10.3969/j.issn.2095-4344.2013.26.024

ObjectiveTo investigate the effect of dexmedetomidine on tracheal extubation response in patients undergoing thyroid surgery after general anesthesia.Methods Forty-two patients who ASA classification Ⅰ - Ⅱ,were performed thyroid surgery under total intravenous anesthesia.They were divided into dexmedetomidine group and control group by random number table with 21 cases each.Both groups patients anesthesia induction and maintenance with the same methods,dexmedetomidine group patients at 15 min before anesthesia induction with venous infusion dexmedetomidine 0.6 μ g/kg(finished 10 min infusion),followed by 0.4 μ g/(kg · h) continuous infusion,control group patients with pump equivalent in 0.9％ sodium chloride injection in the same way.Systolic blood pressure (SBP),diastolic blood pressure (DBP) and heart rate (HR),surgery time,recovery time,extubation time,orientation recovery time,modified Aldrete score ≥9 scores time,rate of recovery from restlessness,tolerance score and recovery from any adverse effects were recorded.ResultsThere were no significant differences between two groups in surgery time,recovery time,extubation time,orientation recovery time,modified Aldrete score ≥ 9 scores time (P ＞0.05).SBP,DBP,HR at immediately and after extubation with 1,3,5 min of dexmedetomidine group were lower than those of control group(P ＜ 0.05 or ＜ 0.01 ).Tolerance score excellent rate of dexmedetomidine group was higher than that of control group[95.2％ (20/21) vs.28.6％ (6/21)] (P ＜ 0.05),the rate of recovery from restlessness of dexmedetomidine group was lower than that of control group[0 vs.28.6％(6/21 ) ] (P ＜ 0.05).ConclusionBefore anesthesia induction in patients with venous infusion dexmedetomidine 0.6 p g/kg(finished 10 min infusion),followed by 0.4 p g/(kg·h) continuous infusion can effectively reduce the patients' cardiovascular response to extubation,strengthen the patients' tolerance to endotracheal tube,reduce the patients' agitation and recover consciousness comfortable.

OBJECTIVE： To determine the concentration of fentanyl in human plasma by HPLC with ultraviolet detection METHODS： External standard method was used The eluation of fentanyl was carried out by shim－ Pack CLC－ ODS（ 6 0mm× 150mm， 5μ m） column with 0 015mol/L NaH2PO4 acetonitril－ H2O（ 30∶ 70， v/v） as the mobile phase， and detection wavelength was 195nm RESULTS： Calibration curve for fentanyl was linear in the range of 2 0～ 100ng/ml（ r=0 999）  The detection limit was 1 0ng/ml The within－ day RSD was （ 6 50± 2 79） ％ ， the between－ day RSD Was （ 6 70± 3 04） ％  The method recovery was （ 91 70± 4 70） ％  The extraction recovery was （ 97 38± 3 69） ％  CONCLUSION： This method was quick and accurate for the determination of fentanyl in human plasma and useful for pharmakinetic study of fentanyl

Objective:To explore the influence factors on amplification of single cell duplex-nested PCR.Methods:The mutational loci region CD41-42 and IVS-Ⅱ654 of ?-globin gene were amplified by duplex-nested PCR with different combination of primers concentration, different Taq DNA polymerases, different neutralization buffers and with or without predenaturation at 98 ℃ before the PCR amplification in single lymphocyte or single blastomere, thus, to investigate the influence of these factors on the amplification efficiency of PCR.Results:TaKaRa EX Taq was the most efficient Taq DNA ploymerase among different Taq DNA ploymerases; primer pair R1+F1 at final concertration of 0.25 ?mol/L and R2+F2 at 0.3 ?mol/L were the most efficient ones in amplification among different combinations of primers concentrations; the amplification efficiency in neutralization buffer-1 (200 mmol/L Tricine) was obviously higher than that of neutralization buffer-2 (900 mmol/L Tris-HCl, pH 8.3/300 mmol/L KCl/200 mmol/L HCl)(P0.05). Conclusion:There were remarkable differences of the amplification efficiency of single cell duplex-nested PCR while using different combination of primers concentrations, different Taq DNA polymerases, different neutralization buffers. However, predenaturation at 98 ℃ before the single cell PCR amplification could not improve the PCR amplification efficiency

Fertilization is a crucial step for origin of life.During Assisted Reproductive Technologies (ART),total fertilization failure is complex and unpredictable.Total fertilization failure may related to some abnormal cellular mechanistic events,such as:any stage of sperm and cumulus-oocyte-complexes penetration,sperm-zona pellucida binding / penetration,sperm-oocyte membrane binding,oocyte activation,sperm discondensation or pronuclear formation.Most of total fertilization failure could be solved by intracytoplasmic sperm injection.But oocytes of some patient still can't fertilize successfully,even though assisted oocyte activation be used.As for total fertilization failure patients in ART,combining the mature of oocyte,sperm quality and some trail to improve clinical protocol in later cycle may prevent failure to happen again.

Objective To explore the influence of peritumoral edema (PTE) on the tendency of recurrent location and morphological character after total resection using MRI. Methods MRI data was collected from 43 patients with recur-rent brain glioma after total resection from four clinical centers and then the influence of of PTE on recurrence patterns af-ter total resection was retrospectively analyzed based on the T2 weighted image. Results The PTE had a significant influ-ence on the recurrent patterns of brain gliomas after total resection. When PTE was mild, the shapes of recurrent gliomas tended to be focal (6/8) and the recurrent locations tended to be local (5/8). When PTE was severe, the shapes of the recur- rent gliomas tended to be spread(30/35 and the recurrent locations tended to be distant (25/35), followed by marginal (7/35), In addition, the morphological patterns and locations of recurrent gliomas were significantly different among different PTE types (all P<0.001). When PTE was ring shape, the shapes of recurrent gliomas tended to be focal (7/9) and the recur-rent locations tended to be local (6/9), followed by marginal (2/9) and distant (1/9). When PTE was irregular shape, most of recurrent locations tended to be distant (25/34), followed by marginal (7/34) but rarely local (2/34). Conclusions The de-grees and the types of brain glioma PTE can significantly influence the locations and morphological patterns of recurrent gliomas after total resection.

BACKGROUND:Odontoid fracture is very common in cervical spine injuries, the special position of odontoid process, which is adjacent to important anatomic structure, makes screw placement difficult, and a slight discrepancy in position and orientation of the inserted screw leads to a decrease in intensity of internal fixation, even invalid internal fixation. Therefore, it is very necessary to develop an individualized treatment protocol by which screws can be precisely and safely placed and which is worthy of clinical popularization. OBJECTIVE:To study the navigation of Mimics software and three dimensional (3D)-printed module in anterior odontoid cannulated screw fixation and to investigate its feasibility and accuracy. METHODS:Sixteen human cadaveric cervical spines were scanned by a continuous thin-slice CT scanner. Original DICOM CT images were three-dimensional y reconstructed using Mimics software. The screw channel and support column were designed for C2 vertebra odontoid cannulated screw fixation for odontoid fracture. Segmentation of bone surface was performed. Navigation modules with screw channel were built using 3D printing technique. Navigation modules were used to aid screw placement. Screw fitting and placement were evaluated using X-ray and CT scan. RESULTS AND CONCLUSION:Total y 16 navigation modules were built and 22 screws were implanted. During and after screw placement, the cortical bone along screw channel and surrounding the vertebral body was not cracked. Postoperative X-ray and CT scans showed that some factors regarding screw placement such as entry point, orientation and depth of placement were consistent with those ideal factors simulated by Mimics software. The navigation modules were closely attached to the corresponding bony structure in front of the vertebral body, with a satisfactory gomphosis. Screw fitting and stability were good during application. These results verify that with the aid of navigation module, anterior odontoid cannulated screw fixation is reliable for treatment of odontoid fracture, which provides insights into the popularization of 3D printing-based digital navigation technique in orthopedic implantation.

BACKGROUND:In three-dimensional CT reconstruction model, fracture virtual reduction and internal fixation cannot be achieved, and reasonable operation scheme cannot be formulated. It cannot fuly meet the needs of clinical orthopedics physicians. OBJECTIVE:To explore the methods to perform three-dimensional reconstruction, reduction on proximal tibial fracture and to design digital plate using software. METHODS:Nine specimens of knee joint were built to be A1-3, B1-3 and C1-3 types of proximal tibial fracture according to the AO standard. Al specimens were treated with CT scan. Three-dimensional reconstruction and reduction on nine types of bone fracture models were performed in Mimics. The digital plates and screws were designed in Solidworks. Virtual internal fixation on the reduced three-dimensional models was performed. RESULTS AND CONCLUSION:Al bone fracture models received three-dimensional reconstruction and reduction, and the design for internal fixational plates and screws as wel as virtual internal fixation were accomplished. A3, B3 and C3 types were presented. These results suggest that the digital plates for proximal tibial fracture could be designed in Mimics and Solidworks with a personal computer. Our experience could be used in the real operation.

Objective To observe the influence of patient′s age, and the number of transferred-good-quality-embryos on multiple gestation rates in in vitro fertilization and embryo transfer(IVF-ET) cycles. Methods In this retrospective study, a total of 4395 patients who transferred fresh embryo between Jan 2004 and Nov 2006 was analyzed. According to the age, the patients were divided into 2 groups: aged < 35 (3442 cycles) or aged ≥135(953 cycles). We regularly transferred 2 -3 embryos. If the patients had only one embryo, one was transferred. And those patients who had only 2 embryos, even if they were more than 35 years old or it would be the second time for them to transfer, were transferred 2 embryos. The influence of female age and the number of good quality embryos transferred on the multiple gestation rates in IVF-ET cycle was analyzed. Results (1)The multiple gestation rate of the groups of 1 good quality embryo,2 good quality embryos, or 3 good quality embryos transferred were 21.08% (35/166), 31.41% (413/1315), and 42. 37% (75/177), respectively in women aged < 35, with a significant difference between them. The pregnancy rates of these groups were 29. 64% (166/560) ,51.63% (1315/2547) ,and 52. 84% (177/335), respectively; there were no significant differences between 2 good quality embryos transferred group and 3 good quality embryos transferred group. (2) The multiple gestation rates of the groups of 1 good quality embryo,2 good quality embryos, or 3 good quality embryos transferred were 19. 51% (8/41) ,20. 65% (19/ 92) ,and 40.66% (74/182), respectively, in women aged ≥ 35; there were no significant differences between 1 good quality embryo transferred group and 2 good quality embryos transferred group. The pregnancy rates of these groups were 19. 07% (41/215), 33.70% (92/273), and 39. 14% (182/465), respectively; there were no significant differences between 2 good quality embryos transferred group and 3 good quality embryos transferred group. (3) The pregnancy rate of the patients aged <35 [48. 17% ( 1658/ 3442) ]was significantly higher than in women aged ≥35[33.05% (315/953) ]. Conclusion The transfer of 2 good quality embryos results in similar pregnancy rates and significantly reduced multiple gestation rates when compared to the transfer of 3 good quality embryos in women regardless of their ages.

BACKGROUND:On CT reconstruction of three-dimensional (3D) model, fracture virtual reduction and internal fixation cannot be achieved, and reasonable operation scheme cannot be formulated. Digital design can fuly meet the needs of clinical orthopedics physicians. Standard parts database can provide the possibility to choose the ideal internal fixation. 3D printing makes the reasonable operation scheme accurate in clinical implementation. OBJECTIVE:To discuss the feasibility, accuracy and minimal invasion of internal fixation in treatment of the distal femoral fracture with digital design of standard parts database by 3D printing. METHODS: (1) Nine adult lower extremity specimens were selected to take continuously thin-layer CT scanning. After Dicom images were imported into the mimics software, the model was established. According to the AO classification, they were classified into A1-3, B1-3 and C1-3 types of distal femoral fracture by virtual design. Internal fixation with plate and screw formed standard parts database virtualy. It was printed out the pilot hole of the navigation module design by three-dimensional printing forming technique. Plate and screw were inserted assisted by the module. X-ray and CT scan were taken postoperatively to access the position. (2) 30 patients with distal femoral fracture were subjected to above fixation. The operation time, intraoperative blood loss and postoperative drainage were recorded. Imaging and curative effects were evaluated during folow-up. RESULTS AND CONCLUSION: (1) Nine samples underwent X-ray and CT scan. 3D reconstruction results revealed plate position, screw entry point, nail direction, length and diameter were consistent with presetting data in Mimics software. The navigation models were designed to fit the lateral bony structure of distal femur. There were good fitting degree, good card position and good stability when the navigation was applied. It could guide plant and screw implantation. (2) In 30 cases, the operation time was (104.63±26.12) minutes, intraoperative blood loss was (121.74±11.49) mL, and postoperative drainage volume was (30.29±6.38) mL. Al patients were folowed up. According to Schagzker criterion, the efficiency of 22 cases was excelent, 6 cases good and 2 cases average, and the excelent and good rate was 93%. The parameters of length, diameter, orientation and angle were consistent with that preoperatively. (3) Internal fixation formed by standard parts database assisted by 3D printing navigation model has advantages of high accuracy, short process, lessened blood loss, high safety, less complications, and precise fixation. Digital design of standard parts database via3D printing navigation module is expected to achieve implant navigation and application.