ObjectiveTo observe the discoloration of chemical indicator cards in different positions in pressure steam sterilization bags and stetilization effect.MethodsFrom January 2009 to January 2011,168 packages needing sterilization were divided into group A and group B randomiy with 84 packages in each.We put chemical indicator cards on different positions in the packages.Then discoloration of chemical indicator cards and the qualified rate of bacteriology detection were observed.ResultsThere were 9cases of uneven discoloration in group A,and the incidence rate was 10.71％,higher than group B.The unqualified rate of bacteriology detection in group A was 2.38％,higher than group B(1.19％),but the difference was not statistically significant.ConclusionsChemical indicator cards could reflect the effect of sterilization,but placing them in different positions can appear different results.The chemical indicator cards that placed between the two packing layer could provide powerful evidence for sterilization effects for clinicians,and avoid unnecessary economic waste in Sterilization and Supply Center,which is worthy of being widely used in Sterilization and Supply Center.

Objective To observe the pulmonary X-ray changes of malignant malaria.Methods The chest routine X-ray examination in 86 cases with malaria in company with respiratory tract symptoms such as fever was performed,the pulmonary changes were obsenved.Results Of 86 cases, 58 cases were abnormal on chest filmes,including lung framework marked in 33 cases,miliary,small or large patchy shadow in 24 cases and multiple round opaque mass lesion in one case.Conclusion The pulmonary X-ray changes of malignant malaria are varied,the common characteristic is that most of them are situated at middle and lower portion of the lungs.This may attribute to blood dynamic abnormality resulting from malaria protozoan and the pathological changes of involved tissues.

Objective To explore the application and clinical effects of nursing procedure of in the patients of Ebola virus dis-ease (EVD).Methods We went on nursing assessments to the 5 EVD patients by applying nursing procedure and made the nursing diagnosis based on the results of nursing assessments.Then we analyzed the possible reasons of common nursing problems and made anticipated goals and carried out the nursing strategies.We evaluated the efficiency of nursing eventually.Results We carried out nursing procedures in 5 EVD patients.No complication was occurred in all patients.Three patients fully recovered and dis-charged from our hospital.We got a good treatment results and achieved good social benefits.Conclusion System nursing to EVD patients,which accords to nursing procedure,helps us reducing the nursing complications,and decreasing the mortality of patients.

‘Two-way’ training of teaching basic skill and medical education method was conducted for young and middle-aged teachers according to characteristics of clinical teachers in teaching hospitals.After two years of training,clinical teachers' teaching ability and teaching enthusiasm and the quality of classroom teaching have obviously improved based on the analysis of related data.Clinical teacher training strengthen the teaching faculty quantitatively.This thesis discussed the importance of clinical teachers' training and further explored the improvement of clinical teacher education mode.

Objectives:B type ultrasonic diagnosis instrument is used to measure the sebum thickness and the relevance vs evaluated with sebum thickness calipers in sebum thickness determination. Methods:The study included 219 healthy adult persons and 11 cases of corpse dead of non disease reason for less than 10 hours.The measurements of sebum thickness were made by B type ultrasonic diagnosis instrument and sebum thickness calipers respectively. Results:The measurement results of two different methods were not significantly different. Conclusions:It is feasible to use B type ultrasonic diagnosis instrument for the measurement of the sebum thickness in clinic.

Objective To establish core competence evaluation index system of orthopaedic specialized nurse .Methods Alto‐gether 35 experts from Class Ⅲ Grade Ⅰ hospital in Chongqing ,Beijing ,Jiangshu were consulted by a three‐round delphi survey ,and finally established the core competence evaluation index system of orthopaedic and the weight of each index .Results The core com‐petence evaluation indexes of orthopaedic specialized nurse included 4 first class indexes ,14 second class indexes and 72 third class indexes .The expert authority coefficient was 0 .833 ,the familiar coefficient was 0 .794 ,the determination coefficient was 0 .872 ,The coordination coefficient of primary and secondary and third indicators were 0 .390 ,0 .324 ,0 .308 ,respectively ,and there were statis‐tically significant differences (P< 0 .05) .Conclusion The expert opinions for the core competence evaluation indexes are consist‐ent ,the results are objective and scientific .It can provide quantitative standards for training ,examining and evaluation of orthopaedic specialized nurse .

Objective serous endotoxin(ET) were measured to determine the relationship between serous endotoxin and differ‐ent type of intestinal obstruction in children .Methods 25 inguinal hernia patients and 43 intestinal obstruction patients were classi‐fied into control group(n=25) ,incomplete intestinal obstruction (n=20) and complete intestinal obstruction group without necrosis of intestine (n=23) according to degree of obstruction .Serous endotoxin were measured in different time (the day of admission ,one day after admission or ,preoperation and one day postoperation ) ,and t test is used to determine the difference between them . Results ET in different group was(6 .53 ± 14 .96) ,(4 .40 ± 1 .15) ,(4 .20 ± 1 .20) ,(4 .09 ± 1 .31) ,(3 .70 ± 1 .46)EU/mL ,respec‐tively .There were no difference between each group .Conclusion ET examination suggests there is no difference between different type of intestinal obstruction in children and endotoxemia is not found in intestinal obstruction according to the results .

Objectives To investigate the prevalence of heterogeneous vancomycin intermediate Staphylococcus aureus(hVISA) and the sensitivity of hVISA to novel antibiotics,and to explore the risk factors and infection attributable mortality associated with hVISA infection.Methods A total of 456 methicillin resistant Staphylococcus aureus (MRSA) isolates were isolated in Zhongshan Hospital from January,2008 to November,2010.All MRSA isolates were investigated for hVISA by two agar screening methods BHIA5T (brain-heart infusion containing teicoplanin 5 mg/L)or BHIA6V (brain-heart infusion containing vancomycin 6 mg/L),as well as macroEtest method(MET).Possible hVISA isolates were tested by modified population analysis profile-area under the curve (PAP-AUC).The minimal inhibitory concentrations(MICs) of vancomycin,teicoplanin and linezolid were determined by microbroth dilution as recommended by Clinical Laboratory Standards Institute(CLSI).The contribution difference between hVISA and vancomycin susceptible Staphylococcus aureus (VSSA) in different MIC range was compared.A retrospective case-control study of the patients with hVISA infection or VSSA infection was carried out and statistical analysis was performed using t test,Mann-Whitney test,x2 test and Fisher exact test.Results A total of 105 isolates of hVISA were screened by BHIA5T and BHIA6V (23.0％) with other 23 isolates by MET(5.0％) and 21 by PAP-AUC(4.6％).All isolates were 100％ sensitive to vancomycin,teicoplanin and linezolid.The vancomycin MIC [(1.76 ±-0.16) mg/L] in hVISA group was significantly higher than that in VSSA group[(1.09 ± 0.07)mg/L,P ＜ 0.01],which was a potential risk factor for hVISA infection.The retrospective study showed chronic obstructive pulmonary disease (COPD) was also a risk factor for hVISA infection of the lower respiratory tract.No significant difference in infection attributable mortality was showed between the hVISA group and the VSSA group.Conclusions The overall prevalence of hVISA in Zhongshan Hospital is estimated as 4.6％,while the prevalence of hVISA isolated from blood is as high as 12.5％.All isolates are 100％ sensitive to vancomycin and linezolid.COPD is a risk factor for hVISA infection of the lower respiratory tract.

Objective To detect the expression of CK19 in sentinel lymph node for breast cancer and to evaluate its clinical significance.Methods SLNs of 30 patients with breast cancer were successfully detected with methylene blue,both SLN and ALN were examined by hematoxylin and eosin staining ( HK staining). The expression level of CK19 in SLNs were assessed by RT-PCR and Western Blot for mRNA and Protein respectively. Results Detection positive rate of SLN melastases was 26. 67% (8/30) by HE staining,and 1 case of false negative. Through RT-PCR,12 cases,including all the positive cases detected by routine pathological examination,were detected to be positive in the expression of CK19mRNA, with a positive rate of 40. 0% ( 12/30) , and a positive rate of 36. 67% (11/30) for CK19 was observed by Western Blot There was a significant difference between RT-PCR or Western Blot methods and routine pathological examination ( P < 0.05 ) for the detection efficiency of SI.Ns melastases. Conclusions CK19rnRNA may be a potential tumor marker for detecting micrometastasis in SLNs of breast cancer. The combined utilization of locating SLNs and detecting CK19 mRNA expression by RT-PCR instead of histopathological examination can greatly enhance the detection efficiency of SLN micrometastasis of breast cancer.

Objective Discussion leukoreduction of red blood cells suspended in two different storage bag placement and he-molysis rate impact on the supernatant free hemoglobin (FHb),to ensure the clinical transfusion is safe and effective.Meth-ods Selected 20 donors to sample 400 ml whole blood per person to make leukodepleted red blood cells,which were evenly divided into 10 bags.The 10 bags were randomly divided into two groups,one to the upright position,one group of horizon-tal.The two groups were stored under the same conditions.Respectively,in the 7,14,21,28,35 day,randomly removed one storage bag from each group,FHb and red blood cell hemolysis rate were measured and analyzed statistically.Results FHb and hemolysis rate results stored in the first 21 days of testing,uprightgroup were (217.310±48.477)mg/L and (0.250± 0.056)%,respectively horizontal group (173.972±39.027)mg/L and (0.189±0.045)%,the results set upright than hori-zontal group,the results were statistically(t=3.114,P =0.003<0.05 and t=3.798,P =0.001<0.05),the difference was statistically significant.Conclusion In the blood storage period,storage bags can be placed horizontally to reduce the de-struction of red blood cells,blood storage is more favorable.