Objective To investigate the effects of penehyclidine hydrochloride combined with ulinastatin on lung injury in patients undergoing cardiac valve replacement with cardiopulmonary bypass(CPB).Methods Sixty ASA Ⅱ or Ⅲ patients of both sexes,aged 33-64,weighing 47-81 kg,NYHA class Ⅱ or Ⅲ ,scheduled for cardiac valve replacement,were randomly divided into 4 groups(n = 15 each): control group(group C),ulinastatin group(group U),penehyclidine hydrochloride group(group P)and penehyclidine hydrochloride + ulinastatin group(group PU).Group U,P and PU received iv injection of ulinastatin 20 000 U/kg,penehyclidine hydrochloride 0.05 mg/kg and ulinastatin 20 000 U/kg + penehyclidine hydrochloride 0.05 mg/kg 30 min after the end of CPB,respectively,while group C received equal volume of normal saline.Then PEEP was increased to 8 cm H2O in all groups.Blood samples were taken at 30 min,3 and 6 h after the end of CPB and 12 and 24 h after operation for determination of PaO2 and serum concentrations of TNF-α,IL-6,IL-8 and IL-10.Airway peak pressure and airway plateau pressure were recorded at the corresponding time points.Oxygen index(OI)and pulmonary compliance(CL)were calculated.Lung injury was scored at 6 h after the end of CPB and 12 and 24 h after operation.Results OI and CL were significantly increased and lung injury score was significantly decreased in group U,P and PU compared with group C(P ＜ 0.05 or 0.01),and in group PU compared with group U and P (P ＜ 0.05).Serum concentrations of TNF-α,IL-6 and IL-8 were significantly lower and the serum IL-10 concentration was significantly higher in group U,P and PU than in group C(P ＜ 0.05 or 0.01),and in group PU than in group U and P(P ＜ 0.05).There was no significant difference in the indices mentioned above between group U and P(P ＞ 0.05).Conclusion Penehyclidine hydrochloride combined with ulinastatin can attenuate lung injury by inhibiting inflammatory response in patients undergoing cardiac valve replacement with CPB.

Objective To investigate the antenatal influencing factors associated with birth weight of twins and the risk factors for the occurrence of discordant twins. Methods Totally, 834 twins delivered at the Third Affiliated Hospital from January 2000 to December 2009 and the First Affiliated Hospital of SUN Yat-sen University, from January 2000 to June 2009, were recruited in the study. The diagnosis criteria of discordant twins was intrapair birth weight difference more than 25 %.Antenatal factors on birth weight were retrospectively investigated among twins and discordant twins respectively with Logistic analysis. Results (1) There were several factors associated with birth weight of twins, including maternal age, conceptive style, chorionicity, gestational diabetes mellitus and placental cord insertion ( P = 0. 021, 0. 000, 0. 000, 0. 012 and 0. 017, respectively). While hypertensive disorder in pregnancy, parity and fetal gender differences were not associated with the birth weight of twins (P＞0.05). Hypertensive disorder in pregnancy (OR=2. 600, 95% CI:1. 566-4. 316) and monochorionicity (OR= 1. 833, 95% CI: 1.010-3. 582) were risk factors of discordant twins. All 834 twin pregnancies were divided into 4 groups according to materal age, ＜25 yrs (n=69), 25-30 yrs (n=312), 30-35 yrs (n=325) and ≥35 yrs (n=128). The average birth weight of twins were (2205±483) g, (2347±406) g, (2381±439) g and (2352±455) g. Significant difference was found bewteen every two groups (P＜0. 05) except that between the 30-35 yrs and ≥35 yrs group (P＞0.05). Among twins of different gender (n=270), the average birth weight of boys and girls were (2416±-514) g and (2322±488) g, and that of female twins (n=272) and male twins (n=292) were (2301±418) g and (2381±428) g. Significant difference was shown between every two groups (P＜0.05) except that between the male twins and male fetus of twins of different gender (P＞0.05).Conclusions The fetal birth weight of twins decreases remarkably when maternal age ＜25, or monochorionicity twins, or complicated with marginal or velamentous placental cord insertion or female pairs.However, birth weight of twins would increase if the pregnancy conceived by assisted reproductive technology or complicated with gestational diabetes mellitus. Twin pregnancy complicated with hypertensive disorder in pregnancy or monochorionicity should alert the clinicians of discordance twins.

Objective To investigate the role of bone marrow-derived mesenchymal stem cells (BMSCs) compounded with bioprotein gel (Bg) in repair of knee articular cartilage defects of rabbits.Methods Bilateral femoral condylar cartilage defect models (3.5 mm in diameter and 3 mm in depth) were established in 36 healthy New Zealand rabbits.Animals were divided into three groups of 12 rabbits each according to the random number table:BMSCs-Bg group,Bg group and blank control group.Effect of repair was evaluated by anatomic observation and histological examination at 4,8,12 and 16 weeks after operation and by articular cartilage histological hemi-quantitative scoring system.Results Hyaline-like cartilage was noted in BMSCs-Bg group at 4 weeks postoperatively,got close to the normal at 8 and 12 weeks and showed no disintegration at 16 weeks.Only fibrous tissue or fibrocartilage was observed in other 2 groups.In BMSCs-Bg group histology scores were (4.5 ± 0.1) points,(4.9 ± 0.1) points,(5.5 ± 0.1) points,and (6.2 ± 0.1) points respectively at 4,8,12 and 16 weeks,higher than those in other 2 groups (P ＜ 0.05).Besides,the histology scores were higher in Bg group than in blank control group but the differences were insignificant.Conclusion BMSCs-Bg compound can well repair the articular cartilage defect in a short-term period,when Bg contributes to cartilage generation as a good cell carrier.

Objective To investigate the effect of dexmedetomidine on the cerebral injury in patients undergoing cardiac valve replacement under cardiopulmonary bypass (CPB).Methods Forty ASA Ⅱ or Ⅲ patients of both sexes,aged 43-64 yr,scheduled for elective cardiac valve replacement,were randomly divided into 2 groups (n =20 each):control group (group C) and dexmedetomidine group (group D).Dexmedetomidine 0.6 μg/kg was injected intravenously over 15 min before induction of anesthesia,followed by infusion at 0.2μg· kg-1 · h-1 until the end of operation in group D.While the equal volume of normal saline was given in group C.Blood samples were obtained from the radial artery and jugular bulb for blood gas analysis before CPB,immediatelv after declamping of the ascending aorta,at the end of CPB and at 6 h after operation (T1-4).The arteriovenous blood O2 difference (Da-jvO2) and cerebral O2 extraction rate (CERO2) were calculated.The plasma concentrations of S-100β and neuron-specific enolase (NSE) in the blood samples obtained from the jugular bulb were measured at T1-4 and 24 h after operation.Results Compared with group C,the jugular venous oxygen saturation was significantly increased and Da-jvO2 and CERO were decreased at T2,3,and the plasma concentrations of S100β and NSE were decreased at T2-4 in group D (P ＜ 0.05).Conclusion Dexmedetomidine can decrease the cerebral O2 metabolic rate and reduce the cerebral injury in patients undergoing cardiac valve replacement under CPB.

Objective To investigate the feasibility and technique in laparoscopic cholecystectomy and exploration of common bile duct (CBD) in patients who have previous subtotal gastrectomy.Methods From January 2001 to October 2010,22 patients who had a history of subtotal gastrectomy received laparoscopic cholecystectomy and CBD exploration in our hospital.In addition,these patients received cholangioscopic lithotomy,electrohydraulic lithotripsy,T-tube drainage,or primary suturing of the CBD wound.Results The procedures were completed successfully in 18 patients.In 4 patients,conversion to laparotomy was necessary because of multiple stones in a stenosed CBD (n=1),severely congested CBD wall with edema (n=1),CBD carcinoma associated with impacted stones (n=1) or Mirzzi syndrome (n =1).T tube drainage was employed in 16 patients,and primary suturing in 2 patients at the end of the operation.There was no hemorrhage,biliary leakage or abdominal infection.At a mean follow-up of 13 (range 3 to 60) months there was no residual stone,biliary stenosis or cholangitis.In 3 patients Stone recurred,and another 3 patients were lost to follow-up.Conclusions A history of subtotal gastrectomy is not a contradiction to laparoscopic cholecystectomy and CBD exploration.With choledocoscopy,surgery can be safe and feasible even for patients with previous gastectomy.

Objective To investigate the relationship between the changes in intracranial excitatory amino acid(EAA) levels and the incidence of postoperative cognitive dysfunction (POCD) in eldedy patients after general anesthesia. Methods Forty ASA Ⅰ-Ⅲ patients of both sexes aged 65-79 yr weighing 48-76 kg undergoing elective non-cardiac surgery under general anesthesia were studied.Anesthesia was induced with midazolam,fentanyl,etomidate and succinylcholine and maintained with continuous iv infusion of propofol,remifentanil,isoflurane inhalation and intermittent iv boluses of vecuronium.The right internal jugular vein was cannulated with a catheter which was advanced cephalad until jugular bulb.The jugular bulb venous blood samples were taken before (T0,baseline),at the end of (T1) and at 24,48 and 72h(T2-4) after operation for measurement of plasma concentrations of glutamate (Glu),aspartate (Asp) and glycine (Gly) by RP-HPLC.The cognitive function was evaluated by mini-mental state examination (MMSE) at T0 and T4.Results Eleven of the 40 patients developed POCD (28%).The plasma Gh,Asp and Gly concentrations were significantly increased after operation as compared with the baseline values in POCD patients and were significantly higher than in non-POCD patients.The plasma concentrations of Glu and Asp were negatively correlated with MMSE score(Glu:r=-0.86.P<0.01;Asp:r=-0.99,P<0.01).Conclusion Elderly patients may develop POCD after operation performed under general anesthesia through increase in intracranial EAA levels.

ABSTRACT:Objective To observe whether N-acetyl-seryl-aspartyl-lysyl-proline (Ac-SDKP)can inhibit rat silicotic fibrosis by regulating stimulatory G proteinα(Gαs)/inhibitory G proteinα(Gαi)signal.Methods Male Wistar rats were randomly divided into three groups (n=1 0 ):control 1 6-w group,silicosis 1 6-w group,and Ac-SDKP pre-treatment group.The pathological changes of the lung tissue was observed by HE staining;the expressions ofα-smooth muscle actin (α-SMA),Collagen Ⅰ,fibronectin (Fn),Gαs,Gαi2 ,Gαi3 and cAMP were detected by Western blot.Immunofluorescence was performed on lung tissue sections to detect the coexpression ofα-SMA/Gαi3 . Results Within silicosis 16-w group,HE staining showed that the silicotic nodule volume increased,nodule fusion and the formation of interstitial fibrosis could be seen,and cell fibrous nodules were visible.Immunofluorescence staining showed the enhanced coexpression ofα-SMA/Gαi3 in fibrosis area.Compared with those in control group, the expressions ofα-SMA,Collagen Ⅰ,Fn,Gαi2 and Gαi3 significantly increased in silicosis 1 6-w group,but the expressions of Gαs and cAMP decreased.Compared with silicosis 1 6-w group,Ac-SDKP pre-treatment group had alleviated lung injury and decreased coexpression ofα-SMA/Gαi3 .The expressions ofα-SMA,Collagen Ⅰ,Fn,Gαi2 and Gαi3 protein significantly decreased in Ac-SDKP pre-treatment group,while the expressions of Gαs and cAMP increased obviously.Conclusion Ac-SDKP can regulate the expressions of Gαs and Gαi and promote the formation of cAMP,thus playing an effective role against silicotic fibrosis.

BACKGROUND: As is well known that hematopoietic stem and progenitor cells (HSPCs) contain in bone marrow, peripheral blood, and cord blood. Recent studies found that human placenta tissue (PT) also exists in HSPCs. But so far the property and differentiation capacity of human PT-HSPCs is not yet known. Furthermore the composition of lymphocyte subpopulations and immunogenicity regarded to human PT-HSPCs are also unclear.OBJECTIVE: To verify whether there are more HSPCs in human PT than those in human umbilical cord blood (UCB), to investigate their capacities of proliferation and differentiation, and to analyze the phenotypes of lymphocyte subpopulations in human PT.DESIGN, TIME AND SETTING: Open eXperiments were performed at the Key Laboratory of Cell Engineering of Guizhou Provinee from January 2004 to December 2006.SETTING: Key Laboratory of Cell Engineering of Guizhou Province, the Affiliated Hospital of Zunyi Medical College.MATERIALS: Twelve human placenta and UCB samples through cesarean delivery were collected aseptically with the informed consents of parturients derived from Maternity Department of the Affiliated Hospital of Zunyi Medical College. The main reagents were detailed as follows: lymphocyte subpopulations analysis reagents Simultest IMK-lymphocyte Kit, CD34 absolute counting reagents Kit (Becton Dickinson); CD34 Multisort Kit, FITC conjugated CD38 monoclonal antibody, anti-FITC microbeads and MS/LS mini MACS segregating, columns (Miltenyi Biotec).METHODS: UCB samples were 1:1 diluted with RPMI-1640 containing 0.1 volume fraction of fetal bovine serum and the mononuclear cells (MNCs) were isolated on Ficoll-Histopaque by centrifugation for 30 minutes. The MNCs at the interface were collected and washed with PBS. Single cells suspension liquid of human PT was prepared by mechanical method combined with 0.25g/L collagenase digestion. After that, the placenta samples underwent the same protocol as used in UCB to isolate MNCs. The percentage of CD34+CD38-, CD34+CD38+ HSPCs and the phenotype of lymphocyte subpopulations derived from human PT-MNCs were analyzed by flow cytometry (FCM). CD34+CD38-, CD34+CD38- cell subsets isolated by magnetic-activated cell sorting (MACS) from human PT were used to carry out colony-forming culture including granulocyte/macrophage colony-forming unit (CFU-GM), burst forming unit-erythroid (BFU-E) and mixed colony-forming unit (CFU-Mix) in order to assess their capacities of hematopoietic progenitor cells' proliferation and differentiation. In parallel, UCB samples underwent the same protocols for comparison.MAIN 0UTCOME MEASURES: Percent compositions of CD34+ HSPCs, hematopoietic progenitors' lineage colony-forming capacities of CD34+ HSPCs, phenotypes and compositions of lymphocyte subpopulations both in PT and UCB.RESULTS: The percentage of CD34+ cells contained in human PT was 8.8 times higher than that of in UCB (P<0.01). The total number of lymphocytes, T cells (CD3+CD2+), B cells (CD19+), Th (CD3+CD4+) and Th/Ts ratio were apparently lower in human placenta, while the number of CD8+CD28- T suppressor cells were higher compared to UCB samples (P<0.01). Among PT, CFU-GM, BFU-E and CFU-Mix frequencies of CD34+CD38- cells subset were much higher than that of CD34+CD38- (P<0.01). Within the same phenotype of cell subsets, however, the number of each colony-forming unit was similar between PT and UCB (P 0.05).CONCLUSION: Human PT is richer in CD34+CD38-, CD34+CD38+ HSPCs and both of them have the abilities of proliferating and differentiating into CFU-GM, BFU-E and CFU-Mix. Considering that human PT have a lower lymphocyte subpopulations and higher Ts cells, human PT might be a alternative and suitable source of HSPCs for clinical transplantation.

Objective:To study the correlation between non-contact anterior cruciate ligament (ACL) injury and functional ankle instability (FAI) in young patients.Methods:A retrospective analysis was conducted of the 102 patients with non-contact ACL injury[61 males and 41 females, with an age of (31.9±6.1) years and a Tegner activity score of (6.1±1.9) points] who had been treated at Department of Orthopedics, Sun Yat-sen Memorial Hospital from January 2017 to March 2020 (injury group). Another 102 citizens without ACL injury from Guangzhou [56 males and 46 females, with an age of (30.3±7.2) years and a Tegner activity score of (6.0±2.1) points] were recruited as a control group. The Cumberland ankle instability tool (CAIT) and the Ankle Joint Functional Assessment Tool (AJFAT) were used to assess whether the subjects had self-conscious FAI or not. A correlation analysis was conducted using the data collected.Results:The 2 groups were comparable because there were no significant differences between them in general data ( P>0.05). By the CAIT score, the incidence of FAI in the injury group [52.9% (54/102)] was significantly higher than that in the control group [32.4% (33/102)] ( P<0.05); by the AJFAT score, the incidence of FAI in the injury group [59.8% (61/102) ] was significantly higher than that in the control group [39.2% (40/102)] ( P<0.05). Pearson correlation analysis showed that diagnoses of FAI by CAIT and by AJFAT were respectively correlated with ACL injury ( r=-0.159, P=0.023; r=-0.215, P=0.002). Conclusions:The incidence of FAI may be high in patients with ACL injury and there is a correlation between FAI and ACL injury.

Objective To observe the function of Ac-SDKP on p-CREB,p-Smad2/3 signal and restraining silicotic fibrosis.Methods Wistar rats were randomly divided into:control group;silicosis group;Ac-SDKP post-treatment group;Ac-SDKP pre-treatment group.The morphology of lung tissue was observed by Van Gieson stain-ing.The expression of α-SMA,cAMP,PKA,p-CREB and p-Smad2/3 protein were assessed by Western blot.The colocalization of p-Smad2/3 and α-SMA were detected by immuno-fluorescence. Results In silicosis group,the deposition of collagen were visible in the fibrotic area,the expression of α-SMA and p-Smad2/3 increased signifi-cantly,and the expression of cAMP,PKA and p-CREB decreased significantly. After Ac-SDKP treatment,the expression of cAMP,PKA and p-CREB were significantly up-regulated,the expression of -SMA and p-Smad2/3 protein were significantly down-regulated,lung tissue damage and collagen deposition decreased. Conclusion By activating the signal of cAMP/PKA/p-CREB,Ac-SDKP was capable of restraining the expression of p-Smad2/3,so as to restrain silicotic fibrosis.