Objective To investigate the effect of histone deacetylase 2(HDAC2) expression by aminophylline on glucocorticoid sensitivity of guinea pigs with lipopolysaccharide -induced sudden hearing loss .Methods Fifty guinea pigs were randomly divided into five groups :control/artificial perilymph(AP) group (n=10) in which both the ears were administrated 5μl sterile artificial perilymph fluid by means of drilling the scala tympani of the cochle‐ar basal turn ;whereas 5 μl of 5 mg/ml LPS was transferred into the cochlea of both the ears of other groups in the same way ,which were model(LPS) group(n=10) ,lipopolysaccharide+ dexamethasone(LPS+ DEX) group(n=10) ,lipopolysaccharide+ aminophylline(LPS+ AMI) group(n= 10) ,and lipopolysaccharide+ dexamethasone+aminophylline(LPS+DEX+AMI) group(n=10) .Guinea pigs with normal hearing tested by auditory brain stem response (ABR) before treatment were included in this study .ABRs were recorded in all guinea pigs 48 hours after surgery .The immunofluorescence staining was used to detect for the HDAC2 in the inner ear .The HDAC2 levels in the cochlea of guinea pigs were detected by ELISA test .Results ABR results showsed that hearing loss in AP group was mild ,the threshold shifts were less than 10 dB at 4 kHz ,8 kHz ,16 kHz frequencies ,at 32 kHz the threshold shift was 11 .50 dB ,respectively .However ,the hearing loss was obvious in LPS group ,especially at the high frequency (the threshold shift was 60 .75 ± 6 .02 dB SPL) .Compared to AP group ,hearing loss in LPS group was statistically significant at all frequencies (P<0 .01) .The hearing improvement was obvious at frequeniies of 16 kHz and 32 kHz in group of LPS+DEX and LPS+AMI (P<0 .05) .The LPS+DEX+ AMI treatment for LPS -induced acute hearing loss was the most remarkable at all frequencies compared with glucocorticoid or aminophylline treatment alone ,especially at 16 kHz (P<0 .05) .The immunofluorescence staining showed positive expression of HDAC2 in the cochlea in the inner and outer hair cells ,stria vascularis ,spiral ganglion and spiral ligament .The correlation analysis showed negative correlations between the expression of HDAC2 and threshold shift of ABR at 8 kHz ,16 kHz ,and 32 kHz (P<0 .05) .Conclusion It is effective for dexamethasone and aminophylline treatment in induced hearing loss in guinea pigs .Aminophylline can elevate HDAC2 expression and improve the effect of glu‐cocorticoid .In conclusion ,HDAC2 plays a critical role in restoring glucocorticoid sensitivity in the inner ear .

Objective To investigate etiology of the 18 -45 years young ischemic stroke and risk factors .Methods We retro-spectively analyzed clinical data of 106 cases patients with ischemic stroke ,carotid ultrasound ,MRA ,CTA ,DSA results analyzed e-tiology ,type .compared patients and the same period youth for the medical check with risk factors .Results The proportion of LAA、SOE in low ages had significant differences with high age(P<0 .05) .The proportion of LAA was 29 .2% and the proportion of SUE was 25 .4% ,On hypertension ,hyperlipidemia ,drinking ,smoking ,obesity ,diabetes ,heart disease ,high homocystine ,young stroke group had significant differences with young control group (P<0 .05) .Conclusion Youth main cause of ischemic stroke is large artery atherosclerotic stroke and unknown cause of stroke .The main youth ischemic stroke risk factors are smoking ,hyperten-sion ,hyperlipidemia ,diabetes ,drinking ,heart disease .

BACKGROUND:There is no doubt that animal model of fracture is the basis of fracture healing research.The fracture animal mode is divided into open osteotomy model and closed fracture model.There is no research about the difference between two kinds of fracture rat models.OBJECTIVE:To compare the modeling process between open osteotomy model and closed fracture model in rats,and to compare fracture healing using radiograph.DESIGN,TIME AND SETTING:The randomized,controlled animal experiment was performed at the Laboratory of Department of Orthopaedics,Second Affiliated Hospital,Soochow University from January to May 2007.MATERIALS:A total of 40 SPF male Sprague Dawley rats,weighing(220?30) g,were randomly divided into an open osteotomy model group and a closed fracture model group,with 20 rats for each group.Electric swing saw was a kind of self-made percussion device for closed fracture models.METHODS:All rats in the open osteotomy model group received open osteotomy to create transverse fracture of the middle femur,and fixed using Kirschner wire.Rats in the closed fracture model group received retrograde Kirschner wire fixation,and midshaft femoral closed fracture induced by model establishment stent.MAIN OUTCOME MEASURES:Mean model establishment time;Successful rate of model establishment;Radiography of fracture healing at 2,3,4 and 8 weeks after surgery.RESULTS:Success rate of open osteotomy model establishment was 90%.Average modeling time was 17 minutes.Rate of malunion and nonunion was 40%.Successful rate of each closed fracture models was 85%,with average modeling time was 12 minutes.There was no malunion and nonunion.At 2,3 and 4 weeks after surgery,X-ray score was lower in the open osteotomy model group compared with the closed fracture model group(P 0.05).CONCLUSION:Model establishment of open osteotomy takes a longer time,with a high rate of malunion and nonunion.In near future or medium-term,fracture healing is significantly lagged.Thus,open osteotomy is not suitable for the study of early or medium-term fracture healing.

Objective To compare the analgesic and side effects of patient-controlled intravenous analgesia(PCIA) with lornoxicam and morphine supplemented by continuous epidural infusion of 0.2% ropivacaine. Methods Sixty ASA I - II patients undergoing elective hysterectomy under epidural anesthesia were randomly divided into two groups: lornoxicam group (L, n = 30) and morphine group (M, n=30). For postoperative analgesia both groups received continuous epidural infusion of 0.2% ropivacaine 4 ml'h . In group L the patients received PICA with 0.008% lornoxicam and in group M 0.001% morphine. The bolus dose was 1 ml, lock-out interval 5 min and maximal amount within 1 h was 12 ml in both groups. If the patient still felt pain after pressing PCA pump 12 times, an additional epidural bolus of 0.2% ropivacaine 5 ml and morphine 0. 5mg was given. The clinical effects were assessed by (1) VAS score of pain( 0 = no pain, 10 = severe pain), (2) Bruggrmann comfort score (0 = persistent pain, 4 = no pain at coughing), (3) modified Bromage score, (4)patients satisfaction, (5) the number of pressing of PCIA pump by the patient (D1 ) at 30 min, 1,4,8,12,16,20,24h and the number of bolus dose delivered (D2), (5) the time when the patient passed gas and (7) complications such as nausea and vomiting and respiratory depression.Results The demographic data were comparable between the two groups. The amount of ropivacaine consumed was 192 mg in both groups.The amount of lornoxicam consumed was (3.4 +2.8) mg in group L and the amount of morphine consumed was (4.7 + 3.5) mg in group M. There was no statistically significant difference in VAS and Bruggrmann comfort score between the two groups. There were less side-effects in group L which were also milder as compared with those in group M.Conclusion The results suggest that continuous epidural infusion of 0.2% ropivacaine combined with lornoxicam in PCIA can provide better analgesia and reduce drug consumption in PICA. The efficacy of analgesia providedby lornoxicam is similar to morphine but lornoxicam causes less side-effects than morphine.

Objective To assess the analgesic effect of continuous infusion of 0.2% ropivacaine with epidural catheter placed at T11-12 or L2-3 after abdominal hysterectomy. Methods Eighty ASA Ⅰ -Ⅱ patients undergoing elective abdominal hysterectomy were randomly divided into 4 groups with 20 patients in each group : in group Al and A2 the epidural catheter was placed at T11-12 and in group Bl and B2 at L2-3 . After surgery two infusion pumps were used. The first pump was used for continuous epidural infusion of 0.2% ropivacaine in the 4 groups. The second pump was used for patient controlled intravenous analgesia (PCIA) with 0.08% lornoxicam in group Al and Bl or with 0.1% morphine in group A2 and B2. The PCIA bolus dose was 1 ml with a lockout time of 5 min. The analgesic effect (assessed using VAS) and the consumption of lomoxicam / morphine were compared among the four groups. Results The ropivacaine consumption was 192 mg during the 24 h after operation in the 4 groups. The lornoxicam and morphine consumption were (3.9?2.8) mg and (4.6?3.5) mg in group Al and A2 with the epidural catheter placed at T11-12 and (7.7?2.5) mg and (7.8?2.4) mg in group B2 and B2 with catheter placed at L2-3.The consumption of lomoxicam or morphine was significantly less with epidural catheter placed at T11-12 than that with epidural catheter at L2-3 (P

Objective To investigate the analgesic efficacy and safety of continuous epidural infusion of 0.2% levobupivacaine in patients after lower abdominal surgery.Methods Sixty ASA Ⅰ - Ⅱ patients undergoing lower abdominal gynecologic operation under epidural anesthesia were randomly divided into two groups : group L levobupivacaine (n = 30) and group R ropivacaine ( n = 30) . An epidural catheter was placed at L2-3 . After operation the catheter was connected through a 3-way Stopcock to a Graseby 9 500 infusion pump for continuous infusion of 0.2% levobupivacaine or 0.2% ropivacaine at a rate of 4 ml?h-1 and a Graseby 3300 infusion pump for PCEA with 0.01% morphine (bolus dose = 2ml, lockout interval = 10 min, total dose limit = 16 ml?4 h-1) (1) VAS score (0 = no pain, 100 = severe pain). (2) the ratio of the number of attempts calculated (D1) to the number of successfully delivered doses (D2) (D1/D2), (3) modified Bromage Motor scale score, (4) Bruggmann comfort scale (BCS), (5) Ramsay sedation score and (6) the severity of side effects were recorded 0, 2,4, 8, 12, 20 and 24h after operation.Results The demographic data (age, body weight, height) and duration of operation were comparable between the two groups. The analgesia was satisfactory in both groups. VAS scores were significantly lower in levobupivacaine group than that in ropivacaine group at 8 and 24 h after operation ( P

BACKGROUND:When hip replacement patients treated with general anesthesia, intubation can cause physical stimulus of receptors of throat and trachea, which can increase stress response of patients, especial y in patients with hypertension. LMA Supreme laryngeal mask can lessen cardiovascular stress response of perioperative patients and reduce airway complications.
OBJECTIVE:To investigate the effects of Supreme laryngeal mask and endotracheal intubation on stress response of hypertensive patients with hip arthroplasty.
METHODS:A total of 45 patients treated with hip arthroplasty in the Shuyang Renci Hospital from January 2010 to September 2014 were enrol ed in this study. They were divided into laryngeal mask group (23 cases) and endotracheal intubation group (22 cases). The same protocol for induction and maintenance of general anesthesia was used in the two groups. During arthroplasty, systolic blood pressure, diastolic blood pressure, heart rate and blood oxygen saturation were monitored in patients. Systolic blood pressure, diastolic blood pressure, blood oxygen saturation, heart rate, blood glucose, plasma epinephrine, norepinephrine, serum cortisol, angiotensin II and atrial natriuretic factor levels were recorded before induction (T0), immediately (T1), 5 minutes (T2) and 15 minutes (T3) after intubation in the two groups.
RESULTS AND CONCLUSION:Systolic blood pressure and diastolic blood pressure were significantly reduced in the T1-T3 compared with T0 in the laryngeal mask group (P<0.05);blood oxygen saturation and heart rate were stable in T0-T3 (P>0.05). Systolic blood pressure and diastolic blood pressure were significantly increased at T1 compared with T0, systolic blood pressure was significantly reduced at T2 and T3 compared with T0, and diastolic blood pressure was significantly diminished at T 3 compared with T 0 in the endotracheal intubation group (P<0.05). Blood oxygen saturation and heart rate were significantly higher at T1 (P<0.05). Compared with endotracheal intubation group, systolic blood pressure and diastolic blood pressure were significantly lower at T 1-T 3 (P<0.05), and heart rate was significantly slower at T1 and T2 (P<0.05) in the laryngeal mask group. Blood oxygen saturation was significantly higher at T1 in the laryngeal mask group than in the endotracheal intubation group (P<0.05). Compared with T0, blood glucose, plasma epinephrine, norepinephrine and cortisol contents were significantly higher at T 1-T 3 in the endotracheal intubation group, and above indexes were higher in the endotracheal intubation group than in the laryngeal mask group (P<0.05). Angiotensin II levels were significantly higher at T1-T3 compared with T0 in the endotracheal intubation group, and it was significantly higher in the endotracheal intubation group than in the laryngeal mask group (P<0.05). Atrial natriuretic factor levels were increased at T 1-T 3 in the two groups, and it was significantly higher in the endotracheal intubation group than in the laryngeal mask group (P<0.05). These results confirm that laryngeal mask slightly impacted stress-related biochemical indicators, which is a physiological basis for slight effect of laryngeal mask on hemodynamics. Compared with endotracheal intubation, laryngeal mask obviously lessened stress reaction of hypertensive patients under general anesthesia treated with hip arthroplasty.

ObjectiveTo investigate the influence of age on hypnotic target plasma concentration (CT) of dexmedetomidine (Dex) administered by TCI.MethodsSixty ASA Ⅰ - Ⅱ patients aged 18-85 yr undergoing lower abdominal or extremity operation under combined spinal-epidural anesthesia were divided into 2 age groups ( n =30each):18 yr＜groupⅠ＜55 yr (Y) and 65 yr＜group Ⅱ＜85 yr (E).Each group was further divided into 5subgroups (n =6 each) receiving Dex administered by TCI at CT of 0.54,0.64,0.76,0.90,1.07 ng/ml in group Y and 0.36,0.42,0.51,0.60,0.71 ng/ml in group E respectively.Hypnosis was defined as no response to verbal command (OAA/S score ≤2) and loss of eyelash reflex.A quantal response model (probit analysis) was used to calculate the concentration-effect curve and predict plasma EC50 and EC95 (95％CI) of Dex.ResultsEC50 (95％CI) was 0.478(0.424-0.536) ng/ml and EC95(95％CI) 0.641 (0.567-0.816) ng/ml in group E,significantly lower than EC50 (95 ％ CI) 0.738 (0.657-0.827) ng/ml and EC95 (95％CI) 0.990 (0.874-1.267 ) ng/ml in group Y.ConclusionThe EC50 and EC95 of dexmedetomidine for hypnosis were significantly lower in the elderly than in younger patients.

Objective To evaluate expression of HDAC2 in peripheral blood mononuclear cells(PBMCs)from glucocorticoid-resistant versus glucocorticoid-sensitive patients with sudden sensorineural hearing loss and identi-ty the relationship between the level of HDAC2 and glucocorticoid insensitivity.Methods PBMCs were collected from10 patients with deviation of nasal septum (control group)and 20 sudden sensorineural hearing loss patients be-fore and after intratympanic methylprednisolone for 10 days.We divided the SSNHL patients into 2 groups (GC sensitive group and GC insensitive group)according to their hearing recovery.Real time PCR and HDAC2 Assay Kit were used to detect the expression level of HDAC2 mRNA and HDAC2 activity in PBMCs.The data were analyzed with SPSS 17.0 software.ResuIts Before intratympanic methylprednisolone,the level of HDAC2 activity were sig-nificantly depressed in SSNHL patients,while the HDAC2 mRNA expressing much higher than the control group. The expression level of HDAC2 mRNA increased significantly after intratympanic methylprednisolone.The HDAC2 activity in GC sensitive group increased significantly.ConcIusion Knockdown of HDAC2 expression induces corti-costeroid in-sensitivity.Glucocorticoids can increase the expression of HDAC2 mRNA.HDAC2 activity can be down-regulated by post-translational modifications.

Ca2+ leak via ryanodine receptor type 2 (RyR2) can cause potentially fatal arrhythmias, and RyR2 mutations have been shown in the aetiology of catecholaminergic polymorphic ventricular tachycardia. We report the case of a patient with catecholaminergic polymorphic ventricular tachycardia resulting from a RYR2 mutation who had not only typical electroencephalogram changes, but also epileptiform discharges in electroencephalogram. We believe the changes were closely related to the RYR2 mutation.