[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.

Lung cancer is the main cause of cancer-related death worldwide. Non-small cell lung cancer (NSCLC) accounts for about 80% of lung cancer cases, but only 25%-30% of initially diagnosed patients have the option of radical surgery because of the lack of effective measures for early diagnosis. For locally advanced and advanced NSCLC, radiotherapy alone or comprehensive treatment with chemoradiotherapy is the main treatment method; however, the curative effect is unsatisfactory. Recently, increasing evidence sug-gests that targeted drugs, such as epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs), combined with radiotherapy/chemoradiotherapy represent a promising treatment modality for NSCLC. This review will discuss the research status of EGFR-TKIs and radiotherapy for locally advanced and advanced NSCLC.

Objective To study the clinical value of bedside ultrasound in predicting the fluid responsiveness in pa?tients with septic shock in intensive care unit (ICU). Methods Forty-two mechanically ventilated patients with septic shock who admitted to ICU of the Affiliated Hospital of North China University of Science and Technology from January 2015 to April 2015 were included in this study. All patients were treated with volume expansion (VE) text. Hemodynamics in?dexes were obtained by ultrasound before and after each test, including stroke volume (SV), aortic peak blood flow velocity variation rate of breathing (△VpeakAO), inferior vena cava expansion index (△IVC) and brachial artery maximum speed vari?ation rate (△VpeakBA). Clinical data and central venous pressure (CVP) were recorded. Based on the responsiveness of SV, patients were divided into responsive group (R) and non-responsive group (NR), respectively. The differences of the above in?dexes were compared between two groups. The correlation of△IVC,△VpeakAO,△VpeakBA and△SV was determined. The role of the hemodynamic index for predicting volume responsiveness was evaluated by receiver operating characteristic ROC curves. Results A total of 47 VE tests were performed in 42 patients, 25 in R group and 22 in NR group. Before VE test, the hemodynamics indicators of△IVC,△VpeakAO and△VpeakBA were significantly higher in R group compared with those of NR group (P<0.05). The values of△IVC,△VpeakAO and△VpeakBA were positively correlated with△SV in two groups. The areas under the ROC curve of the hemodynamics indicators were 0.825, 0.853 and 0.866 for △IVC, △VpeakAO and△VpeakBA, and they all showed high sensitivity and specificity. Conclusion The hemodynamic index measured by bedside ultrasound can predict the volume responsiveness in mechanically ventilated patients with septic shock fluid therapy, and which can be used to fluid therapy with a high degree of specific and sensitivity in clinical practice.

Objective: To investigate the ultrasound evaluation on lfuid responsiveness in patients with septic shock. Methods: There 42 septic shock patients treated by mechanical ventilation in our hospital from 2015-01 to 2015-04 were studied. All patients received volume expansion (VE) text, ultrasound examination was conducted to measure hemodynamic parameters of inferior vena cava variation rate of breathing (ΔIVC), aortic peak blood lfow velocity variation rate of breathing (ΔVpeakAO), brachial artery maximum speed variation rate (ΔVpeakBA) and stroke volume (ΔSV) at before and after text. Based on the response to VE text, the patients were divided into 2 groups as Responsive group and Non-responsive group, the above indexes and their correlations to ΔSV were analyzed. The clinical values of those parameters for predicting volume responsiveness were evaluated by ROC curves. Results: A total of 47 VE tests were conducted in 42 patients including 25 cases in Responsive group and 22 cases in Non-responsive group. Before VE test, the parameters of ΔIVC, ΔVpeakAO and ΔVpeakBA were higher in Responsive group than Non-responsive group; ΔIVC, ΔVpeakAO and ΔVpeakBA were obviously related to ΔSV (r=0.631, 0.668 and 0.619). The area of ΔIVC, ΔVpeakAO and ΔVpeakBA under ROC curves were 0.817, 0.853 and 0.866 respectively, they were all with the high sensitivity and speciifcity. Conclusion: Ultrasound monitored hemodynamic parameters may predict the volume responsiveness in septic shock patients with mechanical ventilation, it could be used for guiding liquid treatment in relevant patients.

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.

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 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.