In March 2009,Mexico reported the first case of human infection with a novel influenza (H1N1).By 11 April 2010,a total of 17798 Laboratory-confirmed cases were fatal which were officially reported to WHO by State Parties to the IHR (International Health Regulations,2005).It has already been qiute clear that clinical management of severe cases is the vital session of the strategies of 'fighting the swine flu'.Some topics on diagnosis and treatment of severe H1N1 cases will be discussed insightfully.Inspirations will spark on early diagnosis/intervention,oxygen/mechanical ventilation,antiviral therapy,antibiotics,corticosteroids and extracorporeal membrane oxygenation,according to the author's clinical experience.

Objective: To explore the operation method and clinical effect of treatment for bilateral cleft lip with improved straight line closure. Methods: On the basis of straight line closure, the vermilion and anterior lip pear were repaired with the muscle-vermilion labial flap of lateral lip. In order to close nasal floor, flap-C from lateral wall of anterior lip and flap-G from nasal wing base were designed, meanwhile, nasal mucosa flap-D and flap-H from two sides of nasal base fissure were designed. The function of the orbicularis oris was repaired by cutting off the anomaly adhesion of the orbicularis oris. Results: The post-operational upper lip was thickened together with good shape and vermilion color, there was no obvious dynamic abnormality, nasal floor was closed well. Conclusion: The improved straight line closure can obtain good shape of lip, reduce the whistling deformities, oronasal fistula and dynamic abnormality.

Objective To study the effects of lung recruitment maneuvers (RM)with different duration combined with low tidal volume (TV)ventilation in acute respiratory distress syndrome (ARDS) with pulmonary and extra-pulmonary origin(ARDSp / ARDSexp). Methods Twenty-six ARDS patients with ventilation were selected including 10 patients of ARDSp (ARDSp group) and 16 patients of ARDSexp(ARDSexp group). All patients were given intermittent high-positive end expiratory pressure (PEEP) combined with low tidal volume RM in the base of usual ventilation. Effects of different duration of RM were evaluated and compared in the patients of ARDSp / ARDSexp. Results MAP decreased and HR increased when sustaining time of RM was above 60 seconds. Significant differences were showed compared with that before treatment. MAP and HR returned to normal after RM stopped.Compared with the state before RM,Pplat and Crs increased immediately after RM (P<0.05). When RM lasted above 60 seconds, Pplat increased significantly compared with that when RM continue lasted 40-59 seconds.But Crs,OI and SpO2 didn't increase obviously. Treatment effects of RM in patients of group ARDSexp were more obviously than those in patients of ARDSp group. There were 1 case of pneumothorax and 3 cases of pneumoderma in ARDSp group and 2 cases of pneumoderma in ARDSexp group when RM lasted above 60 seconds. Conclusions RM with intermittent high-PEEP on low TV is effective to ARDS and best duration is 40～59 seconds. The patients of ARDSexp, with pulmonary interstitial edema as the main pathology, respond better to RM than patients in ARDSp with pulmonary consolidation.

Objective:To evaluate the effects of primers on the bonding of an silicone elastomer to acrylic resin.Methods:Acrylic resin specimens were divided into eight groups.Six new primers and Cosmesil G611 primer were applied to the acrylic resin surfaces respectively.Untreated group was used as control.The shear bond strengths between silicone elastomer and acrylic resin were determined.D primer were measured by Forier transform infrared spectroscopy,and the bands were analyzed using spectrum method.Results:The experiment group with different concentration of ?-MPS showed different shear bond strengths between silicone elastomer and acrylic resin.Type D primer showed 2.20 MPa shear bond strength,which was significantly higher than that of other groups.While 1.44 MPa for Cosmesil G611 primer was found,there was no bond strength for untreated group.Conclusion:The concentration of ?-MPS is relative to the shear bond strength and type D primer can give the highest shear bond strength.

Objective To observe the effect of aminoguanidine by intraperitoneal injection on apoptosis of chondrocyte with osteoarthritis.Methods Totally 32 rabbits were divided into 3 groups at random.Both the experiment and the model groups were fixed by plaster cast in the right hind straighten limb,while the control group received no treatment.The experiment groups were injected with aminoguanidine in abdominal cavity,100mg/(kg?d),and the control groups were injected the same voluminal normal saline in abdominal cavity.At the 4th week,we killed 4 rabbits from the normal group,and 6 from the control group and the experiment group,respectively.At the 8th week,we put the rest to death.We drew the materials from each sample for pathological observation on the whole and under the light microscope by HE and immunohistochemical staining,and counted apoptosis cells by TUNEL for statistical analysis.Results Compared with the control group,the experiment group was more similar to the normal group in general observation and optical microscope observation by HE staining.Both iNOS positive expression cell by immunohistochemical staining and apoptosis cell calculation by TUNEL of the experiment group were fewer than those of the control group(P

Objective To study the change of Insulin-like growth factor 1(IGF-1)and Epidermal growth factor(EGF)level in blood of newborns with asphyxiated.Investigation the effect of stomach-intestine hormone to newborns asphyxiated.Methods plasma IGF-1,EGF level of 48 neonatal asphyxia and 36 normal newborns(1d,3d,7d)were tested by radioimmunoassay.Result In comparision with normal neonatal,IGF-1,EGF level of neonatal asphyxia reduced significantly(P

Objective:To reconstruct a 3-D wax nose model and make a s ilicone elastomer nose prosthesis. Methods:Laser scanning was us ed to get the data of a nose model, selective laser sintering and wax powder wer e used to fabricate a wax nose model,the nose prosthesis was made by silicone el astomer. The differences in length(L),width(W),deepth(D),height(H) and tip-angl e(TA) among the nose models made with plaster, wax powder and silicone elastomer were compared. Results:L(mm) in plaster, wax and silicon e models was 36.61,36.60 and 36.60 respectively.W(mm),D(mm),H(mm) and TA(?) in the three kinds of models were the same:36.23,18.45,43.14 and 74.57 respectively .Conclusion:Nose model made of the wax powder is precise and can meet the requirements for maxillofacial prosthesis.

Objective To test the performance of the field digital oral medical vehicles(two chairs) developed by School of Stomatology,the Fourth Military Medical University.Methods The field digital oral medical vehicle was developed by using dental health care system,diagnostic imaging systems,oral endoscopic systems,infection control systems,digital management system,the sewage treatment system,temperature conditioning systems,power generation systems,automotive GPS positioning system and other systems.Results The vehicle was characteristized by reliable performance,high degree of functional serialization,complete medical facilities and good operability of the internal layout.Conclusion Its functions fully meet the requirements in field oral disease prevention and control as well as first aid.

Objective: To explore the possibility to restore alveolar process cleft and the defects of front maxillae with telescope techniques. Methods: 4-5 telescopes were used as retainers of a prosthesis for cleft alveloar process or the defects of front maxillae; metal framework was used as connector of abutments and obturator in soft-tissue defect. Porcelain or resinmetal crowns were applied to restore defects in dentition. Acrylic resin was applied to repairs the deftcts of alveolar process and front maxillae or defect of palate. By above ways, prostheses were fabricated, the patients were followed up. Results:The following up for 26-28 months in 6 cases showed that the prosthesis retained with telescopes had follow advantages: good retention, convenient application, high masticatary function and satisfactory esthetics effects. Conclusion:The prosthesis with telescopes is feasible for the restoration of cleft alveolar process and the defects of front maxillae.

Objective To explore the clinical application of reconstructing silicone elastomer nose prosthesis by means of selected laser sintering and wax powder PCPI. Methods Laser scanning was used to get the 3-D data of a nose model. Surfacere 10.0 etc softwares was used to reconstruct the nose by mirroring the digitalized model of absent nose. Selective laser sintering and wax powder was chosen to fabricate a wax nose model and the nose prosthesis made by silicone clastomer. Results Perfect silicone clastomer nose prosthesis was made for 2 patients. Conclusion This study suggests that the wax nose model and the new wax powder can meet the requirement of clinical expectation for maxillofacial prosthesis.