Objective:To explore and analyze application of the activity of quality control circle (QCC) in the management of disinfection for laparoscopic instruments.Methods: 1000 non-disinfected laparoscopic instruments of operating room were randomly divided into control group (n=500) and observation group (n=500). The laparoscopic instruments of control group received routine disinfection while that of observation group was implemented activity of QCC during they received routine disinfection. The occurrence rate of damage for instruments and special small component, qualified rate of disinfection, occurrence rate of adverse event and the problem solving ability of paramedic were compared after all of laparoscopic instruments were disinfected.Results:After received the activity of QCC, the damage rate of instruments, miss rate of special small components, loose rate of packaging and error rate of relative record of observation group were significantly lower than that of control group (x2=52.31,x2=64.49,x2=34.51, x2=79.00;P<0.05), and the qualified rate of disinfection in observation group was significantly higher than that of control group (x2=37.70,P<0.05). Besides, the occurrence rate of adverse event of observation group was significantly lower than that of control group (x2=1857.28,P<0.05).Conclusion:The activity of QCC is implemented in the management of disinfection for laparoscopic instruments can efficiently enhance the qualities of disinfection and care, and can enhance the working enthusiasm, responsibility and problem resolving ability of paramedic.

Objective To evaluate the effects and side effects of three different recruitment maneuvers (RM) in acute respiratory distress syndrome (ARDS) caused by extrapulmonary disease.Methods Forty-four patients of extrapulmonary ARDS, according to crossover design methods, were undergone three RM in different periods, including sustained inflation (SI), increase progressively positive end expiratory pressure (IP), pressure control ventilation (PCV). Heart rate (HR), mean arterial blood pressure (MAP), central venous pressure (CVP), oxygenation index, lung compliance were recorded before and after RM, and were analyzed for statistical analysis. Results Oxygenation index and lung compliance were increased obviously in a short time after RM, improvement of IP method were better more obviously than the other two methods [1 h oxygenation index after RM:227 ± 42 vs 190 ± 19,186 ± 21; lung compliance:(59.4±12.5 ) ml/cm H2O(1 cm H2O = 0.098 kPa) vs (50.1 ± 9.3 ), (49.7 ± 10.6) ml/cm H2O;P＜ 0.05], 2h after RM,there were no statistical difference among the three methods (P＞0.05). After RM,HR and CVPwere increased, MAP was decreased in a short time, changes of SI method were smaller than the other two inethods [10 min HR after RM: (94.0±10.3 ) beats/min vs (116.0 ± 14.8 ), ( 107.0 ± 5.7 ) beats/min; CVP:(13.7±3.1 )cm H2O vs ( 18.4 ± 6.7 ), ( 15.4 ± 2.7 )cm H2O; MAP: ( 87.0 ± 12.1 ) mm Hg( 1 mm Hg = 0.133 kPa) vs (73.0 ± 4.8), (81.0 ± 6.6) mm Hg;P＜ 0.05), 20 min after RM, there were no statistical difference among the three methods (P＞ 0.05). Conclusion When extrapulmonary ARDS undergo RM ,IP method is the most effective on increasing oxygenation index and lung compliance, SI method has the smallest side effect on hemodynamics.

Objective To investigate the effect of reformative ventilation method (head-high leg-low 30°-declivate prone position ) in the ventilation of acute respiratory distress syndrome ( ARDS ) patients, and compared with normal prone position ventilation. Methods Forty-four patients of ARDS underwent ventilation were divided into prone position group (22 cases) and reformative prone position group (22cases) by random digits talle. Continuous 30° semireclining position was kept in normal time. The patients of the two groups underwent different prone position ventilation 4 hours every day,and indexes of hemodynamics and respiration before,during and after prone position ventilation were recorded and analyzed. Results After prone position ventilation, oxygenation index of two groups improved similarly (P ＞ 0.05 ). In prone position group, lung compliance decreased [2 h, ( 25.6 ± 5.8 ) ml/cm H2O ( 1 cm H2O = 0.098 kPa) vs. ( 37.2 ± 20.5 )ml/cm H2O] ,average airway pressure increased [2 h, ( 18.5 ± 3.9) cm H2O vs. ( 15.6 ± 5.3 )cm H2O] ,heart rate increased [2 h, ( 112.0 ± 16.2 ) beats/min vs. ( 102.0 ± 11.3 ) beats/min], mean arterial blood pressure decreased [2 h, (86.0 ± 6.7) mm Hg ( 1 mm Hg = 0.133 kPa) vs. (93.5 ± 7.5 ) mm Hg] ,central venous pressure increased[2 h, ( 15.5 ± 3.3 ) cm H2O vs. ( 12.6 ± 4.3 ) cm H2O]. These changes persistently existed during prone position ventilation (P ＜ 0.05 ),and they disappeared in 1 hour when recovered to 30 °semireclining position. Conclusion Reformative prone position ventilation not only has same effect on improving oxygenation index, but also obviates adverse effect on lung compliance and hemodynamics.

Objective To compare the clinical efficacy of three kinds of replacement fluid for continuous hemofiltration in severe sepsis,and to develop a more rational composition.Methods Fifty severe sepsis patients with continuous hemofiltration were divided into four groups randomly.The configuration of the replacement fluid in accordance with the random number table,randomly selected from four different formulations:group A (13 cases):Ports composition provided by Nanjing general hospital;group B (12 cases):Zhongshan hospital composition; group C (11 cases):an improved composition; group D (14 cases):an improved composition by Donghua hospital affiliated to SUN Yat-sen university.Blood electrolytes,blood gas analysis,renal function,blood glucose(highest and lowest serum glucose in treatment period),high sensitive C-reactive protein(hs-CRP) concentration,calcium concentration in filter were tested before and after every treatment period.Results The concentration of blood electrolytes during treatment had no significant change (P ＞ 0.05).Renal function were improved significantly after treatment among four groups (P ＜ 0.05).The level of hs-CRP decreased significantly after treatment (P ＜ 0.05) and there was no significant difference among four groups (P ＞ 0.05).The change of serum glucose during treatment was the smallest in group D than that in group A,B,C [(3.0 + 0.9) mmol/L vs.(11.2 + 2.0),(3.8 + 1.1),(5.5 +1.3) mmol/L](P ＜ 0.05).Calcium concentration in filter was the lowest in group D than that in group A,B,C [(1.5 + 0.5) mmol/L vs.(2.0 + 0.7),(2.3 + 0.5),(2.1 + 0.4) mmol/L] (P ＜ 0.05).The dosage of heparin was the least during treatment in group D than that in group A,B,C[(6.5 ± 2.8) U/(kg·h) vs.(8.9 ± 3.4),(7.9 ± 3.0),(8.7 ± 3.1) U/ (kg· h)] (P ＜ 0.05).Conclusions Improved composition by Donghua hospital affiliated to SUN Yat-sen university hospital compared to other compositions can better maintain a stable blood glucose levels,have a better anticoagulant effect,reducing the application of heparin,maintain a stable homeostasis.It is worthy of using in clinic.

potential use in clinical therapy and prognosis estimation of the tumor.

Objective To clear, amplify and detect the activity of the recombinant adeno-assoeiated virus vector with adiponectin( rAAV2/1-Aerp30 ). Methods Recombinant plasmid pSNAV2.0-Acrp30 was obtained. The recombinant plasmid was then transfected into BHK21 cells using LipofectAMINETM 2000. The G418 resistant cells were obtained consequently. These cells were infected with HSVI-rc/△UL2 which has the function of packaging and copying recombinant AAV. After purification, the construction of recombinant rAAV2/1-Aerp30 was collected. Results The construction of recombinant pSNAV2.0-Acrp30 was confirmed by PCR electrophoresis and digestion with restriction enzyme. The gene sequencing showed that the recombinant pSNAV2.0-Acrp30 was correct. The virus titer was about 1.0×1012 μg/ml. The purity f the recombinant AAV2/1 was fairly high using the SDS-PAGE method. Conclusion With this method, rAAV2/-Aerp30 with high virus titers and purity can be acquired successfully and it can meet the demands of the experimental study of Acrp30 gene therapy of GK rats.

To observe the therapeutic efficacy of electric stimulation on points for children's amblyopia.Method:Ninety children amblyopia cases with ametropia upon correction were randomized into three groups:point electric stimulation,comprehensive conventional therapy and integrative therapy of the above two.And then visual function changes of kids in the three groups were observed.Results:Among the above three therapies,the recovery rates of point electric stimulation,comprehensive conventional therapy and integrative therapy of the two were 83.9%,82.6%and 94.25 respectively,showing no significant difierence(P＞0.05) among the three groups.Conclusion:Point electric stimulation has similar action with comprehensive conventional therapy in the treatment of children's amblyopia,and the combination of the two therapies has better effect,indicating point electric stimulation can speed up recovery of visual function of kids with amblyopia.

Objective To predict the secondary structure and the B cell epitopes of human heparanase protein, and to identify its immunogenicity. Methods The flexible regions of secondary structure and the B cell epitopes of human heparanase amino acid sequence were predicted by DNAStar and Bcepred software. The multiple antigenic peptides (MAP) of the epitopes were synthesized in 8-branch form. Rabbits were immunized with the 8-branch MAPs mixed with a universal T-helper epitope human IL-1β peptide (VQGEESNDK, amino acid 163-171 ). The immunogenicity of the synthesized peptides was evaluated by ELISA, Western blot and immunohistochemistry. Results Amino acid 1 -15 ( MAP1), 279-293 (MAP2) and 175-189(MAP3) of large-subunit of human heparanase protein was predicted as the most potential epitopes of human heparanase protein. All the three synthesized MAPs induced high titer of antibodies. ELISA, Western blot and immunohistochemistry analysis showed all the three MAPs could produce high titer serum antibodies, antibodies induced by MAP1 and MAP2 had high specific binding activity , and MAP2 antibody showed the strongest binding activity with liver cancer tissues. Conclusion The large-subunit No. 1-15, 279-293 amino acid of human heparanase protein may be the B cell preponderant epitopes and the strongest immunogenicity may be No. 279-293 peptide, which provided a theoretic basis for the antibody and vaccine development of heparanase subunit peptide.

Objective To explore available immune strategy to improve immunological effects of the B cell epitopes of human heparanase protein.Methods Based on predicted potential B cell epitopes of human heparanase protein,three candidates of multiple antigenic peptides(MAP)with 8-branches were synthesized and identified by conjugation to antibody against full human heparanase protein.C57BL/6 mice were immunized with the 8-branch MAPs mixed with or without the universal human T-helper IL-1β peptide.The antibody titers of immune serum was assayed by ELISA.Results Most potential epitopes of human heparanase protein were predicted as No.1-15(MAP1),279-293(MAP2)and 175-189(MAP3)in large subunit of human heparanase protein.All three synthesized MAPs mixed with the T-helper epitope induced higher titers of antibodies than them without the T-helper epitope.Conclusion The three B cell epitopes of human heparanase protein could he its B cell preponderant epitopes.The 8-branch MAPs mixed TH cell epitope may be an available and optimizing immune strategy.

Objective To select and identify human leukocyte antigen(HLA)-A2-restricted T-cell epitope within heparanase(Hpa),and to provide aeademic bases for peptide-based immunotherapy with malignant tumor.Methods The Hpa sequence was scanned for prediction of the immunogenic peptides-based CTL epitopes using the HLA-binding prediction software SYFPEITHI and BIMAS.Ten the affinity of candidate epitopes to HLA-A2 was evaluated by T2 binding test.Acfivation of T cell was assessed by ELIS-POT and cytotoxictiy by lactate dehydrogenase(LDH)release assay.Results of the six predicted nona-peptides,Hpa(310-318,FLNPDVLDI)showed high affinity of binding to HLA-A2 and led to IFN-γ secre-tion in vitro.Furthermore,Hpa(310-318) FLNPDVILDI could induce PBMC from a HLA-A2 positive healthy donor to lyse specifically HCC-LM6 and SW-480 cells which expressing both Hpa and HLA-A2.Conclusion The nona-peptide Hpa(310-318)FLNPDVLDI may be all HLA-A2-restricted CTL epitope.which is capable of inducing Hpa-specific CTL in vitro.