Objective To design an intravenous indwelling needle in battle field aid.Methods Several concavity were made on the hollow tube inner surface posterior puncture needle case,and some corresponding convexity uplifted peripheral needle handle pistons posterior puncture needle core.Revolution could be avoided because the needle handle pistons were just embedded in hollow tube concavity.It was convenient to operate and decreased the operator's orientation transformation by the needle's handhold vane adopting rectangle instead of butterfly shape.Results The improved puncture needle was stable and the rate of success of intravenous puncture was increased.Conclusion The improved venous retaining needle can be applied in battle field aid.

Objective To evaluate the efficacy and safety of permissive hypercapnia ventilation in mechanically ventilated newborns.Methods PubMed,Embase,the Cochrane Library,China National Knowledge Infrastructure (CKNI),Wanfang Data and Chinese BioMedical Literature Database (CBM) were searched up until March 31,2013.Randomized controlled trials (RCTs) comparing permissive hypercapnia (PHC) group with normocapnia (NC) group in mechanically ventilated newborns were included.The primary outcomes included the incidence of ventilator associated lung injury (VALI),bronchopulmonary dysplasia (BPD),intraventricular hemorrhage (IVH),periventricular leukomalacia (PVL),patent ductus arteriosus (PDA),neonatal necrotizing enterocolitis (NEC),neurodevelopmental injury and the mortality rate.Secondary outcomes included the duration of ventilatory support and the length of hospital stay.The Cochrane Handbook 5.1.0 was used to evaluate the methodological quality and RevMan 5.1 software from Cochrane Collaboration was used for meta-analysis.The fixed effects model or the random effects model was adopted according to the result of heterogeneity.Results (1) A total of 325 articles were searched,and eight RCTs involving 605 newborns (302 newborns in PHC group while 300 newborns in NC group) which met the inclusion criteria were selected.In seven studies,the partial pressure of carbon dioxide (PCO2) was controlled at ＜ 65 mmHg (1 mmHg=0.133 kPa) and pH at ≥ 7.2 in PHC group.In one study,PCO2 was ＞ 52 mmHg and pH＞7.2,without descripition of the upper limit of PCO2.(2) Four articles described the method of random allocation in detail; three described allocation concealment; all eight studies used blinding method for research subjects; two used blinding method for outcome assessment; all eight studies reported complete data; and three articles described the source of other bias.(3) All eight studies reported the incidence of VALI (I2=56％,P=0.03).The random effects model was used for the meta-analysis,and there was significant difference between PHC group and NC group (RR=0.52,95％CI:0.29-0.93,P=0.03).According to the gestational age,the eight studies were divided into two subgroups.One subgroup,including three studies with an average gestational age of 25 weeks (I2=0％,P=0.46),showed no significant difference in the incidence of VALI between PHC and NC group (RR=1.05,95％CI:0.72-1.54,P=0.78).The other subgroup,including five studies with gestational age of ＞27 weeks (I2=0％,P=0.68),showed significant difference in the incidence of VALI between the two groups (RR=0.27,95％CI:0.14-0.50,P＜0.01).The in-hospital mortality and duration of ventilation showed significant difference between the two groups (in-hospital mortality:RR=0.40,95％CI:0.22-0.74,P＜0.01; duration of ventilation:difference in means=-0.75,95％CI:-1.04--0.46,P＜0.01).There was no significant difference in the incidence of BPD,IVH,PVL,PDA,NEC and neurodevelopmental impairment between the two groups (all P＞0.05).Conclusions PHC ventilation in mechanically ventilated newborns can decrease the incidence of VALI,the in-hospital mortality and the duration of ventilation,while its protective efficacy against BPD is not remarkable.It does not increase the risk of IVH,PVL,PDA,NEC and neurodevelopmental injury,when the PCO2 is ＜ 65 mmHg and pH ≥ 7.2.

Objective To evaluate in-hospital and mid-term results of endovascular type B aortic dissection by stent graft.Methods From May 2002 to September 2006, 46 patients with type B aortic dissection underwent stent graft implantation. The study included 36 men and 10 women with mean age of 62?18 years old. Twenty one patients underwent stent-graft implantation in the acute phase and the other 25 patients in the chronic phase. All patients were followed up for 1 to 52 months (average 17?16 months) and the clinical data of the patients were analyzed. Results No patients died during hospitalization and within 30 days after operation. Transient post-implantation syndrome occurred in 11 patients. Left subclavian artery was totally occluded in 2 patients. Endoleak occurred in 5 patients and in 4 of them the leak closed spontaneously after three months of follow-up. Late endoleak occurred in 1 patient after one year. One patient developed paraplegia at 6 months after the operation. The follow-up CT scan at 3 months documented occlusion of the intimal tear by the stent-grafts and complete thrombosis of the false lumen in all patients. The true lumen of the aorta was enlarged and there was no evidence of migration or twisting of the stent-grafts. Ascending aortic dissection occurred in 1 patient after one year. Three patients died within the follow-up period. The mortality during the follow-up period was 6.7%. The actuarial survival curve by the Kaplan-Meier method showed a 4-year survival rate was 89.3%. Conclusion In-hospital and mid-term results showed that endovascular repair was effective in the treatment of type B aortic dissection.

Objective To evaluate the effectiveness and safety of successive interventional treatment in patients with thoracic aortic dissection and coronary heart disease by endovascular graft exclusion(EVGE)and percutaneous coronary intervention(PCI)respectively.Methods From January,2005 to July,2007,8 patients with Stanford B aortic dissection and coronary heart disease received successive EVGE and PCI in our centre.All patients were performed with EVGE 3-7 days prior to their PCI.Results The site of dissection tears were confirmed by aortic angiography which located within 0~10 mm from the exterior margin of left subclavian artery in 1 patient,11-30 mm in 4 patients and 31-50 mm in 3 patients.One patient had two tear gaps.Dissection of or distal to the renal arteries were involved in 7 patients.Talent graft(Medtronic Corporation,U.S.)was used in one patient and Aegis grafts(Microsport Medical Corporation,China)in 7 patients.Eight trunk tectorial membrane stents were used with lengths ranged from 100 to 140 mm with diameters ranged from 34 to 38 mm.Left subclavian artery was thoroughly covered by the proximal section of the graft in one patient,which resulted in a weak left radial artery pulse but with no obvious ischemic symptom of the left upper limb and brain.Procedures were technically successful in all patients and no severe complication such as death,paraplegia,and kidney insufficiency occurred after the procedure during hospitalization.Post-procedural aortography showed no leakage in 4 patients and minor leakage in 4 patients.Two patients had residual thoracic back pain which could be relieved by drugs.Coronary angiography showed that 4 patients had single-vessel disease,2 had double-vessel disease and one had triple-vessel disease.The mean stenosis rate of the target lesions was 85.6%?14.0% and the mean diameter of the reference vessels was 2.8?0.3 mm.Twelve stents were inplanted in 11 target vessels in 8 patients.The mean length of stents was 23.5?13.6 mm.The procedural success rate of PCI was 100% and no severe complication occurred.No mortality,delayed endo-leak,adverse cardiac events and repeat intervention was recorded during a mean follow-up period of 18.0?8.5 months.Conclusion It is safe and feasible to treat Stanford B aortic dissection and coronary heart disease by successive inter vention of EVGE and PCI.The effect of anticoapulation therapy after PCI on EVGE still requires further investigation.

OBJECTIVE To reduce the nosocomial infection rate among bone marrow transplanted patients.METHODS The related factors of infection among bone marrow transplanted patients were analyzed.RESULTS The environmental microbiology pollution,carrying opportunistic pathogens,oral mucosa damage,deep venous catheterization and others were the main related factors of infection.CONCLUSIONS The proposed control of endogenous and exogenous infection and strengthening the counter measures in the oral care and deep venous catherization care could effectively prevent nosocomial infection among bone marrow transplanted patients.

OBJECTIVE To advocate the establishment of a hospital center for intravenous drug preparation,in order to control infection caused by intravenous infusion.METHODS The unsafe factors brought by traditional distributed intravenous drug preparation were analyzed and propose the necessity and importance of the establishment of pharmacy intravenous admixture center.RESULTS Without any case of transfusion reaction occurred for 3 years,the Pharmacy intravenous admixture center could ensure the safety of patients.CONCLUSIONS Pharmacy intravenous admixture center plays an important role in providing the aseptic environment,shortening the preparatory time after the liquid stored and ensuring that the liquid is not contaminated.

Objective To identify risk factors for anastomotic leakage after low anterior resection (LAR) in rectal cancer patients and study its impact on patients'long-term prognosis.Methods Chnical data were analyzed from 720 patients who underwent low anterior resection(LAR) for rectal cancer between 1996 and 2006.Results Anastomotic leakage after anterior resection occurred in 44 cases(6.1%).The median time of anastomotic leakage after operation was 5.6 days.Muhivariate analysis showed male patients.history of preoperative chemoradiation therapy,diabetes,cancer distance from anus less than 7 cm and hand-sewed anastomosis were independent risk factors predisposing anastomosis leakage (P<0.05).Tumor local recurrence rate was 13.6% in patients suffering from leakage and 5.9% for those without leakage (χ2= 4.116,P<0.05).The distant metastasis rates were 25.0 and 14.1 percent for the leakage and noaleakage groups,respectively(χ2=3.943,P<0.05).The survival rates were 56.8 and 72.5 percent in the leakage and nonleakage groups,respectively(χ2=4.979,P<0.05).Conclusion Sex,preoperative chemoradiation therapy,diabetes,cancer distance from anus less than 7 cm and hand-sewed anastomosis were found to be independent risk factors for anastomotic leakage after rectal cancer surgery.Anastomotic leakage was associated with poor prognosis.

Objective To analyze the trends and status of percutaneous coronary intervention(PCI)in Shenyang General Hospital of P.L.A.during a 18-year period.Methods Between August 1989 and April 2007,a total of 10 225 patients with 17762 target lesions had undergone PCI.Their clinical and angiographic baseline characteristics,PCI strategies and perioperative outcomes were retrospectively analyzed.All data were collected from PCI database of our hospital.Results Patients' age ranged from 22 to 92 years old(mean,59.9 years).A total of 2057 patients(20.2%)were with diabete,8647(84.6%)with acute coronary syndromes,1428(14.0%)with acute myocardial infarction(AMI)and underwent emergent PCI,477(4.7%)with cardiogenic shock;6701(65.5%)with multivessel disease,483(4.7%)with left main disease and 1795(17.2%)with chronic total occlusions(CTO).Overall patient success rate was 98.5% and lesion success rate was 98.3%.Procedural success was obtained in 99.6% of patients with left main disease and 90.5% of CTO lesions.About 89.8% of all patients underwent coronary stenting.Mean implanted stent number was 1.45 per patient.In-hospital mortality was 4.4%(63/1428)for AMI patients who underwent emergent PCI and 19.7%(42/213)for AMI patients with cardiogenic shock.Overall perioperative mortality was 1.1%(113/10 225),including 2 deaths during procedure(0.02%)and 80(0.8%)deaths after procedure.Two patients(0.02%)underwent emergent CABG.Acute or subacute stent thrombosis occurred in 58 patients(0.57%)and slow flow or no-reflow occurred in 127 patients,which accounted for 8.9% of AMI patients who underwent emergent PCI.Overall incidence of perioperative complications was 3.6% and the rate of procedure related complications was 0.48%.Conclusion In skilled cardiac center,PCI is associated with high procedural success rate,low incidence of complications and good short-term outcomes.PCI should be the first choice for treating patients with coronary artery disease,especially for high risk patients with AMI,cardiogenic shock or left main disease,etc.

Objective:To explore the route of automatic computer-aided design for occlusal rest of the removable partial denture.Methods: A new module for the design of occlusal rest was developed.The three-dimensional data of a partially dentate dental cast was obtained and imported into the new module.The contour of the occlusal's tissue surface was identified.Then,the tissue surface and polished surface were constructed respectively and connected to each other to form an integrated entity.Results: The surface of the occlusal rest was smooth and the curvature matched that of the surrounding area of the abutment tooth.The accuracy was satisfying.Conclusion: Design of occlusal rest was much more convenient and time-saving using the newly developed module.The future development of special software package for the design of removable partial denture will benefit from it.