【Objective】 To investigate the profile of Rh blood group antigen in pregnant women and hemolytic disease of the newborn (HDN) in Qingdao area. 【Methods】 10 597 pregnant women admitted in our hospital during October 2016 to February 2020 were selected and the ABO, Rh blood group system antigen (D, C, c, E, e) and the irregular antibody were detected, and positive antibody was further identified. The irregular antibody of Rh blood group in pregnant women was statistically analyzed according to the history of blood transfusion and pregnancy. Twelve HDN cases were studied, and the results of ABO, Rh blood group antigen and irregular antibody, antibody property identification, HDN test and blood routine test were retrospectively analyzed. 【Results】 Among 10 513 cases of Rh-positive pregnant women, the common phenotype was CCee>CcEe>Ccee>ccEE>ccEe; among 84 cases of Rh-negative pregnant wome, the common phenotype was ccee>Ccee> CCee> ccEE>ccEe. The positive rate of irregular antibody was 1.06% (112/10597) in 10 597 pregnant women, of which the Rh antibody was the highest, rated at 56.25% (63/112). For 64 pregnant women with positive antibodies, antibodies against Rh system were different from those against other systems when stratified by the history of blood transfusion (P<0.05) and pregnancy (P<0.05). Twelve neonates were diagnosed with Rh-HDN, with IgG anti-E in 6 cases, IgG anti-D 3, IgG anti-cE 1, IgG anti-C 1and IgG anti-c 1. Among them, 3 were seriously ill and treated with blood exchange. 【Conclusion】 As two-child policy was implemented, the incidence of Rh HDN had increased. ABO, RhD, C, c, E and e matched transfusion should be administered for women at childbearing age. Meanwhile, clinical termination of delivery was recommended for pregnant women, who probably develop Rh-HDN and are with critical situation. Rh phenotype matched fresh blood should be prepared, which has great clinical significance for rescuing newborns.

【Objective】 To explore the application of capillary ultracentrifugation technology in accurate identification of Rh phenotype and clinical blood transfusion. 【Methods】 132 samples, presenting mixed field agglutination during Rh phenotyping in our laboratory from May 2019 to February 2020, were separated using capillary ultracentrifugation technology, and the proximal and distal red blood cells were taken for Rh phenotype test, and then blood donors with the same Rh phenotype as the proximal cells were selected for cross matching. 【Results】 132 samples were subjected to capillary ultracentrifugation, and new red blood cells were successfully isolated from the proximal side in 128 (96.97%)cases, and the Rh phenotype was accurately identified, i.e. CcDEe in 47 cases (36.72%), CcDee in 12(9.38%). ), ccDEEin 11 (8.59%), CCDee in 52(40.63%), ccDEe in 5 (3.91%), and ccDee in 1(0.78%). 4 cases of mixed field reaction remained after centrifugation, and all of them had a history of blood transfusion within 2 days. For the 128 patients whose Rh phenotype was accurately identified, blood donors with the same type of Rh phenotype were selected, and 4 patients whose Rh phenotype could not be determined, donors with CCDee phenotype were selected based on the frequency of phenotype distribution and the principle of reducing antigen exposure. The cross-matched blood of all patients were consistent. 【Conclusion】 Capillary ultracentrifugation technology can effectively separate the new red blood cells, improve the accurate identification of Rh phenotype, and provide safety guarantee for clinical targeted blood transfusion.

The majority of cervical spine injuries in children occur in the upper cervical spine, of which odontoid fracture is the most common. Odontoid fracture in children is a very insidious injury. Due to the unclear language and incompatible physical examination, the disease is often missed diagnosis. Because the child axis is still in the developmental segment, including 4 synchondrosis and 6 ossification centers, there are obvious anatomical and biological differences between the child odontoid fracture and the adult. Therefore, the choice of treatment is different from that of adults. This article will introduce the development of odontoid in children, and summarize the injury characteristics, clinical classification and treatment of odontoid fracture in children.

Lumbosacral transitional vertebrae (LSTV) is a common phenomena of developmental anomaly, which is characterized by anatomic variation and biomechanical changes. LSTV is often accompanied with low back pain, lumbar disc herniation, lumbar spinal stenosis, lumbar spondylolisthesis and other spinal diseases. The diagnosis of LSTV has a great significance for proper treatment process. Early imageological studies have limitations on distinguishing different types of LSTV from the aspect of morphological changes. This review focuses on recent studies of LSTV anatomy and variation, its influence in local biomechanics and spinal alignment, and its relationship with spinal diseases.

Postoperative delirium is a common complication after spinal surgery, and it is a complex issue involving multiple factors. However, there is currently insufficient understanding of postoperative delirium in patients undergoing spinal surgery, and there is still a lack of clear regulation in prevention and treatment. Although the literature and research on postoperative delirium have been comprehensive, there are still few studies on postoperative delirium in patients undergoing spinal surgery. This article mainly reviews the incidence, social and economic problems, risk factors, prevention and treatment of postoperative delirium in patients undergoing spinal surgery.

Objective To investigate the influence of preoperative anxiety-depression status on the postoperative pain in patients undergoing gynecologic laparoscope surgery.Methods Ninety pa-tients,aged 18-65 years,BMI 18-30 kg/m2,ASA physical status Ⅰ or Ⅱ,undergoing gynecologic laparoscope surgery were included in this single-center observational study.All the patients were in-terviewed by anesthetists the afternoon before surgery and completed a Hospital Anxiety and Depres-sion Scale (HADS)to evaluate the anxiety-depression status.Then the patients were divided into two groups,low HADS group (group L)(HADS score≤9)and high HADS group (group H)(HADS score>9).Patients'visual analogue scores (VAS)were recorded at the time 30 min,60 min,6 h, 12 h,24 h after operation.The correlation analysis between HADS before operation and VAS scores at different time point was performed.The use of analgesia medicine,exhausting time and complica-tions such as nausea, vomiting, dizzy, pain of shoulder and back were also recorded. Results Compared to group H,VAS score was lower in group L at 6 hour after surgery but no sig-nificant different was found at 30 min,60 min,12 h,24 h after surgery.There was a significant asso-ciation between preoperative HADS scores and VAS at 6 hour after surgery (r=0.634,P=0.01);but no significant association was found between preoperative HADS scores and VAS at the other time point after surgery.The exhausting time was significantly longer in group H than group L (P<0.05).There was no significant difference in the incidence of nausea,vomiting,dizzy or pain of shoulder and back between the two groups.Conclusion Preoperative anxiety-depression status has a positive influence on postoperative pain at 6 hour after gynecologic laparoscope surgery,and also can delay the recovery of gastrointestinal function.

Though great progress on spinal sagittal alignment has been seen recently, which focuses on the lumbar spine-pelvic region and the whole spine, while there is a few research mainly concentrated on the cervical spine. In recent years, a growing number of researchers have been exploring the changes in the compensation of cervical sagittal alignment and their effect on surgery, and the preliminary results of these researches are satisfactory. The present review focuses on the measurement of sagittal plane parameters of cervical spine, changes of sagittal alignment in cervical spine disorders, and its effect on cervical surgery.

Objective To evaluate the analgesic interaction between butorphanol and sufentanil.Methods Ninety patients,aged 18-64 yr,with body mass index ＜30 kg/m2,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,undergoing elective laparoscopic gynecological surgery,were divided into 3 groups (n =30 each) using a random number table:butorphanol group (group B),sufentanil group (group S) and butorphanol mixed with sufentanil group (group BS1).The doses of butorphanol and sufentanil were determined by the modified Dixon's up-and-down method.In B and S groups,the initial doses of butorphanol and sufentanil were 0.5 mg and 5 μg,respectively,with 0.1 mg and 1 μg increment/decrement,respectively.In group BS1,butorphanol combined with sufentanil at the ratio of 2 ∶ 1 based on the equivalent dose,and the initial dose was butorphanol 0.25 mg plus sufentanil 2.5 μg with 0.05 mg and 0.5 μg increment/decrement for butorphanol and sufentanil,respectively.Effective analgesia was defined as numeric rating scale pain score ≤ 3 or the extent of decrease in numeric rating scale scores ＞ 50％ within 15 min after administration.The median effective dose (ED50) and 95％ confidence interval (CI) of butorphanol and sufentanil were calculated by probit analysis.Isobolographic analysis was used to analyze the analgesic interaction between butorphanol and sufentanil.When the equivalent dose of two drugs was very different from that selected in group BS1 on the basis of the actually calculated ED50 in B and S groups,the combination of butorphanol and sufentanil in group BS2 (n=30) was set at the ratio of 1 ∶ 1 based on the actual equivalent dose:the initial dose was butorphanol 0.4 mg plus sufentanil 1.8 μg with 0.1 mg and 0.45 μg increment/decrement for butorphanol and sufentanil,respectively.Results The ED50 of butorphanol was 0.80 mg (95％ CI0.74-0.87 mg),and the ED50 of sufentanil was 3.68 μg (95％ CI 3.07-4.41 μg).The ED50 of butorphanol and sufentanil was 0.28 mg (95％ CI 0.25-0.32 mg) and 2.82 μg (95％ CI 2.52-3.16 μg),respectively,in group BS1.The ED50 of butorphanol and sufentanil was 0.38 mg (95％ CI 0.33-0.43 mg) and 1.7 μg (95％ CI 1.5-1.9 μg),respectively,in group BS2.The isobolographic analysis showed that the combination of butorphanol and sufentanil at 2 ∶ 1 or 1 ∶ 1 produced an additive analgesic effect.Conclusion The analgesic effect of butorphanol and sufentanil is additive when combined at the ratio of 2 ∶ 1 or 1 ∶ 1 based on the equivalent dose.

Objective To detect the content of plasma ctDNA and the mutation rate of BRAF V600E in plasma of patients with thyroid carcinoma ,and to explore its clinical significance. Methods Plasma ctDNA was extracted from 16 patients with thyroid carcinoma and 59 patients with benign thyroid nodules by using the blood genomic DNA Extraction Kit. The ctDNA content was detected by fluorescence quantitative PCR ,and the mutation of circulating BRAF V600E was detected by PCR and sequencing. Then the clinical significance was analyzed by combined detection analysis. Results The content of ctDNA in thyroid cancer group was significantly higher than that in benign nodule group (P < 0.01). BRAF V600E mutation detection showed that the mutation rate was 43.75%,but benign nodules had no mutation. Parallel combined detection improved the sensitivity and the specific-ity of the combined detection was higher. Conclusion Combined detection of ctDNA and BRAF V600E in plasma is helpful for differential diagnosis of benign and malignant thyroid nodules.

Objective To compare the effect of low concentration versus ultra-low concentration of ropivacaine in combination with sufentanil delivered via programmed intermittent epidural bolus (PIEB) with patient-controlled epidural analgesia (PCEA) during labour on obstetric and anesthetic outcomes.Methods Seventy-six ASA Ⅰ or Ⅱ nulliparous parturients who were at full term with a singleton fetus in vertex presentation were randomized to receive 0.1 ％ ropivacaine with 0.5 μg/mL sufentanil (Group L,38 cases) or 0.06％ ropivacaine with 0.5 μg/mL sufentanil (Group UL,38 cases).Another matched 76 cases of primiparas without labor analgesia (Group C) served as controls.For primiparas received analgesia,an epidural catheter was inserted when the cervical dilatation was up to 2-3 cm.The analgesia level was controlled below T8,and VAS score was controlled below 4.Thirty minutes after analgesia started,Group L and UL received PIEB with PCEA regimen including basal infusion of 8 mL/h of ropivacaine with sufentanil,patient-controlled bolus 6 mL and lockout interval 10 minutes.The duration of labor,delivery mode,Apgar score,VAS score and anesthetic drug consumption of each group were recorded.Results The second stage of labor were not statistically different between Group UL and C.The second stage of Group L was longer than that of Group C (P＜0.05).Furthermore,with similar performance in pain score and satisfactory level at each time point,Group UL consumed much less ropivacaine than Group L (P＜0.05).The cesarean section rate,instrumental delivery rate and the Apgar score were not significantly different among the 3 groups.Conclusions While using PIEB with PCEA,0.06％ ropivacaine was capable of providing satisfactory analgesia effects for primipara and has less effects on the obstetric outcome.Therefore,it could be recommended for labour analgesia.