ObjectiveTo investigate the therapentic effect and safety by use of Metoprolol to control patients ,heart rate in off-pump coronary artery bypass graft (OPCAB). MethodsAnalyse the dates of 40 OPCABG patients in anesthetic stage. ResultsIn all of the cases,when patients were treated with venous injection of Metoprolol, the heat rate obviously decreased 1 minutes later( P ＜ 0.01 ). the heat rate decreased significant to( 69.2 ± 10. 8)times/min 3 minutes later, Compared to the heat rate ( 85.1 ± 13.5) times/min of pretherapy there was statistical significance. the heat rate decreased to nadir(63.0 ± 6.2) times/min 10 minutes later. While it raised gradnally 30 minutes later,but patients'heat rate nulli-exceed. it of pretherapy. On post-treatment of 3min、5min、 10min、30min, The MAP nulli-genic marked change. ConclusionMetoprolol could control effectively patients,heat rate in OPCAB and keep hemodynamics stable.

Objective To study the clinical and pathological features of a case of retroperitoneal desmoplastic small round cell tumor. Methods One case of desmoplastic small round cell tumor was presented with review of the literature. Results A 11 years old child complained of abdominal pain and a 9.0 cm?6.0 cm?3.0 cm cystic tumor located in the left retroperitoneal space near the left kindey was resected.The connective tissue was significantly proliferated around the tumor cell nests. Immunohistochemical staining revealed CD 99 (+) and EWS/WT1 (+). After resection of the tumor,chemotherapy was performed with DDP?ifosfamide and VP16. No tumor recorrence has been noted 16 months after operation. Conclusions Desmoplastic small round cell tumor has specific clinicopathologic stigmata occuring usually in young males and the tumor was characterized by expression of MIC2 gene product CD 99 and the EWS/WT1 protein. Surgical resection with cheomotherapy is the treatment of choice.

ObjectiveTo study the effects of different priming dose of muscle relaxant at the onset and endotracheal intubation conditions.Methods120 ASA Ⅰ～Ⅱ grade patients were randomly divided into 6 groups (n=6),vecuronium group (V 1,V2,V3) and cis-atrscurium group (C1,C2,C3).All patients were induced with propofol plasma (TCI)3 μg/ml,fentanil3 μg/kg.The V1 and C1 group were not given priming dose,and the V2,V3,C2,C3 groups were given priming dose of 10 μg/kg,20 μg/kg vecuronium and 15 μg/kg,30 μg/kg cis-atracurium.Intubating conditions were evaluated,and the onset time was monitored with train-of-four (TOF) technique.ResultsIntubating conditions were excellent in all patients.The onset time of priming groups of the four different doses was significantly shorter than that of the nonpriming group [(80.5±7.2) vs (146±10.7);(79.8±6.5) vs (146±10.7);(138.5±7.2) vs (218±10.7) ; (127.1±6.5) vs (218±10.7),P ＜ 0.05 ].ConclusionsThe taking-effect time of priming dose of muscle relaxant was significantly shorter than that of the nonpriming dose group.Increasing the priming dose not decrease onset time more than the smaller dose.

Objective To compare pharmacodynamics of vecuronium administered according to body surface area and body weight during general anesthesia.Methods Forty ASA Ⅰ or Ⅱ patients,aged 18-64 yr,weighing 40-85 kg,undergoing general anesthesia,were randomly divided into 2 group ( n =20 each ).The patients received vecuronium 2× ED95 based on body weight (group W) or based on body surface area (group S).Anesthesia was induced with propofol 2 mg/kg,fentanyl 3 μg/kg and vecuronium 0.1 mg/kg ( group W) or 2.824 mg/m2 (group S).The patients was tracheal intubated and mechanically ventilated when the maximal depression of T1 was achieved.PET CO2 was maintained at 35-45 mm Hg and BIS value was maintained at 40-50.The intubation condition was evaluated using Cooper's score.The onset time,maximal depression of T1,duration of clinical action,recovery index,duration of pharmacological action and amount of vecuronium consumed were recorded.The coefficient of variation for all the indexes mentioned above was calculated.Results There was no significant difference in the coefficient of variation for intubation condition,onset time,duration of clinical action,recovery index,and duration of pharmacological action between the two groups ( P ＞ 0.05).Compared with group W,the coefficient of variation for the maximal depression of T1 and amount of vecuronium consumed were significantly decreased in group S ( P ＜ 0.05).Conclusion Vecuronium 2 × ED95 administered according to body surface area can reduce the individual variation in pharmacodynamics during general anesthesia.

Objective To discuss the indication and efficacy for treating hypospadias with ure-throplasty of Pedicled preputial double-faced island flap(PPDIF). Methods Records of 99 children (mean age, 5.1 years; age range, 4 months-12 years)with hypospadias who underwent PPDIF oper-ation were reviewed. Of them, 56 cases were penile type of hypospadias, 24 cases of penile root type, 13 cases of scrotal type and 6 cases of perineal type according to Barcat classification. Based on Duck-ett technique, the partial preputial cortical plate remained and was displaced to gastr-penis with ure-thra. , and finally the new urethra would be covered by the cortical plate. Results During follow-up of average 2 years, 8 patients(8. 1%) developed urethral fistula, 1 (1.0 %) developed mild meatal ste-nosis, and 1(1.0 %) developed flap necrosis. The success rate for total PPDIF procedure was 89.90 % (89/99). And the success rate of simple PPDIF for cases with penile and penile root hypospadias, and PPDIF+Duplay for cases with serotal and perineal hypospadias were respectively 91.25 % (73/80) and 84.21%(16/19). respectively. Conclusions PPDIF is good for treating most hypospadias. Furth-more it make penis better shape. In the severe cases, PPDIF+Duplay prededure is recommended and the effect was affirmative.

Objective To explore the potential risk factors for aortic and mitral valve calcification in maintenance hemodialysis(MHD)patients. Methods Patients on MHD for at least 6 months.aged≥1 8 years without history of surgery or catheter for heart valve disease were enrolled in the study.Echocardiographic examination was performed to detect the calcification.The risk factors for aortic and mitral valve calcification were analyzed by Logistic regression. Results One hundred and eighty-one MHD patients(98 men and 83 women)were enrolled in the study.Of all the patients,aortic or mitral valve calcification was found in 94 patients(5 1.9%),aortic valve calcification in 90 patients(49.7%),mitral valve calcification in 30 patients(16.6%),aortic and valve calcification in 26 patients(14.4%).Multivariate Logistic regression showed that age(β=5.52,P=0.007),dialysis duration(β=6.99,P=0.039)and pre-albumin(β=-12.616,P=0.004)were independently correlated with aortic valve calcification.Mitral valve calcification was independently correlated with dialysis duration(β=6.057,P=0.002),history of primary hypertension(β=3.054,P=0.008),hemoglobin(β=-0.061,P=0.035)and β2 microglobulin(β=7.63,P=0.01).While the correlation between mitral valve calcification and age was borderline significant(β=0.085,P=0.05).Conclusions Valve calcification is prevalent in MHD patients,and aortic valve calcification is more common than mitral valve calcification.Age,dialysis duration and low serum pre-albumin are independent risk factors for aortic valve calcification.The risk factors for mitral valve calcification include age,dialysis duration,history of primary hypertension,anemia and high serum β2 microglobulin.

ObjectiveTo investigate the clinical therapeutic effect of gemcitabine hydrochloride combined with stereotactic radiotherapy for locally advanced pancreatic cancer. MethodsA total of 122 previously untreated patients with locally advanced pancreatic cancer who were not able to undergo surgical resection and were admitted to Fuzhou General Hospital from June 2008 to June 2013 were selected, and according to the therapies, they were divided into the group with a combination of gemcitabine hydrochloride and stereotactic radiotherapy (group A, n=56) and the group with gemcitabine therapy alone (group B, n=66). The changes in condition, toxic and side effects, and death time were recorded. The chi-square test was applied for comparison between groups, and the Kaplan-Meier method was applied for plotting survival curves. ResultsThere was a significant difference in response rate between group A and group B ［67.8% (38/56) vs 227% (15/66), χ2=25.11, P＜0.01］; the effective pain-relieving rate showed a significant difference between group A and group B (95.8% vs 77.2%, χ2=7.39, P＜0.01); there were significant differences in 1-year survival rate, 2-year survival rate, and median survival time between the two groups ［58.9% (33/56) vs 31.8% (21/66), χ2=9.03, P＜0.01; 28.6% (16/56) vs 106% (7/66), χ2=6.39, P＜0.01; 12.8 months vs 7.9 months; χ2=15.51, P＜0.01］. ConclusionGemcitabine hydrochloride combined with stereotactic radiotherapy has good short- and long-term efficacy, and toxic and side effects are tolerable.

10.3969/j.issn.1007-3969.2013.04.003

Psychiatric professional talents is specially needed in China.Our university was ratified by ministry of education of people's republic of China in 2011 to cultivate professional master degree postgraduates majoring in mental health and psychiatry.According to the social needs and requirements of ministry of education,we carried out comprehensive reform and exploration in cultivation direction and objective,time management and course offering,cultivating model,examination and evaluation system.Cultivation direction included clinical psychiatry,forensic psychiatry,community psychiatry,behavioral medicine and clinical psychology,which were closely related with social needs.The objective was to cultivate high-grade psychiatric special talents with higher political diathesis,competent clinical skills,certain teaching and research abilities and grasping one foreign language.The total time for cultivating clinical skills should no less than two years and a half.Course offering included degree course and non - degree course,clinical skills,academic activities,teaching practice,medical record arrangement or case analysis essay writing.We developed the cultivating model combining ‘ medicine,study and research' and developed multilevel and comprehensive examination and evaluation system.

Objective To report our self-designed guide module for placement of posterior column lag screws in anterior-posterior column acetabular plate using CT reconstruction data.Methods The CT scan data of 50 normal adult pelves were collected from February 2012 to April 2013,involving 30 males and 20 females with an average age of 46.4 years(range,from 25 to 69 years).The data were imported into Mimics 10.01 software for reconstruction of semi-pelvic models.Virtual cylindrical implants were placed intraosseously in both the left and the right posterior columns.The perpendicular distance (OP) from the insertion point O of the virtual cylindrical implant to the arcuate margin (P) and the distance (PI) from the point P to the point I,the crosspoint of the extension line of the ischial ramus and the arcuate margin were measured respectively.The angle (∠φ) between the direction of screws and the plane of guide module and the angle (∠θ) between the direction of screws and the long axis of guide module were also measured respectively.Results The average length of PI was 0.98 ± 0.13 cm,with 1.08 ± 0.22 cm in females and 0.95 ± 0.27 cm in males.The difference between genders was not statistically significant (P ＞ 0.05).The average length of OP was 1.09 ± 0.26 cm,with 1.06 ± 0.29 cm in females and 1.12 ± 0.24 cm in males.The gender difference was not statistically significant either (P ＞ 0.05).The mean value of ∠ φ was 55.43° ± 3.64°,with 55.33° ± 4.00° in females and 55.50° ±3.43° in males.The difference between genders was not statistically significant (P ＞ 0.05).The ∠θ value in females was 39.21 ° ± 2.45° and 35.58° ± 2.31 ° in males.The gender difference was statistically significant (P ＜ 0.05).Conclusions In design of the guide module,the nail holes should be located about 1 cm away from both the posterior edge and the medial edge,the angle between the screw direction and the module plane should be approximately 39° in females and 35° in males,and the angle between the screw direction and the long axis of the module approximately 55°.