Objective To evaluate the effects of hydrocolloid dressings with conventional care in the prevention of pressure ulcers.Methods Randomised controlled trials and quasi-randomised trials,which assessed the effects of hydrocolloid dressings in preventing pressure ulcers compared to conventional care were sought.Data were pooled using RevMan 5.0.Results 17 eligible trials were identified with a total of 1 371 study participants.Meta-analysis showed that:Compared to conventional care,conventional care and hydrocolloid dressings were effective for preventing pressure ulcers for patients at risk of pressure ulcers [RR =0.29,95％CI (0.18,0.46)] and using noninvasive positive pressure ventilator [RR=0.30,95％CI (0.18,0.52).Conclusions Hydrocolloid drcssings and conventional care can reduce the pressure ulcer incidence of patients at risk of pressure ulcer or using noninvasive positive pressure ventilator.

Objective To compare computed tomography angiography (CTA) and digital subtraction angiography (DSA) in identifying anatomical variation of hepatic artery.Methods A retrospective analysis was made on 220 patients who underwent both CTA and DSA in our hospital.The volume rendering (VR) reconstruction of CTA images was performed.The image quality and the recognition of hepatic artery anatomic variation between CTA and DSA were compared.Results There was a significant difference in the image quality of hepatic artery between the two imaging methods (x2 =88.016,P =0.000),DSA was superior to CTA.There was no significant difference in the accuracy of hepatic artery anatomical identification between CTA and DSA (x2 =0.252,P =0.615).This study has found five other types of hepatic artery anatomical variation besides Micheles types.Conclusion The anatomical variation of hepatic artery is complex,and there are many other variations besides Micheles types.CTA,as a noninvasive method,can provide sufficient information for hepatic artery anatomy.

Objective ToexploreamethodofusingCaspase-3smallinterferenceribonucleicacid (siRNA)in vitro to decrease the apoptosis in stable cell lines of bone marrow mesenchymal stem cell (MSC)in ordertoestablishMSCcelllineswithstableexpression.Methods VirusparticlescontainingCaspase-3siRNA were generated in 293FT cells by retroviral packaging system,then were transfected into MSC of rats. And the transfected cells were screened and cultured to get the stable MSC lines. According to the characteristics of retrovirus,the stable expression of the cell lines was identified by Western blot and real-time fluorescent quantitative PCR (RT-QPCR). The apoptosis of stable cell lines and normal MSC were detected by terminal dexynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL ) and their differences were compared.Results Comparedwiththenormalcells,thecaspase-3proteinexpressionandmRNAcontentof stable MSC lines were significantly reduced. In the same condition in vitro,the apoptosis quantity of stable MSC linessignificantlydecreasedcomparedwiththenormalcells.Conclusions StablecelllinesofMSCwithstable expression of Caspase-3 siRNA can be obtained by retroviral packaging system. The apoptosis quantity of stable MSC Lines significantly decreased compared with the normal cells.

Objective To explore the value of virtual monochromatic spectral (VMS) images acquired from dual-energy spectral CT (DESCT) with metal artifact reduction (MAR) algorithm in CT-guided microcoil localization for lung nodules.Methods Totally 80 patients with lung nodules underwent DESCT after CT-guided microcoil placement.At optimal keV level,VMS images and VMS with MAR algorithm (VMS+MAR) images were reconstructed,and image quality scores were compared.Results 74 keV was selected as the optimal level.The image quality of VMS+ MAR images at 74,90,110 and 140 keV were better than that at 50 keV (all P＜0.05).There was no statistical difference of image quality among 74,90,110 and 140 keV VMS+MAR images (all P＞0.05).At 74 keV,the image quality of VMS+MAR images was better than that of VMS images (P＜0.05).The consistency was good between the 2 observers (Kappa=0.78).Conclusion VMS images at 74 keV with MAR algorithm could reduce artifacts from microcoil,and clearly display lung nodules.

Objective:To investigate the incidence and risk factors of hepatic artery injury during percutaneous transhepatic biliary drainage (PTBD).Methods:From Apr 2002 to Dec 2020, the clinical data of 1 446 patients undergoing PTBD were retrospectively analyzed.Results:Hepatic artery injury occurred in 7 cases, with an incidence of 0.48%. Fluoroscopy guided puncture was used in all cases. In those 7 cases (0.48%) a drainage catheter was failed to put in place after multiple attempts, hepatic artery injury occurred in 1 case; One drainage catheter was inserted in 1 314 cases (90.87%), hepatic artery injury occurred in 5 cases; One hundred and twenty-five cases (8.65%) were implanted with two drainage catheter, and 1 case had hepatic artery injury. Failure to successfully insert the drainage catheter increase the incidence of hepatic artery injury ( OR=0.06,95% CI 0.01-0.71, P=0.026) .There were 1 430 cases (98.89%) with oblique needle tip and 5 cases had hepatic artery injury; There were 16 cases (1.11%) with triangular needle tip and 2 cases had hepatic artery injury. Triangular needle tip increased the incidence of hepatic artery injury( OR=55.57, 95% CI 6.84-451.38, P<0.001). Conclusion:Hepatic artery injury is a rare complication of PTBD.The use of triangular needle and the failure of drainage were the risk factors of hepatic artery injury.

Objective To study the value of parameters of Transit-Time Flow Measurement(TTFM) as predictor and judge for one-year after coronary artery bypass transplantation in patency rate of vessel grafts .Methods Parameters of quantity of blood flow and the value of PI( pulsation index) were measured and recorded by intraoperative TTFM in CABG .One-year of follow-ing up, coronary artery CT or coronary angiography examination were accomplished.Results Our study include artery grafts 46(including LIMA grafts 44, RIMA graft 1 and radial artery graft 1) with the patency rate of grafts 91.3％ for one-year after CABG, and vein grafts 48 with the patency rate of grafts 66.7％ .There exists statistically significant difference between above two groups(P<0.001).High PI is independent risk factor(P =0.037) in patency rate of vessel grafts for one-year after CABG by binary logistics regression analysis but no other parameters have the statistical significance (P>0.05) .The results from logistic regression were summarized using the area under the ROC curve(AUC) .The pulsation index has been found hav-ing moderate judgment ability(P=0.016) for the dysfunction of grafts after CABG for one-year with optimal cut-off value of 2. 45.Conclusion Intraoperative high value of PI is the independent risk factor in patency rate of vessel grafts for one-year after CABG.

Objective To study the injury factors, pathogenic process and clinical features of delay two-phase multiple organ dysfunction syndrome (MODS) in severe burned patients and to replicate a standardized animal model that would accurately imitate the clinical features of MODS.Methods Forty-five human patients with burn size larger than 30% total body surface area (TBSA) were analyzed. All of them underwent severe burn shock in early stage and sepsis in late stage. Thirty-two goats were randomly divided into three groups: 1) hemorrhagic shock (group H, n=6); 2) endotoxemia (group E, n=6); and 3) hemorrhagic shock plus endotoxemia (group M, n=20). Hemorrhagic shock was produced according to the method of Wigger (6.7 kPa for an hour, 1 kPa=7.5 mmHg). Endotoxin (E. coli O111 B4) was given via the portal vein 24 hours after the resuscitation of hemorrhagic shock, in a dose of 30 ng/kg/min for 5 consecutive days. During the observation period of 10 days, all animals were hemodynamically monitored, given standard metabolic support and due cardiac and pulmonary support according to human intensive care.Results All the patients showed burn shock at 1-3 days and hyperdynamic circulation, hypermetabolism and systemic inflammatory responses over two weeks post-injury. Thirteen cases were found to develop MODS according to the prevailing diagnostic criteria, and 10 of them died with a mortality of 77%. Eighteen animals died in group M with a mortality of 90%, 12 of the 18 developed MODS, with overall incidence of 60%. Most animals in group M showed changes similar to that observed in human cases. The experimentation proved that in the pathogenic process of MODS, there was a two-hit phenomenon in the dvelopment of the syndrome. To prevent the development of MODS, it therefore was imperative to blunt the first hit or the second hit, so that an excessive inflammatory response was alleviated. This postulation has been verified in the treatment of extensive burns. Two patients with burn extent reaching 100% TBSA survived with only mild acute respiratory distress syndrome (ARDS) and renal dysfunction after comprehensive treatment of burn shock, including adequate fluid resuscitation, drugs to remove oxygen free radicals, rapid restoration of pHi, and early extensive excision of burn eschars.Conclusion Both in human patients or animal experimentation, the typical delay two-phase MODS is shown to be produced by two successive insults in the forms of hypovolemic shock and sepsis. This postulation is helpful in formulating the prevention and treatment modality of MODS.