Objective:To evaluate the efficiency and safty of home-bleaching.Methods:Randomised controlled trials on home-bleaching were searched using CBM,CNKI,Medline,EMBASE and Cochrane Library up to April,201 3.The articles were selected by inclusion criterion,qualified by Cochrane system and analysed by Meta method.Results:1 2 studies with 61 1 cases were finally includ-ed and analysed.The results showed that 1 0% carbamide peroxide (CP)produced better bleaching efficiency than 1 5% CP(MD, 0.21 ;CI:[0.03,0.38];Z =1 .92;P =0.002).Hydrogen peroxide(HP)at 35% lead to higher tooth sensitivity in office-bleaching than CP at 1 0% in home-bleaching(MD,-1 .68;95%CI:[-2.75,-0.61 ];Z =3.09;P =0.002);home-bleaching were asso-ciated with less tooth sensitivity than office-bleaching(MD,-2.64;95%CI:[-3.96,-1 .32];Z =3.93;P <0.000 1 ),while there was no significance of tooth sensitivity between home-bleaching using CP and HP (OR,1 .94;95%CI:[0.84,4.44];Z =1 .56;P =0.1 2).Conclusion:1 0% CP home-bleaching may produce better bleaching efficiency;home-bleaching is associated with less tooth sensitivity than office-bleaching.

Objective To explore the correlation of pulmonary heart disease (PHD) with erythrocyte immunity function and serum erythropoietin(EPO)level. Methods Forty-eight patients with PHD were selected as PHD group, while forty people were chosen as control group. The erythrocyte C3b receptor (E-C3bRR), erythrocyte immunity complex (RBC-ICR) and serum EPO content were detected by yeast rosette method and enzyme-linked immunosorbent assay (ELISA),and blood gas indexes were examined by blood gas analyser.Results The E-C3bRR and serum EPO content were lower, while the RBC-ICR was higher in PHD group than in control group(both P< 0. 01). Compared with control group, PCOz and HCO3-levels were higher, but blood oxygen saturation(SaO2) level was lower in the PHD group than in control group(both P<0. 01). There were no differences in pH value and PO2between two groups(both P>0. 05). The E-C3bRR was positively related to serum EPO content (r=0. 623, P<0.01), and HCO3-was positively related to pH value and PCO2(r=0. 219 ,P<0. 05;r=0. 585,P<0. 01) ,whereas PCO2was negatively related to pH value(r=-0. 529,P<0.01),and PO2was positively related to SaO2(r=0. 682,P<0.01)in PHD group. Conclusions There is a correlation between E-C3bRR and serum EPO content in PHD patients.

The teaching team of undergraduates of anesthesiology in Anhui Medical University applied the primary trauma care system of encourage, heuristic teaching and practical teaching to further deepen the educational reform and improve teaching quality for undergraduate education.They designed the diversified section such as drills, discussion, teaching, questions, feedback and so on, implemented the simulation training of anesthesia crisis management skills and completed the feedback evaluation of comprehensive ability before and after the teaching, and then achieved the effect of improving the actual operation ability and clinical thinking capacity of students.So it is a good method and worth extending.

Objective To explore the necessities and clinical value of acute intestinal obstruction with com-puted tomography of whole abdomen in over 80 years old patients.Methods 50 patients with acute intestinal obstruc-tion were diagnosed in department of emergency surgery and underwent the abdominal CT examinations.The clinical data,CT and surgery pathology of all patients were compared and analyzed.Results All cases were verified by surgi-cal operation and pathological diagnosis,including colorectal cancer(n =21)and incarcerated abdominal external her-nia(n =21),appendicitis(n =2),adhesive intestinal obstruction(n =2),intestinal volvulus (n =2),and intestinal intussusception(n =1)and stercoral intestinal obstruction(n =1),12 cases were accompanied by bowel necrosis and perforation.12 patients were treated by laparoscope surgery,38 cases by open laparotomy,48 patients acquired good recovery,and 2 cases died from extensive bowel necrosis and multi -organ failure.Conclusion CT examination in whole abdomen could rapidly and accurately diagnose the cause of intestinal obstruction,evaluate complications and risks,so as to provide reasonable treatment choice and time,making patients acquired the effective effects as soon as possible,reducing the bad consequences.

The major ways to reinforce the ship-borne medical equipment are summarized to fit for the mechanical environment of modern ships.Based on the practice in reinforced design of ship-borne medical equipments,the principle and evaluation to carry out a reinforced design are simply discussed,according to the using conditions and function requirement.

Objective Comparative effect of WeChat platform nursing intervention and routine nursing intervention on reducing the incidence of complications of children skin expansion in the process of external ear reconstruction. Methods 132 cases of congenital microtia received skin expander implantation at our institution from Jan 2014 to Aug 20 14 were included as control group. 122 cases of congenital microtia received skin expander implantation at our institution from Sep 2014 to Apr 2015 were included as the intervention group. Children and their families in the control group were treated with routine propaganda and education, and the intervention group were added with internet nursing intervention. Collection and analysis the family health knowledge degree and the occurrence of complications in children of the two groups. Results The score of health knowledge about skin expansion in the intervention group was (33.67 ± 2.44),which was significant higher than that of in the control group (25.07 ± 2.02), t=9.71, P < 0.01. The incidence rate of complication in the intervention group was 2.46%(3/122), which was significant lower than that of in the control group, 8.33%(11/132),χ2=4.20, P<0.05. The satisfaction rate of patients′family member in the intervention group was 95.08%(116/122), which was significant higher than that of in the control group, 84.09%(111/132 ),χ2=15.65, P<0.05. Conclusions WeChat platform nursing intervention can reduce expansion flap complications occurrence rate in the periods of expander. It is worthy of clinical application.

Gastrointestinal stromal tumors (GISTs) are relatively common mesenchymal tumors of the digestive tract characterized by c-kit mutations and the stomach is the commonly involved site.Clinical and pathological diagnosis of GISTs can be achieved by B sonography,computed tomography and immunohistochemical detection of marker CD117.Surgical resection of GISTs has been the most effective therapy.Target therapy with tyrosine kinase inhibitors may reduce the development of recurrence or progression of GISTs.The optimized method of diagnosis and treatment of huge GISTs is still controversial.In this paper,the diagnosis and treatment for huge GIST combined with large right inguinal hernia were discussed.

Objective To evaluate and compare the efficacy of holmium laser enucleation of the prostate(HoLEP) and plasmakineticenucleation of the prostate(PKEP) for treating benign prostatic hyperplasia (BPH).Methods A total of 86 cases of BPH were selected from the Shandong Energy Zibo Mining Group Co.Ltd Central Hospital from January 2013 to June 2014.The patients received either HoLEP (40 cases) or PKEP(46 cases) treatment.Clinical data including postvoid residual volume (PVR),international prostate symptom score(IPSS),quality-of-life score(QOL score),maximum urinary flow rate (MFR) were evaluated before and 3 months after operation.Blood loss in operation,operation time,weight of resected prostate tissue,bladder irrigation time,catheterization time and length of hospital stay were also collected from the perioperative period.Results Three months after surgery,PVR,IPSS,QOL and MFR were all significantly improved in both HoLEP and PKEP groups compared with the data before operation (P =0.000),while there was no significant difference between the two groups(P＞0.05).Patients from the HoLEP group showed markedly lower values of bone loss in operation than that of PKEP group((69.5±23.6) ml vs.(87.5±38.0) ml,P=0.011).There were no significant differences in terms of other indexes (P＞ 0.05).Conclusion HoLEP and PKEP have similar efficiency in treating BPH,while HoLEP is suggested superior in regard of bone loss.

Objective To investigate the relationship between maintaining concentration and loss of consciousness (LOC) concentration of propofol target controlled infusion (TCI) in patients undergoing heart valve replacement.Methods Thirty patients undergoing elective heart valve replacement were enrolled to receive propofol by ladder plasma TCI for anesthesia induction,8 males and 22 females.The initial plasma concentration (Cp) of propofol was set to 1.0 μg/ml,0.3 μg/ml Cp was increased every 1 min until LOC when the prediction effect-cite concentration (Ce) reached 0.5 μg/ml,then sufentanil 0.8-1.0 μg/kg and rocuronium 0.6-0.9 mg/kg were given for intubation.When BIS reached 50,Cp was decreased to the level of Ce.All the surgeries were performed under hypothermia CPB.MAP,HR,CVP,CO,SV,SVR,BIS,propofol Cp and Ce values were recorded at baseline (T0),LOC (T1),BIS reached 50 (T2),and other time points during operation (T3-T9).The correlation analysis between propofol Ce at LOC and perioperative variables were completed.Results In correlation analysis,there was a significant positive correlation between propofol Ce at LOC and baseline CO,SV (P<0.01),there was a significant negative correlation between propofol Ce at LOC and age (P<0.05),there was a significant positive correlation between propofol Ce at LOC and propofol Ce at T2-T9(P<0.01).Conclusion In patients undergoing valvular replacement,the Ce of propofol at maintenance are related to the concentration of propofol at LOC,which is helpful for adjusting the Ce of propofol at maintenance according to the Ce of propofol at LOC.

Objective To evaluate the effect of dexmedetomidine on the postoperative cognitive function in the elderly patients with fragile brain.Methods One hundred and twenty elderly patients with fragile brain,aged 65-85 yr,weighing 50-80 kg,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,with preoperative Mini-Mental State Examination score≥ 20,scheduled for elective gastroenteric surgical procedures,were randomly assigned to one of 2 groups (n =60 each) using a random number table:control group (group C) and dexmedetomidine group (group D).In group D,dexmedetomidine was intravenously infused in a loading dose of 0.4 μg/kg over 10 min before anesthesia induction,followed by an infusion of 0.4 μg · kg-1 · h 1until 30 min before the end of surgery.While the equal volume of 0.9％ nomal saline was given instead of dexmedetomidine in group C.Postoperative delirium was assessed within 3 days after operation using Confusion Assessment Method.Postoperative cognitive dysfunction was assessed at 7 days after operation using Mini-Mental State Examination.Results Compared with group C,the incidence of postoperative delirium was significantly decreased within 3 days after operation (P＜ 0.05),and no significant change was found in postoperative cognitive dysfunction at 7 days after operation in group D (P＞0.05).Conclusion Dexmedetomidine can decrease the occurrence of postoperative delirium in the elderly patients with fragile brain.