[Objective]To observe the clinical effects and the comments of the circular external fixator on the treatment of spiral and oblique fractures of distal one-third of tibia-fibular.[Method]Fifteen patients(11 males,4 females),with a mean age of 38.5 years(range 21 to 57)with spiral and oblique fractures of distal 1/3 of tibia-fibular were treated with circular external fixator from August 2005 to October 2008.The aetiologies of the fractures were as follows:8 cases,motor vehicle accident;5 cases,falls;2 cases,crush.All the fractures were closed.Nine cases had skin and soft tissue contusion on the distal leg and ankle.[Result]All patients were followed up and acquired the bony union.The mean follow-up time was 10.5 months(range 6～30 months).The mean framing time was 4.5 months(range 2.5～9 months).None of the patients had soft tissues infection and osteomyelitis.None of the patients suffered from the complications such as shortness,angulation,rotation deformity.None of the patients suffered from refracture after removal of the frame.Three patients had pin tract infection and were treated by oral antibiotics.Four patients had loss of range of motion in the ankle after the removal of the frame.These 4 patients had loss of mean 5-degree dorsiflexion and mean 10-degree plantar-flexion.All the patients had full knee function.[Conclusion]The circular external fixator may be used as an alternative method in the treatment of spiral and oblique fractures of distal 1/3 of tibia-fibular and the patients can avoid suffering from the removal of internal fixators.

[Objective]To investigate the clinical effects of Ilizarov external fixator combined pedicle flaps transfer on the treatment of infective fracture nonunion with soft tissue defects in legs.[Method]Fiftecn patients aged 20-58 years(mean age 40 years) were treated with Ilizarov external fixator combined pedicle flaps transfer from July 2005 to September 2008.The areas of flaps were 6 cm?5 cm-15 cm?10 cm.[Result]All patients were followed up.The mean follow-up time was 13 months(range 8-33 months).Fourteen patients achieved fracture union.One patient had partial flap necrosis and recurrent infection and healed aafter a repeat operation.The average tibia fracture healing time was 6.5 months.The mean framing time was 7.0 months.[Conclusion]Ilizarov external fixator combined pedicle flaps transfer can effectively treat infective fractures nonunion with soft tissue defects in legs.In order to achieve the desired results,proper surgery timing and surgical indications are important.

Objective To investigate the clinical diagnostic value of transperineal ultrasound in women in late pregnancy with stress urinary inconti?nence. Method Totally 66 cases of women in late pregnancy were selected,who did not suffer from SUI(groupⅠ),and 54 cases of women in late pregnancy who suffered from SUI(groupⅡ). Another 63 cases of healthy childless women were used as normal control(groupⅢ). Transperineal ultrasound was used to dynamically observe their pelvic floor structure,and the ultrasonic parameters were recorded and analyzed,including the posi?tion of bladder neck in X axis and Y axis((Djx,Dzx,Djy,Dzy)during resting period and tension period,the vesicourethral angle(αj,αz),the Bladder angle(βj,βz). The moving of the bladder neck in X axis(ΔDx=Dzx-Djx)and Y axis(ΔDy=Dzy-Djy),as well as the bladder rotation an?gle(Δβ=βz-βj)were calculated and the movement of the bladder neck(ΔD)was measured,followed by comparative analysis. The threshold val?ues of all ultrasonic parameters were determined by the ROC curve analysis. Results The bladder neck of all three groups were backward during tension period. Compared with groupⅢ,ΔDy,Djx,Dzx obviously decreased in groupⅠand groupⅡ,whileβj,βz,αj increased significantly.ΔDx of groupⅡwas significantly larger than that of groupⅢ(P<0.05);There was significant difference in Djy,Dzy,ΔD,Δβandαz among the three groups(P<0.05);In ROC curve analysis,when the critical value of Djy,Dzy,ΔDy,ΔD,αz andΔβwas-1.75 cm,-1.71 cm,0.25 cm,0.29 cm,131.5° and 3.5° ,their sensitivity was 88.9%,88.9%,72.2%,83.3%,88.9%and 72.2%,and the specificity was 72.2%,81.8%,72.7%, 95.5%,86.3%and 68.2%,respectively. Conclusions The transperineal ultrasound could clearly show the pelvic floor of the women in late preg?nancy,the bladder urethral support structure damage or defect was more serious in the women in late pregnancy who were suffering from SUI,and the determination of the critical values of all ultrasonic parameters helped the screening of SUI in women in late pregnancy.

Objective To investigate the pharmacokinetics of different concentrations of levobupivacaine for lumbar epidural anesthesia.Methods Twenty ASA Ⅰ or Ⅱ patients of both sexes, aged 35-59 years and scheduled for elective radical resection of rectal or colon carcinoma under general anesthesia combined with epidural block, were randomly divided into 2 groups (n=10 each):group Ⅰ (receiving 0.75% levobupivacaine) and group Ⅱ (receiving 0.5% levobupivacaine). Epidural block was performed at L1-2 interspace. Group Ⅰ and Ⅱ received epidural 0.75% and 0.5% levobupivacaine 2 mg/kg (containing adrenaline 5 μg/kg)injected slowly over 2 min, respectively. And 30 min later, general anesthesia was induced with y-hydroxybutyrate 60-80 mg/kg and remifentanil 1-2μg/kg. Tracheal intubation was facilitated with succinylcholine 1-1.5 mg/kg and the patients were mechanically ventilated. Anesthesia was maintained with inhalation of nitrous oxide (N2 O) and O2 (1:1) and continuous infusion of remifentanil 0.01-0.1μg·kg-1·min-1 and intermittent intravenous boluses of atracurium. Sensory and motor blocks were assessed after epidural levobupivacaine. Blood samples were taken from the central vein at 0, 10, 20, 30, 45, 60, 90, 120, 210, 300, 420,540, 660 and 840 min, respectively, after epidural administration for determination of plasma concentrations of levobupivacaine by high performance liquid chromatography.Results The plasma concentration-time curves of levobupivacaine were fitted to a two-compartment open model in the two groups and there were no significant differences in the pharmacokinetic profiles between the two groups. The onset time of sensory and motor blocks was shorter and the duration of the two blocks was longer with 0.75% levobupivacaine as compared with 0.5%levobupivacaine. The incidences of nausea and vomiting and hypotension were low and no severe cardiovascular and neurological side-effects developed.Conclusion The pharmacokinetic parameters do not differ significantly between epidural 0.75% and 0.5% levobupivacaine when the total doses are the same. And epidural anesthesia with either 0.75% or 0.5% levobupivacaine is safe.

Objective To understand the features of cognitive impairment in patients with subclinical hypothyroidism. Methods The cognitive function of the patients with subclinical hypothyroidism and the healthy controls was tested using Mini-Mental State Examination (MMSE) and Wechsler Memory Scale (WMS). The change in cognitive function was observed and analyzed before and after L-T4 treatment. Results Fifty-seven patients with subclinical hypothyroidism and the same number of healthy controls were enrolled in this study. There were no significant differences between two groups in biochemical indexes and MMSE score (all P＞0.05). But there were significant differences between two groups in WMS score, including pictures, memories, learning, touch, understanding memory and back several test scores (all P＜0.05). There existed certain degree of cognitive dysfunction mainly displayed in memory, attention, etc. After three months of L-T4 treatment, all had significant improvement (all P＜0.05). Conclusions Patients with subclinical hypothyroidism have cognitive dysfunction, when the thyroid stimulating hormone is restored to normal level, cognitive function is also improved.

One leading research target of modern tumor radiotherapy is to increase radiosensitization of tumor and improve curative effect of radiotherapy.Histone deacetylase inhibitors are epigenetic drugs that can play a part in radiosensitization through means of induction of apoptosis,inhibition of repair of DNA doublestrand breaks,cell cycle arrest,improvement of tumor cell hypoxia and increase of reactive oxygen species.There is an urgent need to develop biomarkers based on these pathways,which can promote clinically individualized treatment.

Objective To study the effect of different iodine nutrition on thyroid function in adult and pregnant women.Methods A random sampling method was used to select healthy adult and pregnant woman from the communities of coastal city,coastal rural and inland rural areas in Liaoning Province.Drinking water,urine and salt samples were collected to measured urinary iodine (U I),salt iodine (SI) and water iodine content.Fasting venous blood was collected to measured thyroid stimulate hormone (TSH),freethyroxine (FT4),free triiodothyronine (FT3),thyroglobulin antibody (TgAb) and thyroid peroxidase antibody (TPOAb) with the method of immunoassay chemical luminescence.Results A total of 150 salt samples were collected,means of SI was (30.1 ± 6.0)mg/kg.A total of 72 pregnant woman and 271 adults were investigated in iodized salt supplied regions.median UI of pregnant woman and adults were 176.3,203.2 μg/L.Iodine nutrition of pregnant women and coastal region adults was in an adequate level.Means of SI of inland adults(244.4 μg/L) was higher than appropriate level but not reached the excessive level.FT4 of the adults (11.7 pmol/L) and pregnant women (10.7 pmol/L) in inland regions were slightly higher than that of coastal city,rural adults(11.2,8.6 pmol/L) and pregnant women (10.9,9.6 pmol/L).TSH,FT3 and FT4 were not statistically different between regions (all P ＜ 0.05).But UI,FT4 and FT3 levels of pregnant women(176.3 μg/L,9.5 pmol/L,4.3 pmol/L) were significantly lower than that of the adults(203.2 pμg/L,11.3 pmol/L,4.7 pmol/L,all P ＜ 0.05).Hypothyroxinemia(4.4％,10/173) was higher than that of the inland adults (2.0％,2/98,P ＜ 0.05).And all hypothyroxinemia were found in women of childbearing age.Hypothyroxinemia prevalence of pregnant women(16.7％,12/72) was higher than that of adults(4.4％,12/271,P ＜ 0.05),The prevalence of hypothyroidism,hyperthyroidism and subclinical hyperthyroidism between the 3 regions adults and pregnant women were not statistically different (all P ＞ 0.05).Conclusions Under appropriate supply conditions of iodized salt,iodine nutrition and thyroid function are closely related.Pregnant women and women of childbearing age are at risk of iodine deficiency.The thyroid function of these people should be strengthen detect.

Objective To evaluate the effects of gender on the pharmacokinetics of propofol in patients.Methods Twenty ASA physical status Ⅰ or Ⅱ patients of both sexes (10 male,10 female),aged 42-59 yr,weighing 46-76 kg,scheduled for elective surgery for gastrointestinal cancer,were randomly divided into 2 gender groups (n =10 each):male group and female group.Combined intravenous-inhalational anesthesia was performed during surgery.Anesthesia was induced with iv injection of 2％ propofol 2 mg/kg,remifentanil 1.5 μg/kg,and suxamethonium chloride 1.5 mg/kg.The patients were tracheally intubated and mechanically ventilated.Anesthesia was maintained with inhalation of the mixture of 1％-2 ％ isoflurane and nitrous oxide (N2 O ∶ O2 =1 ∶ 1.),iv infusion of remifentanil 0.2-0.3 μg/kg and intermittent iv boluses of atracurium.Blood samples were taken from the central vein before propofol administration,and at 1,2,3,4,6,10,15,30,45,60,90,120,180,240,360 and 720 min after propofol administration for determination of the plasma concentration of propofol by high-performance liquid chromatography.The blood concentration-time curve of propofol was drawn and the pharmacokinetic parameters were calculated.Results The blood concentrations of propofol were significantly lower at each time points within 10 rmin after administration of the single bolus of propofol in female group than in male group (P ＜0.05).The blood concentration-time curves of propofol were fitted to a three-compartment open model in the 2 groups.The central volume of distribution and clearance rate were significantly larger in female patients than in male patients (P ＜ 0.05).Conclusion After iv injection of propofol,the blood concentration of propofol is lower,and the central volume of distribution and clearance rate are larger in female than in male,suggesting that gender has significant effect on pharmacokinetics of propofol.

Objective To investigate the effects of age on the pharmacokineties and pharmacodynamics of levobupivacaine after epidural administrstion.Methods Forty-five ASA Ⅰ or Ⅱ patients of both sexes (26 male, 19 female) aged 30-72 yr, weighing 52-83 kg scheduled for elective lower extremity surgery under epidural anesthesia, were divided into 3 age groups ( n = 15 each) : group Ⅰ≤45 yr; group Ⅱ 46-64 yr and group Ⅲ > 64 yr. Epidural anesthesia was performed at the L1,2 interspace. All of the patients received levobupivacaine 1.8 mg/kg with epinephrine 5 μg/ml given epidurally over 1.5 min. Assessment of sensory block (onset time, peak effect time, upper spread of sensory block, duration of anesthesia) and degree of motor block (using modified Bromage scale) were made. Blood samples were taken from central vein at 0, 10, 20, 30, 45, 60 90, 120, 240, 360, 480, 840 and 1 440 min after epidural administration for determination of plasma concentration of levobupivacaine by high-performance liquid chromatography (HPLG) in nine patients in each group. The pharmacokinetic parameters were calculated from plasma concentration-time data with 3P97 software package. Results The cephalad spread of sensory block was significantly higher in group Ⅲ than in group Ⅰ . The duration of sensory and motor block was significantly longer in group Ⅲ than in group Ⅰ . The plasma concentration-time curves of levobupivacaine were fitted to a two-compartment open model in the 3 groups. The plasma concentrations of levobupivacaine were significantly higher at 1 440 min after epidural administration in group Ⅲ and Ⅱ than in group Ⅰ. The t1/2β was significantly different among the 3 groups. Conclusion 0.75% levobupivacaine is safe and effective for epidural anesthesia. Age affects the pharmacokinetics (t1/2β in particular) and pharmacodynamics of levobupivacaine administered epidurally.

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