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It is the first time in the world that the integrated pre-built underwater push-out final joint of immersed tube tunnel in Shenzhen-Zhongshan link is applied. In order to reduce underwater operation, the relative position of the final joint in the extended section should be adjusted according to the axis deviation after the installation of E22 and E24 immersed tubes before floating and effectively locked in the extended section. Due to the influence of the construction period, the steel shell and the locking device should be made before the measurement of the axis deviation of E22 and E24 immersed tubes. The welding of steel structure, the grouting of the final joint and the steel shell of the extended section, and the final joint push back test all have a certain influence on the position accuracy of the locking device, thereby affect the locking of the final joint. In order to meet the construction requirements, a temporary locking device which can adapt to the three-way docking deviation of transverse +5 cm, longitudinal +1 cm and vertical +1 cm was developed. The locking device has been successfully applied in the floating stage of the final joint of the Shenzhen-Zhongshan Link, and effectively saving the immersed tube installation window time. The temporary locking device can provide reference and inspiration for the design of similar construction installation equipment. [ABSTRACT FROM AUTHOR]

Lynchburg Nephrology Dialysis Incorporated started its nightly home hemodialysis (NHHD) program in September 1997.The purpose of this study was to evaluate episodes of exit-site infections, catheter sepsis, and safety and longevity of accesses for patients doing NHHD.If internal jugular (IJ) catheter was chosen, the patient was started on 2 mg coumadin per day when catheter was placed. If catheter malfunctioned, it was blocked with a thrombolytic agent and coumadin was adjusted to meet a goal international normalized ratio (INR) of 1.5 to 2.25. If the problem persisted, the catheter was exchanged. For catheters, a threaded lock cannula (BD InterLink device, BD) was used to prevent air emboli and infections and a locking device was used to prevent disconnects. If arteriovenous (AV) fistula was used, four buttonholes were established using 16-gauge needles. If AV graft was used, patients were taught the rope ladder cannulation technique using 16-gauge needles.As of September 1, 2003, 45 patients have completed training and have performed 27,063 treatments at home. Total catheter time at home was 930 months. Total AV fistula and AV graft times at home were 190 and 20 months, respectively. Upon completion of training, 34 patients were using tunneled IJ catheters, 10 were using AV fistulas, and 1 was using an AV graft. The IJ catheter exit-site and sepsis infection rates were 0.35 and 0.52 episodes per 1000 patient-days, respectively. Mean catheter life was 8.5 months with the longest being 66.7 months and the shortest being 0.2 months. The AV fistula and graft exit-site and sepsis infection rates were 0.16 and 0 episodes per 1000 patient-days, respectively. Catheter complications included one episode of disconnect due to patient's failure to use the locking device, one episode of central stenosis, and one episode of intracranial hemorrhage, due to prolonged INR, with resolution of symptoms.Data support the fact that tunneled IJ catheters, AV fistulas, and AV grafts are effective and safe permanent accesses for patients on NHHD. [ABSTRACT FROM AUTHOR]