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 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 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 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 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.

BACKGROUND: It is of great significance to understand the effects of different components of blood pressure on the occurrence of cerebrovascular diseases and administer proper decompression treatments in various situations.OBJECTIVE: To study the relationship of increased pulse pressure with the occurrence and severity degree of cerebral infarction by analyzing the data of pulse pressure recorded in hospitalized patients with acute cerebral infarction.DESIGN: Case-control analysis.SETTING: First Affiliated Hospital of Harbin Medical University.PARTICIPANTS: A total of 300 patients hospitalized at the First Affiliated Hospital of Harbin Medical University between June 2002 and January 2003 for ischemic cerebral infarction were enrolled, including 196males and 104 females aged (57.9±11.9) years. Another 199 persons who came to the same hospital for physical examination at the same period were set as normal group, including 110 males and 89 females aged (55.9±12.4)years.METHODS: ① Measurement of blood pressure: Systolic pressure and diastolic pressure of each person were recorded with mercury sphygmomanometer at the site of brachial artery of the right upper extremity and pulse pressure was calculated. ② Evaluation of neurological impairment:Upon hospital admission, each patient with ischemic cerebral infarction was evaluated with the stroke scale made by the National Institute of Health (NIHSS), in which a higher score means more severe infarction.MAIN OUTCOME MEASURES: ① Comparison of blood pressure parameters of subjects in the two groups. ② Distribution of different pulse pressure levels in the two groups. ③ Comparison of pulse pressure of subjects of different age in the two groups. ④ Results of non-parameters tests of neural function loss in cerebral infarction patients with different pulse pressure levels.RESULTS: ① Mean systolic pressure: It was significantly higher in the case group than in control group [(152±22), (133±19) mm Hg, t' =10.494,P ＜ 0.01]. Mean diastolic pressure: It was higher in the case group than in control group [(93±14), (81±11) mm Hg, t' = 10.129, P ＜ 0.01]. Meanpulse pressure: It was higher in the case group than in control group [(59.61±11.86), (51.93±14.10) mm Hg, t' =5.612, P ＜ 0.05]. Pairwise corre lation analysis showed that Pearson correlation coefficient between pulse pressure and systolic pressure was 0.789 (P ＜ 0.01); Pearson correlation.coefficient between pulse pressure and diastolic pressure was 0.169 (P ＜ 0.01). Therefore, there was a close correlation between pulse pressure and systolic pressure. ② Pulse pressure was distributed between 60 mm Hg and 69 mm Hg in most subjects in the case group, which accounted for 27.7%.It was 40-49 mm Hg in control group, which accounted for 35.7%. It indicated that the incidence rate was high when the pulse pressure was over 60 mm Hg in cerebral infarction. ③ Pulse pressure increased with age.The level of pulse pressure in 40-69 years case group was higher than that in 40-69 control group [(54±16), (45±9)mm Hg, t=4.86, P=0.000]. ④ Patients with cerebral infarction of different levels of pulse pressure were given non-parameter tests of neurological impairment evaluation. The resuits of Kruskal-Wallis test were χ2=4.779, P=0.572 ＞ 0.05; results of median test were as x2=8.365, P=0.213 ＞ 0.05. The results of the two non-parameter tests suggested that there was no significant differences in hospitalization evaluation, that is, although the pulse pressure increased obviously in cerebral infarction, the degree of increase had no correlation with the severity of neurological impairment.CONCLUSION: The increase of pulse pressure is related to the occurrence of cerebral infarction and is also an important factor for evaluating cerebral infarction. However, pulse pressure change is not related to the severity of cerebral infarction.

Objective To investigate the clinical characteristics and the course of diagnosis and therapy of asparaginase associated pancreatitis (AAP) in adults, in order to improve the ability of diagnosis and treatment.Methods Data of 384 cases of acute lymphoblastic leukemia (ALL) who received treatment in Department of Hematology, Zhejiang Hospital, and Department of Hematology, Second Hospital Affiliated to Wenzhou Medical University from January 2009 to June 2015 was retrospectively analyzed.All patients were given multi-drug chemotherapy including PEG-asparaginase or L-asparaginase, the incidence of AAP, clinical manifestations, diagnosis, treatment and prognosis were analyzed.Results Among the 384 cases, 18 patients developed AAP, and the incidence of AAP was 4.7％, including 13 cases of mild AAP (MAAP), 5 cases of severe AAP (SAAP).Sixteen cases of AAP occurred during the induction-remission treatment phase, 2 cases during the maintenance-intensification phase.The major manifestations of AAP were abdominal pain, and increased serum amylase and lipase.After treatment, abdominal pain of MAAP patients alleviated, serum amylase and lipase obviously decreased, and re-use of PEG-Asparaginase or L-Asparaginase was not associated with the recurrence of AP.Levels of serum amylase and lipase in 5 cases of SAAP repeatedly increased, 1 case died of severe infection, cyst rupture and hemorrhage.Conclusions Adults patients with ALL present with abdominal pain during chemotherapy of aspargase should consider the possibility of AAP, the measurement of serum amylase and serum lipase should be strengthened, in addition, ultrasound and CT scanning may be helpful for early diagnosis and treatment of AAP, and improve the prognosis.

Objective To explore the feasibility and operation technique of endoscopic thyroid surgery. Methods A retrospective analysis was made on the clinical data of 42 patients with various thyroid diseases who were treated by endoscopic thyroidectomy.Results 41 cases were successful,1 case was converted to open operation because of operative bleeding. One case had a small area of ecchymosis in the presternal skin postoperatively, and 1 with hoarseness that recovered 3d after operation.No case of parathyroid injury or subcutaneous emphysema.The anterior cervical drain was removed 24h after operation, and patients were discharged 5d after operation.Conclusions With adherence to the indications of endoscopic thyroidectomy and operating with fine technique , endoscopic thyroidectomy is safe for the treatment of patients with thyroid disease and has a more favorable cosmetic effect.

Objective To investigate the effects of propofol on the release of noradrenaline ( NE) from the locus coeruleus in the brain of rabbits trying to elucidate the central mechanism of the cardiovascular inhibition induced by propofol.Methods Nine healthy male New Zealand rabbits weighing 2.0-2.5 kg were used in this study. A trocar (0.8 mm in diameter) was inserted into locus coeruleus using the stereotactic technique and fixed. Four days later push-pull perfusion of the brain was performed. 37℃ artificial cerebrospinal fluid (aCSF) was infused through the trocar at 0.1 ml?min-1 . A loading dose of propofol 2 mg?kg-1 was given i.v. followed by continuous infusion at 150 ?g?kg-1?min-1 for 30 min. The experiment was concluded at 20 min after propofol infusion. The perfusate having passed through the locus coeruleus was collected before and every 10 min during and after infusion. The NE concentration of the perfusate was measured by high performance liquid chromatography. Results The NE concentration of the perfusate from locus coeruleus significantly decreased after the loading dose and during the infusion of propofol and reached its bottom level at 10 min after loading dose. The maximal decrease was 75.5% [from (15.9 ? 3.2) pg??l-1 to (3.9?0.5) pg ? ?l-1]. Conclusion Intravenous propofol decreases the NE concentration in locus coeruleus. The cardiovascular inhibition induced by propofol may partly be explained by this central mechanism.

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.