ObjectiveTo compare the efficacy of intravenous infusion of dexmedetomidine and midazolam for premedication in children.MethodsNinety-two ASA Ⅰ or Ⅱ children (46 cases aged 1-3 yr and 46 cases aged 4-6 yr) scheduled for elective general or urologic surgeries,were enrolled in this study.The children were randomly divided into 2 groups (n =46 each):midazolam group (group M) and dexmedetomidine group (group D).The children accompanied by their parents were admitted to the anesthesia preparation room at about 20 min before induction of anesthesia,and midazolam 0.1 mg/kg òr dexmedetomidine 1 μg/kg was infused intravenously over 10 min.Anesthesia was induced with proporol-rocuroniume-remifentanil,and maintained with sevoflurane-remifentanil-rocuroniume.Modified Yale Preoperative Anxiety Scale (mYPAS) score,sedation score,HR,mean arterial pressure (MAP),respiratory rate (RR) and SpO2 were recorded before premedication (T1),before separation from their parents (T2) and when entering the operating room (T3).The incidence of sleep (a sedation score of 4) was recorded at T2,3.The end-tidal concentration of sevoflurane,infusion rate of remifentanil,laryngeal air way removal time,emergence time,duration of stay at the recovery room,incidence of delirium during recovery period,the percentage of patients requiring rescue analgesic,and adverse effects were also retorded.ResultsCompared to that at T1,the mYPAS score was significantly decreased at T2,3,and the sedation score was significantly increased at T2,3 in both groups ( P ＜ 0.05),HR at T2 and MAP at T2,3 were significantly decreased in group D,and HR at T3 was significantly increased in group M ( P ＜ 0.05 ).Compared to group M,the sedation scores and the incidence of sleep were significantly increased at T2,3,and the HR was significantly decreased at T2 in group D ( P ＜ 0.05).There was no significant difference in the mYPAS score,RR,MAP,SpO2,end-tidal concentration of sevoflurane,infusion rate of remifentanil,laryngeal air way removal time,emergence time,duration of stay at the recovery room,incidence of delirium during recovery period,the percentage of patients requiting rescue analgesic,and incidence of adverse effects between D and M groups ( P ＞ 0.05).ConclusionThe sedative efficacy of iv dexmedetomidine is superior to that of iv midazolam when infused for premedication in children,but it exerts much influence on hemodynamics,and the changes in hemodynamics should be noted.

Objective To Explored the relative factors which caused the extubation failure in neurological intensive care unit (NICU).Methods It was a retrospective study.40 cases of patients who met the criteria,were brought into statistical analysis.They were admitted in NICU in Nan Fang Hospital from December 2008 to February 2011.The name,sex,age,diagnosis,respiratory parameters,24 hours discrepancy quantity,sputum,and Glasgow Coma Scale,Full Outline of UnResponsiveness Scale were recorded.SPSS 13.0 was used as statistic software.P ＜ 0.05 was considered statistically significant.Results Both in extubation successful and failure groups,GCS and Four were significantly different (all P ＜ 0.05).Howerer,there were no statistically significant in the other factors.There were significantly differences between GCS and Four in predicting extubation results (P =0.012).Logistic multiple regression showed that Four and GCS grade were predictive factor of extubation failure (P =0.041).Conclusions The result suggests that it is statistically significant to use GCS and Four as factors to predict extubation results.It can be widely used to help medical personnels monitoring the changes of patients'clinical conditions,judging prognosis,and making treatment plan in NICU.Wether other factors would effect the extubation results,more prospective,randomized controlled studies were needed.

Objective To compare the efficacy of closed-loop infusion of propofol for surgery in pe-diatric patients of different ages. Methods Forty-five pediatric patients of both sexes, weighing 10-63 kg, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, scheduled for elective urologic sur-gery under general anesthesia, were divided into 3 groups(n=15 each)according to the age: infant group (1-3 yr), pre-school group(4-6 yr)and school-age group(7-12 yr). The bispectral index(BIS)moni-tor was connected to the closed-loop anesthesia delivery system, and the system automatically regulated the target plasma concentration of propofol to achieve a target BIS value of 45-55 during maintenance of anes-thesia. Remifentanil was given by target-controlled infusion at a target plasma concentration and rocuronium was intravenously injected when necessary during surgery. BIS40-60time percentage(percentage of time of BIS value maintaining at 40-60 in time of closed-loop infusion), median performance error(MDPE), me-dian absolute performance error(MDAPE), wobble and global score were recorded. The consumption of propofol, mean target plasma concentration and regulating frequency and consumption of remifentanil and rocuronium were recorded during surgery. Extubation time or laryngeal mask airway removal time, time to eye-opening and time of regaining consciousness were recorded. Results The BIS40-60time percentage was significantly higher, MDPE, MDAPE, wobble and global score were lower in pre-school and school-age groups than in infant group(P<005). Compared with pre-school group, the consumption of remifentanil was significantly decreased(P<005), and no significant change was found in BIS40-60time percentage, MDPE, MDAPE, wobble or global score in school-age group(P>005). There was no significant differ-ence in the consumption of propofol, mean target plasma concentration, regulating frequency, consumption of rocuronium, extubation time or laryngeal mask airway removal time, time to eye-opening or time of regai-ning consciousness among the 3 groups(P>005). Conclusion Closed-loop infusion of propofol produces better stability for surgery in pre-school and school-age children than in infants.

OBJECTIVETo observe the images of early lesions of condylar cartilage of osteoarthritic rats in synchrotron radiation diffraction enhanced imaging (DEI).

METHODSThe animal model of temporomandibular joint osteoarthrosis was established in rat following the method of partial resection of the joint disc. The changes of osteoarthritic condylar cartilage in different pathological stages were observed by DEI and compared with those in situ histopathological sections.

RESULTSWith DEI, straight and orbicular lines were detected in condylar cartilage 45 to 60 days after discs resection. The lines were confirmed by histopathology to be collagen degradation and tiny fissure formation inside the cartilage.

CONCLUSIONSDEI is capable of imaging the early stages of pathological changes of excised condylar cartilage such as collagen degradation and tiny fissure formation, and this technique is of potential value to clinical application.

Animals ; Cartilage, Articular ; diagnostic imaging ; pathology ; Male ; Mandibular Condyle ; diagnostic imaging ; pathology ; Radiography ; Rats ; Rats, Wistar ; Temporomandibular Joint Disorders ; diagnostic imaging ; pathology ; X-Ray Diffraction ; methods

OBJECTIVETo observe the mitochondrial fragmentation and the expression of mito-fusion 1 gene in the cortical neurons of rats with chronic fluorosis, and to reveal their roles in mitochondria damage to neurons due to chronic fluorosis.

METHODSSD rats were divided randomly into three groups of 20 each (a half females and a half males housed individually in stainless-steel cages), and fed with the different doses of fluoride containing in drinking water (untreated control containing 0 mg/L fluoride, and low-fluoride and high supplemented with 10 and 50 mg/L fluoride, respectively). After 3 or 6 months exposure, the mitochondrial morphology of the neurons in rat brains were observed by transmission electron microscopy (TEM), then the expression of mitochondrial fusion gene, Mfn1, were detected by immunohistochemistry and western-blotting, respectively.

RESULTSDental fluorosis was obvious in the rats exposed to excessive fluoride in their drinking water, that is, (16 rats out of 20) numbers of I° detal fluorosis in the low-fluoride group, and (11 rats out of 20) numbers of I° and (9 rats out of 20) numbers of II° detal fluorosis in the high-fluoride group were observed after 3 months exposure. Moreover, (14 rats out of 20) numbers of I° and (6 rats out of 20) numbers of II° detal fluorosis in the low-fluoride group and (6 rats out of 20) numbers of Io, (13 rats out of 20) numbers of II°, and (1 rats out of 20) numbers of III° detal fluorosis in the high-fluoride group were observed after 6 months exposure. And both of untreated controls without detal fluorosis were also observed. The urinary level of fluoride in the low-fluoride group (3.30 ± 1.18) mg/L and in the high-fluoride group (5.10 ± 0.35) were observed after 3 months exposure (F = 3.18, P < 0.05). Moreover, the urinary level of fluoride in the low-fluoride group (4.16 ± 1.39) mg/L and in the high-fluoride group (5.70 ± 1.70) mg/L were also observed after 6 months exposure (F = 3.17, P < 0.05). The normal mitochondrial morphology of neurons in rats without fluorosis was observed after 3 and 6 months, while the abnormal mitochondrial morphology of neurons with fluorosis was shown, presenting mitochondrial fragmentation with swollen cristae and even the fragmented, shortened or stacked punctuate membranes (section observation of three bullous mitochondrial-mitochondrial fission process) by TEM. As compared with controls (53.0 ± 4.54 and 1.21 ± 0.18) at the experiment period of 3 months, Mif1 protein analysis with immunocytochemical (the numbers of positive cells: 51.09 ± 6.25) and western-blotting (1.22 ± 0.26) were no significant difference for low fluoride group (t = 1.7, 1.1, P > 0.05); Mif1 protein analysis with immunocytochemical (the numbers of positive cells: 59.71 ± 5.64) and western-blotting (1.66 ± 0.20) were significantly increasing for high fluoride group (t = 2.1, 2.1, P < 0.05). As compared with controls (36.43 ± 4.04 and 1.00 ± 0.13) at the experiment period of 6 months, Mif1 protein analysis with immunocytochemical (the numbers of positive cells 20.05 ± 4.55 and 17.10 ± 3.86) and western-blotting (0.64 ± 0.08 and 0.39 ± 0.06) were significantly decreasing for the two fluoride group (t = 2.1, 2.2; 2.2, 2.2 respectively, all P value were < 0.05).

CONCLUSIONSTaking excessive amount of fluoride might result in the mitochondrial fragmentation for the changed expression of Mfn1, and the neurons damage from the chronic fluorosis might be associated with the dysfunction of mitochondrial fusion.

Animals ; Drinking Water ; chemistry ; Female ; Fluoride Poisoning ; metabolism ; pathology ; Fluorosis, Dental ; metabolism ; Male ; Membrane Proteins ; metabolism ; Mitochondria ; pathology ; Mitochondrial Proteins ; metabolism ; Neurons ; metabolism ; pathology ; Rats ; Rats, Sprague-Dawley

OBJECTIVETo evaluate the clinical value of MDCT and MRI in the diagnosis and treatment of complex fractures of tibial plateau.

METHODSFrom March 2004 to January 2009,71 patients with complex fractures of tibial plateau estimated Schatzker III, V and VI were included in the study. Their X-ray films, MDCT, MRI were analyzed and compared. Twenty-four patients (14 males and 10 females with a mean age of 33.6 years) were treated with double incision and single plate. Average follow-up period was 31.4 months. Twenty-one patients (12 males and 9 females with a mean age of 33.2 years) were treated with double incision and bilateral plates. Average follow-up period was 28.4 months. Twenty-six patients (17 males and 9 females with a mean age of 35.3 years) were treated with bilateral plates via genicular anterior midline incision. Average follow-up period was 28.4 months. The index such as diagnosis correction for fracture location, fracture comminuted degree,fracture displacement degree,bone defect degree,and positive ration for number of collapsed joint surface,injuries of cruciate ligament, collateral ligament and menisci of knee joint.

RESULTSThe satisfaction score of X-ray flims, MDCT and MRI were (1.04 +/- 0.20), (1.82 +/- 0.38) and (1.12 +/- 0.33) separately for fracture positions; (0.81 +/- 0.51), (1.92 +/- 0.26) and (0.83 +/- 0.60) separately for fractures comminuted degree; (1.23 +/- 0.48), (1.92 +/- 0.26) and (0.46 +/- 0.58) separately for fracture displacement degree; (0.36 +/- 0.51), (1.55 +/- 0.79) and (0.26 +/- 0.53) separately for bone defect; the number of patients having collapse of tibial articular surface were 6,61 and 12 separately; the number of patients having cruciate ligaments were 3,10 and 17 separately; the number of patients having menisci injuries were 0,0 and 6 separately;the number of patients having collateral ligament injuries were 1, 1 and 8 separately. MDCT was the most sensitive method in the diagnosis of tibial articular surface collapse,avulsion tibial fracture at the point of cruciate ligament,fracture comminuted degree and fracture displacement degree (P < 0.01). MRI was the most sensitive method in the diagnosis of injuries of cruciate ligament, collateral ligament, menisci, the cartilage peeling of articular surface (P < 0.01).

CONCLUSIONMDCT and MRI further detail the Schatzker classification based on X-ray films, which also conduce to make precise diagnosis and reasonable treatments. MDCT and MRI are more sensitive for the diagnosis of insidious damages around knee.

Adult ; Case-Control Studies ; Diagnostic Techniques and Procedures ; Female ; Fracture Fixation, Internal ; Humans ; Internal Fixators ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Tibia ; diagnostic imaging ; injuries ; Tibial Fractures ; diagnosis ; diagnostic imaging ; surgery ; Tomography, X-Ray Computed ; methods ; Young Adult

AIMTo investigate the relationship between the positioning of the lower central incisor and physical morphology of the surrounding alveolar bone.

METHODOLOGYThirty-eight patients (18 males, 20 females), with mean age of 13.4 years, were included in this study. As part of orthodontic treatment planning the patients were required to take dental Cone-beam CT (CBCT) covering the region of lower incisors, the surrounding alveolar bone and the mandibular symphysis. The cephalometric parameters were designed and measured to indicate the inclination of lower central incisor and physical morphology of the adjacent alveolar bone. Computer-aided descriptive statistical analysis was performed using SPSS 15.0 software package for Windows. A correlation analysis and a linear regression analysis between the incisor inclination and the alveolar bone morphology were performed.

RESULTSSignificant positive correlations were found between the lower central incisor inclination and the morphological contour of the alveolar bone (P < 0.05). The lower central incisor root apex was closer to the lingual alveolar crest when it was buccally inclined.

CONCLUSIONThe morphology of the alveolar bone may be affected by incisal inclination.

Adolescent ; Alveolar Process ; diagnostic imaging ; pathology ; Cephalometry ; methods ; Chin ; diagnostic imaging ; pathology ; Cone-Beam Computed Tomography ; methods ; Female ; Humans ; Incisor ; diagnostic imaging ; pathology ; Male ; Mandible ; diagnostic imaging ; pathology ; Numerical Analysis, Computer-Assisted ; Patient Care Planning ; Software ; Tooth Apex ; diagnostic imaging ; pathology

0.05).The cubitus varus incidence evaluation was done by follow-up study,2 cases were in operation group and 8 cases in non-operation group,there was a significant difference between the 2 groups(P

0.05).But in Bikini cut group,there was no intraoperative lateral femoral cutaneous nerve injury,and operation cut was so hidden and so parents were willing to accept the operation.If it was hecessary to carry out femur rotation osteotomy and internal fixation of femur,the steel plate accords with the principle of tension band,so the fixation could be stable and the fracture can easily heal up.Conclusions In the treatment of DDH,Salter pelvic osteotomy through Bikini cut has exact clinical efficacy comparing with S-P cut,and its operation cut is safe,hidden,and there is rare injury to joint function after operation.