded and venous blood samples were taken before induction of anesthesia (baseline),at tracheal intubation at the moment of CO2 insnfflation 10 min and 30 min after CO2 insufflation,5 min after deflation and at extubation for determination of plasma corticesteroid,aldosterone and glucose levels.The duration from termination of infusion of the anesthetics to recovery of spontaneous breathing,eye opening at command and tracheal extubation were recorded.Results SP,DP and HR were within the normal range.Plasma levels of comcesteroid,aldosterone and blood glucose were significantly increased during operation as compared with the baseline values.The duration from termination of infusion of the anesthetics to recovery of spontaneous breathing,eye opening at command and tracheal extubation were4.5±1.9,6.4±2.7 and (12.6±1.5)min respectively.Conclusion Sufentanil 0.1-0.3 μ·kg-1·h-1 combined with propofol 1-4 mg·kg-1.h-1 can inhibit stress response during video-assisted endoscopic transthoracic sympathectomy with stable hemodynamics.

BACKGROUND:Kartogenin can induce chondrogenic differentiation of mesenchymal stem cel s as reported in in vitro experiments. The discovery of Kartogenin finds a novel path to cartilage repair, and it is expected to develop into a new drug to treat osteoarthritis. OBJECTIVE:To observe the inductive role of Kartogenin in the process of human bone marrow mesenchymal stem cel s differentiating into chondrocytes in vitro. METHODS:In vitro cultured human bone marrow mesenchymal stem cel s were grown to the logarithmic phase, and then divided into control group (0μmol/L Kartogenin), 1μmol/L Kartogenin group, and 10μmol/L Kartogenin group. After 72 hours of culture, cel proliferation and differentiation were observed microscopical y. Matrix metal oproteinase 2 and type II col agen levels in the cel supernatant were detected by enzyme linked immunosorbent assay and immunofluorescence staining, respectively. RESULTS AND CONCLUSION:Under the microscope, Kartogenin was shown to significantly promote the proliferation and differentiation of human bone marrow mesenchymal stem cel s. With the increase of Kartogenin concentrations, the level of type II col agen was increased, while the level of matrix metal oproteinase 2 was decreased. These findings indicate that Kartogenin can induce human bone marrow mesenchymal stem cel s to differentiate into chondrocytes, and with the increase of Kartogenin concentration, destruction of the cartilage extracel ular matrix may be inhibited.

Objective To evaluate the value of MRI in diagnosis of meniscus tear of knee joint.Methods MRI manifestations of meniscus tear of knee joint were analyzed in 60 cases.Four-grade classification of meniscus injury was suggested according to Stoller's classification.Results Meniscus tear was seen in 65 menisci of 60 patients,including 15 medial tear,40 lateral tear,and 5 cases(n=10) of bilateral tear.Fifteen lateral discoid menisci were found among the 60 cases of meniscus tear.MRI revealed a accuracy of 90.8%.Thirty-nine cases were complicated by ligament injury,bone contusion,effusion of joint,fracture and meniscus cyst.Conclusion MRI can accurately diagnose meniscus tear and its complication.

To evaluate the validity of osteoarthritis model induced by bilateral ovariectomy in guinea pig, 32-month-old female guinea pigs were randomly divided into two groups: a sham operation group (control group) and an ovariectomized group (OVX group). The animals were killed 6 or 12 weeks after the operation and the degeneration of the knees were assessed microscopically and histologically by scanning electron microscope (SEM), transmission electron microscope (TEM) and light microscope. The serum levels of estrogen and gestone were detected by immune contest assay. The scoring of articular cartilage histopathology of tibial plateau was performed by histopathological examination. The blood serum levels of estrogen and gestone were decreased significantly in the OVX group as compared with the control group 6 or 12 weeks after the operation. Joint cartilage degeneration as detected by SEM and TEM could be found at the 6th week, but severe degenerative lesions were observed at the 12th week in the OVX group as compared with the control group (P<0.01). The histopathological score of articular cartilage in tibial plateau in OVX group was higher than that of control group, which was coincident with the changes of estrogen and the ultrastructure (P<0.01). The findings suggested that bilateral ovariectomy in guinea pig can induce the severe osteoarthritis that is similar to the aging-induced OA in human. Therefore, the model of the osteoarthritis by bilateral ovariectomy in guinea pig in this study is valid.

To investigate the estrogen receptor (ER) expression in cartilage cell in the development of osteoarthritis induced by bilateral ovariectomy in guinea pig and to find their relationship. 30 two-month-old female guinea pigs were randomly divided into two groups (n = 15 each): sham operation (control) group and ovariectomized group (OVX); Scanning electorne microscope (SEM) and transmission electron microscope (TEM) were obtained to analysis the cartilage degeneration of the hind limb knee joint after 6 and 12 weeks of ovariectomy. Dextran-Coated-Charcoal (DCC) was taken to quantitively detect the expression of ER. The serum levels of estrogen and gestone were detected by immune contest assay. The results showed that ER do exist in the cartilages of the guinea pigs, with higher expression in the control group than in OVX group at the same time point (P < 0.05). It was increased also at 12 th week after operation than that of preoperation. The blood serum levels of estrogen and gestone showed a similar tendency to the expression of ER. Joint cartilage degeneration detected by SEM and TEM could be found at 6 th week, but severe degenerative lesions at 12 th week in the OVX group compared with the control group (P < 0.01). The data suggested that bilateral ovariectomy in guinea pig lead to severe osteoarthritis which mighgt be related to the lower serum level of estrogen and the downregulation of the expression of ER in the cartilage also.
Cartilage, Articular/cytology ; Cartilage, Articular/*metabolism ; Chondrocytes/metabolism ; Estrogens/*blood ; Osteoarthritis/*etiology ; Osteoarthritis/metabolism ; Ovariectomy ; Random Allocation ; Receptors, Estrogen/*biosynthesis ; Receptors, Estrogen/genetics

Neutrophils play a critical role in ventilation-induced lung injury. This study was aimed to investigate the characteristics of neutrophils influx in lungs induced by high tidal volume ventilation. Anaesthetized rats were randomly divided into low tidal volume ventilation group (Vt: 7 mL/kg, LV group) or high tidal volume ventilation group (Vt: 42 mL/kg, HV group) (n=40 in each). Rats in each group were ventilated for 0, 60, 90, 120 and 240 min. The wet/dry lung weight ratio (W/D) was measured. The levels of macrophage inflammatory protein-2 (MIP-2) and tumor necrosis factor-α (TNF-α), and the activity of myeloperoxidase (MPO) were detected by enzyme-linked immunosorbent assay (ELISA). The number of neutrophils in bronchoalveolar lavage fluid (BALF) was counted after Wright's staining, and the percentage of netrophils in lung tissues calculated. Histopatholgical examination was used to observe the changes of lung tissues after different ventilations. The results showed that the W/D weight ratio was increased, and the levels of MIP-2 and TNF-α significantly enhanced in HV group at 90, 120 and 240 min. Neutrophils in BALF and the neutrophil percentage in lung tissues were also elevated at 120 and 240 min, which coincided with the enhanced activity of MPO in HV group. The lung injury was significantly related with the ventilation time and the infiltration of neutrophils in lungs in HV group. In conclusion, in ventilation-induced lung injury, neutrophil infiltration is present in a time-dependent manner and associated with the aggravated lung injury. Pulmonary structural damage may be the main reason for ventilation-induced lung injury.

Objective To investigate the expression levels of tumor necrosis factor alpha (TNF-α),interleukin-6(IL-6) and the change of serum ferritin in patients with intracranial aneurysm and its clinical significance.Methods 22 patients with intracranial aneurysm and 16 cases of traumatic brain injury who recevied operation in Department of Neurosurgery in Quzhou People's Hospital from Jan.2014 to Jan.2015 were enrolled as observation group and control group.The intracranial aneurysm tissues and normal cerebral vascular tissues were collected respectively to detect the situation of inflammatory cell infiltration,and the expression of TNF-α and IL-6 was detected by HE staining and immunohistochemical staining.The serum was collected on hospitalized,postoperative 3 days and postoperative 7 days to detect serum ferritin.Results The positive cells were observed in the observation group after immunohistochemical staining,in which the expression levels of TNF-α [(0.194 ± 0.074) vs.(0.135 ± 0.047),t =2.799] and IL-6 [(0.152 ± 0.057) vs.(0.103 ± 0.028),t =3.494] were significantly higher than those in the control group(P =0.008,0.001).The serum ferritin level in the observation group was significantly higher than that in the control group at postoperative 3d [(232.25 ± 105.26) ng/mL vs.(169.51 ± 66.24) ng/mL,t =2.097] and postoperative 7d[(263.39 ± 114.73) ng/mL vs.(166.57 ± 73.71) ng/mL,t =2.955] (P =0.043,0.005).The difference of serum ferritin on different day in the observation group also was statistically significant(F =8.625,P =0.003).Conclusion The expression levels of TNF-α and IL-6 in intracranial aneurysms were high,which may be one of the important factors in the formation of intracranial aneurysms,and it provides an important reference of early prevention and drug treatment for patients with intracranial aneurysm.The serum ferritin is related to the rupture and hemorrhage of intracranial aneurysm,which can be used to judge prognosis and guide rational treatment,and worth further study to confirm.

Objective To report the primary experience of open placement of triple-branched stent graft for acute Stanford type A aortic dissection. Methods Between June 2008 and September 2009, 20 well-selected patients with acute Stanford type A aortic dissection underwent open placement of triple-branched stent graft for total arch reconstruction. When core cooling to a 20℃ nasophageal temperature, perfusion to the lower body was discontinued and the ascending aorta was transected at the base of the innominate artery. Through a transverse incision, the triple-branched stent graft was inserted into the true lumen of the arch and descending aorta, and each side arm of the stent graft was positioned one by one into the arch branches.The transected stump of the ascending aorta was reconstructed by inner proximal stent-free dacron tube of the main graft and outer teflon felt, and subsequently continuous anastomosis to the 1-branched dacron tube graft was made. Results Open placement of triple-branched stent graft was technically successful in all patients. The mean cardiopulmonary bypass time, aortic cross-clamp time and lower body arrest time were (163.2 ±19.2) min, (89.4 ±10.0) min and (32. 7 ±6. 6)min, respectively. Transient postoperative neurological dysfunction was observed in 1 patient and acute renal failure in 1 patient. All patients were discharged from the hospital. Their computed tomographic scans at 3 months postoperatively showed that all stent grafts were fully opened without distortion. In the vascular stent implantation site the dissected false lumen was eliminated. The false lumen of the descending aorta distal to the stent graft was closed with thrombus in 16 cases. Conclusion Open placement of triple-branched stent graft is a new effective technique for total arch reconstruction in acute type A aortic dissection. Patients have the indications of the extensive primary repair of the thoracic aorta without primary intimal tears in the arch may be the best candidates for this new technique. The size of the stent graft, the distances between two neighboring side arm grafts and the prevention of the intimal trauma during the placement are crucial for successful open placement of triple-branched stent graft.

Objective To analyze the virulence genes expression and drug resistance situation of type three secretion system (TTSS) of pseudomonas aeruginosa in Zhongshan area to provide a basis for clinical anti-infection treatment .Methods Seventy-six clinically isolated strains of Pseudomonas aeruginosa were collected from the Zhongshan Municipal People′s Hospital from July to September 2016 .Four virulence genes exoU ,exoS ,exoT and exoY were isolated from the strains by PCR .The Vitek2 Compact au-tomatic microbiological identification instrument was used to detect the sensitivity of antibacterial drugs .The enumeration data were processed with chi-square test .Results The detection rates of gene exoS and exoY were highest ,which were 52 .6% (40/76) and 63 .2% (48/76) respectively ;genotype exoU(-)exoS(+ )exoT (-)exoY(+ ) were predominant and accounted for 59 .26% .The positive rates of 4 virulence genes had no statistical difference between the multiple resistant and non-multiple resistant strains of pseudomonas aeruginosa .The resistance rates in the TTSS positive group to 13 kinds of drugs were commonly lower than those in the TTSS negative group ,the difference was statistically significant .Conclusion The geographic difference exists in virulence genes carrier of pseudomonas aeruginosa .The virulence genes carrying situation in both the multiple resistant and non-multiple resistant strains of pseudomonas aeruginosa is similar .

Objective To explore the risk of pituitary dysfunction for spontaneous subarachnoid hemor -rhage( s-SAH) patients and to evaluate its correlation with clinical data .Methods 63 cases of patients with s-SAH were selected.Indicators(serum adrenocorti cotrophic hormone (ACTH), growth hormone(GH), insulin-like growth factor-1(IGF-1), thyroid stimulating hormone(TSH), thyroxine(T4), triiodothyronine(T3), folli-cle-stimulating hormone(FSH), luteinizing hormone(LH), total testosterone(in males), estradiol(in females) and prolactin)dynamic observation were tested 7 days, 1 year, 2 years, 3 years after the onset.Results Thirty patients( 47.6%) had some type of pituitary dysfunction .ACTH deficiency was the most frequent disorder (14.3%), followed by GH deficiency(12.7%), hypogonadatrophic(6.3%), hypothyroidism(3.2%)and high prolactin(1.6%).six patients(9.5%)showed deficiencies in more than one axis .Hormone deficiency was relat-ed to vasospasm, Fisher grade 4(P<0.05)and recovery time.Conclusions A greater incidence of hormone de-ficiency after s-SAH was related with vasospasm , Fisher grade and recovery time .Follow-up time should be ex-tended.