Objective To study the hypnotic interaction between propofol and ketamine with isobologram. Methods Seventy-five ASA Ⅰ - Ⅱ patients (35 male, 40 female) aged 20-50 yr, weighing 40-80 kg, undergoing elective upper abdominal surgery were randomly divided into three equal groups of 25 patients : propofol group (P); ketamine group (K) and propofol-ketamine combination group (P/K), Each group was further divided into 5 subgroups. Propofol 0.8, 1.0, 1.25, 1.56 or 1.95 mg ? kg-1 was given in 5 propofol subgroups (P1-5 ) respectively. Ketamine 0.32, 0.40, 0.50, 0.63 or 0.78 mg?kg-1 was given in 5 ketamine subgroups (K1-5 ) respectively. Propofol /ketamine 0.45/0.15, 0.60/0.20, 0.80/0.29, 1.05/0.35 or 1.41/0.47 mg?kg-1 were given in the 5 propofol-ketamine combination subgroups (P/K1-5 ) respectively. Two minutes after drug administration the patients were asked to open their eyes. Failure to open eyes was taken as the start-point of hypnotic effect. If the patient failed to respond to verbal order twice consecutively, the patient was considered to be in the hypnotic state. When the patient in hypnotic state failed to respond to electric stimulation of certain intensity, the patient was considered to be in anesthetic state. ED50s of propofol, ketamine and P/K combination for hypnotic and anesthetic effect were calculated. Isobologram was drawn. ED50 and 95 % confidence limit of ketamine were plotted on the abscissa and of propofol on the ordinate. The ED50 s of the two drugs were connected. If the ED50 of P/K combination was located on the connecting line, the two drugs are additive, on the left side of the connecting line synergistic, on the right side of the connecting line antagonistic. SBP, DBP, HR, SpO2 and BIS were continuously monitored before, during and after drug administration. Results The ED50 s for hypnotic and anesthetic effect were : 1.15 mg? kg-1 and 1.59 mg? kg-1 in group P; 0.40 mg? kg-1 and 0.72 mg? kg-1 in ketamine group; 0.65/0.22 mg?kg-1 and 1.19/0.40 mg?kg-1 in P/K group. The deviation of the location of ED50 of P/K combination from the connecting line was statistically insignificant. There was no significant change in SBP and DBF after administration of drugs in P/K group. Conclusion The hypnotic and anesthetic interaction between propofol and ketamine was additive. In terms of hemodynamic stability, P/K combination was the best among the three groups.

Adenine ; adverse effects ; analogs & derivatives ; Fanconi Syndrome ; chemically induced ; Hepatitis B, Chronic ; drug therapy ; Humans ; Hypophosphatemia ; chemically induced ; Organophosphonates ; adverse effects ; Osteomalacia ; chemically induced

Objective To analyze the outcomes of frozen-thawed blastocyst and cleavage embryo transfer after whole embryos cryopreservation. Methods The data of 489 IVF-ET cycles in reproductive medicine center of our hospital from September 2012 to August 2013 were analyzed retrospectively. Whole embryos cryopreservation in 214 patients were carried out with vitrification method and served as group A , 275 cycles performed fresh embryo transfer were served as group B. Then group A and group B were subdivided into group A1 (83 cycles),group A2 (131 cycles), group B1 (120 cycles)and group B2 (155 cycles)according to blastocyst transfer or cleavage-stage embryo transfer. The clinical outcomes of all groups were compared each other. Results The pregnancy rate and embryo implantation rate in group A1 were significantly higher(71.1% ,53.0%)than those in group A2, B1 and B2 (A2 group: 57.3%, 34.0%, B1group: 55.0%,42.1%, B2 group: 52.9%, 32.7%,respectively)(P<0.05). The embryo implantation rate in group B1 were higher than those in group B2 (P < 0.05). Conclusion F-ET after whole embryos freezing could significantly improve the embryo utilization rate and clinical pregnancy rate. Frozen-thawed blastocyst transfer could get better clinical outcomes than frozen-thawed cleavage-stage embryo transfer.

Objective To evaluate the clinical value of frozen-thawed blastocyst transfer and the blastocyst derived from frozen-thawed cleavage stage embryo transfer.Methods The data of 5 1 8 cycles in reproductive medicine center of the hospital from Sep-tember 2012 to August 2013 were analyzed retrospectively.According to the frozen-embryos type,all patients were divided into three groups,group A:frozen-thawed blastocyst transfer,129 cycles;group B:blastocysts derived from frozen-thawed cleavage stage embryos transfer,123 cycles;group C:frozen-thawed cleavage embryos transfer,266 cycles.The clinical outcomes of all groups were compared with each other,and the rates of blastocyst formation and cancellation were compared between group A and group B.Re-sults The rates of biochemical pregnancy,clinical pregnancy and embryo implantation in group A(70.5%,61.2%,42.3%)and group B(67.5%,58.2%,40.2%)were significantly higher than group C(53.0%,42.5%,23.1%)(P<0.05);there were no signif-icant differences in the rates of early abortion,ectopic pregnancy,multiple pregnancy among three groups(P>0.05);there were no significant differences in the blastocyst formation rates of the high quality cleavage embryos at D3 in fresh cycles and the frozen-thawed cleavage embryos(62.5%vs.57.7%)(P>0.05)and those two groups were both significantly higher than the poor quality cleavage embryos at D3 in fresh cycles(20.3%)(P<0.05).Conclusion Blastocyst transfer in vitrified-thawed cycles could get rel-atively satisfactory clinical outcomes.There are higher blastocyst formation rate and better clinical outcomes of transfer blastocyst derived from frozen-thawed cleavage embryo.

Recently,wide application of MRI in clinic accelerates researches into the etiology,diagnosis,treatment and prognosis of bone bruises.MRI manifestations of bone bruises include trabecular microfracture associated with hemorrhage,oedema of subchondral bone because of direct or indirect traumatic force and focal abnormalities in subchondral bone of the knee.This condition is also known as occult injury of the knee,because it is likely to be overlooked or misdiagnosed in hospital due to its diagnostic difficulty by plain radiographs and CT.If timely intervention is not given,it will be accompanied by chronic pain which seriously affects the daily life of the patients,even resulting in early degeneration.This article discusses the current research on bone bruises of the knee.

Objective To analyse the clinicopathological changes of Alport syndrome (AS) and to detect the deposition of type Ⅳ collagen within basement membrane of Alport patients. Methods Fourteen patients with AS (12 families) hospitalized from 1990. 1 to 1996. 6 were investigated. Eleven were male and 3 female (mean age 29. 4 years). Results Microscopic hematuria was found in 13, with recurrent gross hematuria in 7. All had proteinuria. Three patients presented nephrotic syndrome. Progressive renal failure occured in 10 of 11 male(11 - 39 years) and 1 female (40 years). Six patients were treated with hemodialysis, two of them with transplantation. Sensorineural deafness was observed in 9 patients particularly high frequency sound. Anterior lenticonus were presented in 2. It showed heterogeneitic, 50% transmitted as X-linked dominant(XD) trait. In 7 renal biopsies, the findings by light microscopy mostly revealed focal and segmental sclerosis glomerulonephritis (4/7). The results of immunofluorescenc e (IF) were ne gatt ye in 4. Ultrastructural studies showed variable thickening, thinning of glomerular basement membrane (GBM) in 7 specimens with lamellation and basket-weaving of GBM in 1. Using the iIF technique, the ?3, 4, 5 (Ⅳ) chains were absent within both GBM and EBM of 4 male XD-AS patients. Conclusions AS is not a rare hereditary disease characterized by hematuria, proteinuria and progressive renal failure with sensorineural deafness and ocular lesions. Type Ⅳ collagen within Alpori patients' basement membrane is abnormal and iIF study of type Ⅳ collagen chains distribution is useful to confirm the diagnosis of AS.

Objective To discuss the method and treatment outcome of vascular variation in repairing skin defect of the hand by free transplantation of posterior interosseous perforator flap.Methods Eight cases with vascular variation were adjusted flap position,two cases were repaired by single perforator flap,three cases were repaired by cutting perforator and anastomosing perforator after changing the path,three cases were repaired by designing composition leaves flap.Results Seven flaps survived,one flap partly necrosis and healed by skin-grafting,and all of the patients were followed-up 3 to 18 months.The color,texture and thickness of the flaps were satisfactory.The movements of the fingers were satisfactory.According to the hand function evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association,outcomes were rated excellent in 1 case,good in 5 cases,fair in 2 cases.The excellent and good rate was 75％.Conclusion When finding vascular variation in repairing skin defect of the hand by free transplantation of posterior interosseous perforator flap,adjust flap position,repair by single perforator flap,cutting perforator and anastomosing perforator after changing the path,or designing composition leaves flap is a good treatment option.

Objective To investigate the application of ultrasound-guided vacuum-assisted biopsy for breast masses in primary hospital and the degree of patients' cognition.Methods A retrospective analysis of 1691 female patients in the department of breast diseaseofHuidongwomen and children hospital from September 2012 to September 2014 undergoing biopsy, 1004 casesofultrasound-guided vacuum-assisted biopsy with 1325 masses, and 687 Cases of open surgery with 712 masses, all confirmed by pathological examination after operation.Results In 1325 masses in 7 breast cancercases accounted for 0.7％.Twenty-one (2.1％)cases of postoperative subcutaneous ecchymosis, hematoma in 10(1％) cases.Operation takes 2-26 min.Average hospitalization expenses of unilateral lesions was 6490 yuan.712 masesby open surgery in 9 infiltrating ductal carcinoma accounts for 3.8％ , 8(1.2％) postoperative cases of subcutaneous ecchymosis, 0 case withhematoma, operationtakes 35 to 74 minutes.Average hospitalization expenses of unilateral lesions was 3805 yuan.The follow-up of 3 to 27 months.Recurrenceof 5 fibroadenoma by vacuum-assisted biopsy and 3 by open surgery, there was no difference between its (P ＞ 0.05).Survey was found 97.4％ good cosmetic effectby vacuum-assisted biopsy, significantly higher than open surgery (P ＜ 0.05).There were mild pain after two kinds of operations, no difference (P ＞ 0.05).The cost of vacuum-assisted biopsy was higher than 2485 vuan of open operation.Grade 4a in 993cases with ultrasonic diagnosis found 2 cases of breast cancer (0.2％) in two groups of patients, and grade 4b in 132 cases found 10 cases of breast cancer (7.6％) and 2 cases in grade 5 was breast cancer (100％), and nobreast cancer in 2-3 grade was found.Conclusions Ultrasound-guided vacuum-assisted biopsy is not only fast and accurate diagnosis of early breast cancer, but also be further one-step surgical biopsy of benign tumor in primary hospital, and is safe, simple and convenient operation with high postoperative satisfaction.Strictly select a case can reduce hematoma complications.The ultrasonic BIRADS grade has good guidance for breast masses of diagnosis and treatment, and can reduce the missed diagnosis of breast cancer.Ultrasound-guided vacuum-assisted biopsyand BIRADS grade of breast massesare appropriate technology for diagnosis and treatment in the primary hospitals.

Objective: To discuss the methods and items for clinical linear accelerator (Clinac) and 3D treatment planning system (TPS)/intensity modulated radiotherapy(IMRT) system based on 2D ionization chambers array(2D-ICA). Methods: The 2D-I-CA laid on the anthropomorphic phantom with five centimeters and which was put on another five centimeters same phantom.All data have gained as following conditions: the SAD is 100 cm and the SSD is 90 cm; the fields' size are 2 cm, 5 cm, 10 cm,15 cm ,20 cm respectively and 2 cm×10 cm ,5 cm×20 cm ,20 cm×5 cm, MU=100 cGy;the Clinae and TPS were verified by some special items for checking their dose accuracy, such as, square fields, rectangular fields, and rectangular fields with 600 wedge or 300 wedge, which were measured for verification their flatness and symmetry. And some measured items were only for checking multileaf collimator (MLC) and TPS calculated accuracy. So, we developed moveable MLC fields and IMRT plans and compound fields to evaluate leafs side effects and leafs end effects and transmission effects. Results: The flatness value of square and rectangular fields was 100.07%～102.66%,and their symmetry value was 0.10%～1.49%; and these irradiate fields' size were compared with light fields' sizes, which the X direction deviation was-1.5%～0.7% ,the Y direction deviation was-1.4%～1.0%,and their average value was-0.47%.To verify calculated data for TPS ,we developed Gamma value and ab-solute value (<4%)to evaluate their accuracy. For square and rect-angular fields, The Gamma value was 92.02%～96.35%.In com-pound fields Which were composed with two half fields (X1 = 5 cm, X2 =0 cm, Y= 10 cm and X1 = 0 cm,X2 = 5 cm, Y=10 cm),the maximum deviation was about 5%.And five fields (2 cm×10 cm) composed one fields (10 cm×10 cm),the maximum deviation was about 10% in the joint place. The Gamma value of one fields was 96.6%, another was 93.2% in the moveable fields. Conclusions: To dollop 2D ionization chambers array to verify the dose for Clinac and TPS, it was so quick and simple, and it was important that it bring more accurate dose evaluation and more clinical quality assurance and quality control methods.

Objective To investigate the underlying mutation in a late-onset Chinese patient with classic Bartter syndrome. Methods The mutation analysis of CLCNKB gene was performed by the PCR direct sequencing. The patient's parents and siblings were studied as well. Fifty normal volunteers were analyzed as control group. Results The heterozygous deletion mutation cDNA 753delG and heterozygous missense mutation G433E were detected in the patient. Her father was found to carry heterozygous G433E and her mother to carry cDNA 753delG mutation respectively. Her brother carried heterozygous G433E and her sister was normal. Conclusions Two mutations of the CLCNKB gene in this Chinese patient with late-onset classic Bartter syndrome are identified. The cDNA 753delG mutation has not been reported previously.